title: Plantar impact causing midfoot fractures result in higher forces in Chopart's joint than in the ankle joint.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Trauma Department, Hannover Medical School, Hannover, Germany. richter.martinus@mh-hannover.de
authors.forename: M
authors.initials: M
authors.lastname: Richter
authors.forename: B
authors.initials: B
authors.lastname: Wippermann
authors.forename: H
authors.initials: H
authors.lastname: Thermann
authors.forename: G
authors.initials: G
authors.lastname: Schroeder
authors.forename: D
authors.initials: D
authors.lastname: Otte
authors.forename: H D
authors.initials: HD
authors.lastname: Troeger
authors.forename: C
authors.initials: C
authors.lastname: Krettek
mesh_terms: D000293:Adolescent; D000328:Adult; D016512:Ankle Injuries / Q000209:etiology* / Q000503:physiopathology; D000843:Ankle Joint / Q000503:physiopathology; D001696:Biomechanical Phenomena; D018409:Foot Injuries / Q000209:etiology* / Q000503:physiopathology; D050723:Fractures, Bone / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013639:Tarsal Bones / Q000293:injuries* / Q000503:physiopathology