Plantar impact causing midfoot fractures result in higher forces in Chopart's joint than in the ankle joint

Richter, M.; Wippermann, B.; Thermann, H.; Schroeder, G.; Otte, D.; Troeger, H. D.; Krettek, C.

Abstract and keywords

Purpose: Force effect (impact, extent of foot compartment deformation) and result (fracture pattern) for midfoot fractures in car occupants is known. An analysis of the processes in the foot was intended to improve car safety.

Materials and methods: Eleven fresh, unfrozen, unpreserved intact human cadavers (age: 36.8 (16–61) years, gender: male, race: Caucasian) were studied 24–72 h after death. In 3 cadavers (5 feet) the experimental design was established: entire cadaver fixed on a special tray in supine position, pendulum with bar impactor hitting the foot plantar to Lisfranc's joint. A custom-made pressure sensor was inserted in the ankle (A), talonavicular (TN) and calcaneocuboid (CC) joints (resolution: 1 cm², sampling rate: 500/s).

Results: Sixteen feet were measured; midfoot fractures were induced in 11 feet. The maximum pressure amounted to 1.22–2.55 MPa (2.04 ± 0.412) at 0.005–0.195 s (0.067 ± 0.059) after impact. The maximum pressure occurred in 8 (50%) cases in the ankle, in 7 (44%) of the TN and 1 (6%) of the CC joints. A comparison of the first 200 pressure samples after impact of all sensor fields resulted in higher forces in Chopart's joint than in the ankle (t-test: p < 0.001). These force differences were higher in cases with midfoot fractures (mixed model analysis of variance: p = 0.003).

Conclusion: Due to considerable forces in Chopart's joint we recommend a modification of the actual crash test dummy lower extremity model with an additional load cell that detects forces in the longitudinal direction of the foot axis.

Keywords: Midfoot fracture; Plantar impact; Joint pressure; Ankle; Chopart

Links

DOI: 10.1016/S0736-0266(01)00096-1

PubMed: 11918301

WoS: 000174406600009

History

Received: 2001-06-05

Accepted: 2001-06-22

Online: 2006-01-01

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Cited By (7)

Year	Entry
2011	Mittlmeier T, Beck M. Verletzungen der Fußwurzel [Injuries of the midfoot]. Der Chirurg. 2011;82(2):169-188.
in press	Zhang Z, Chen W, Wu W, Ren G, Zhang X, Zhang Y. Modified anteroposterior and oblique radiographs of the midfoot and their efficiency in demonstrating the tarsometatarsal joints. Clin Radiol.
2012	Frimenko RE, Lievers WB, Riley PO, Crandall JR, Kent RW. A method to induce navicular‐cuneiform/cuneiform‐first metatarsal sprain in athletes. In: Proceedings of the 2012 International IRCOBI Conference on the Biomechanics of Injury. September 12-14, 2012; Dublin, Ireland.265-276.
2014	Kösters C, Bockholt S, Müller C, Winter C, Rosenbaum D, Raschke MJ, Ochman S. Comparing the outcomes between Chopart, Lisfranc and multiple metatarsal shaft fractures. Arch Orthop Trauma Surg. October 2014;134(10):1397-1404.
2011	Funk JR. Ankle injury mechanisms: lessons learned from cadaveric studies. Clin Anat. April 2011;24(3):350-361.
2015	Lievers WB, Frimenko RE, McCullough KA, Crandall JR, Kent RW. Etiology and biomechanics of midfoot (Lisfranc) injuries in athletes. Crit Rev Biomed Eng. 2015;43(2-3):213-238.
2010	Schepers T, Kieboom B, van Diggele P, Patka P, Van Lieshout EMM. Pedobarographic analysis and quality of life after Lisfranc fracture. Foot Ankle Int. 2010;31(10):857-864.