Fusion of the chopart joint with screws [Die schraubenarthrodese des chopart-gelenkes]

Objectives: Arthrodesis of the Chopart joint. Should a malalignment exist, it must be corrected prior to fusion. Elimination of painful functional disturbances and reduced need for custommade shoes. Indications: Osteoarthritis and malalignment of the Chopart joint accompanied by painful limitation of function. Paralytic deformities. Pes planovalgus (flexible flat foot). Contraindications: Diabetic arthropathy, vascular insufficiencies. Severe osteoporosis. Surgical Technique: Resection of the articular surfaces, correction of malalignment, and compression arthrode-sis using the "Double Rail Technique". Addition of autogenous iliac bone grafts may be necessary. Postoperative Care: Early functional exercises. After approximately 2 weeks application of a below-knee walking cast and permission to partial weight bearing (about 15 kg) of the limb. Control radiographs after 6 and 12 weeks. After removal of the cast physiotherapy, prescription of inserts. Results: Between January 1979 and July 1997, this operation was performed in 12 patients (between 18 and 70 years of age, 37 ± 20 years). In 6 patients the indication was a remote comminuted fracture of the scaphoid, in 4 patients a nonunion after previous attempts at fusion, in 1 patient an osteoarthritis of the calcaneocuboid joint and in another patient an idiopathic osteoarthritis. Follow-up of the 12 patients after 2.7 ± 1.7 years. Assessment using the Hannover Medical School (HMS) and the Kitaoka scores: out of 100 possible points, patients reached 81.3 ± 13 points with the HMS score. Similar results were observed using the Kitaoka score. © Urban & Vogel, München.