The Chopart Variant Dislocation: Plantar Dislocation of the Cuboid and Navicular.

This case report demonstrates a unique variant of a Chopart dislocation resulting in a plantar cuboid and navicular dislocation without concomitant fracture in a 48-year-old man. The mechanism of injury involved a low-energy plantarflexion moment from stepping off a small embankment. This report reviews the pertinent midfoot anatomy, discusses the proposed mechanism of injury, and demonstrates an effective method of treating these complex injuries with open reduction and internal fixation. Final results with 20 months of follow-up were excellent. This unusual midfoot dislocation is a complex injury that required open treatment for anatomic restoration. In complex Chopart dislocations, early open reduction should be strongly considered as the initial treatment to properly restore anatomy and function. Level of Evidence: Level V, expert opinion.

Reconstruction of the foot after leg or foot compartment syndrome.

Compartment syndrome should be treated early and aggressively to prevent late complications. Patients may have late deformity because of a failure of diagnosis, inadequate decompression, or a delay in fasciotomies. Late reconstruction will allow a plantigrade and relatively functional foot. Complete excision of scarred muscle will prevent recurrence in established deformities. Early treatment may prevent significant functional impairment by well-placed tenotomies. In patients with severe long-term deformities with extensive soft tissue contraction, incremental correction may be an appropriate intermediate intervention.

Salvage of failed neuropathic ankle fractures: use of large-fragment fibular plating and multiple syndesmotic screws.

The purpose of this study was to develop a salvage procedure for failed fixation of ankle fractures that occurs in patients with sensory neuropathy. Six patients, with insensitivity to a 5.07 monofilament on the plantar surface of their foot (five with diabetes mellitus, one with alcoholic peripheral neuropathy) presented to a foot and ankle referral center with failed traditional fixation of their Weber B and C ankle fractures. Five fractures were the result of trauma. One fracture occurred without a discernable traumatic event. A laterally placed 4.5 DCP plate on the fibula with multiple 4.5-mm syndesmotic screws engaging both cortices of the tibia was used as fixation. All patients postoperatively were immobilized in a non-weight-bearing below-knee cast for a minimum of 3 months after surgery. At follow-up, all six patients were satisfied with their results as determined by aligned, functional, and asymptomatic limbs. The patients were especially pleased that after multiple attempts to provide stability to their fractured neuropathic ankles, they had retained their own legs and did not need an amputation. Fibular plate fixation using multiple large-fragment syndesmotic screws provides a reasonable salvage alternative for neuropathic patients with ankle fractures that failed using traditional hardware techniques.

Placement of solid screws with cannulated precision.

Cannulated screws can be inserted in a precise manner with minimal damage to surrounding structures but lack the mechanical strength of solid screws. Our method allows the insertion of a solid screw with the precision of the cannulated technique. With the use of equipment from a variety of operative sets from one manufacturer, a "custom" equipment set can be developed. This "custom" equipment set allows the surgeon to benefit from the strength of solid screws while preserving the precision of a cannulated system.