Irreducible dorsal MTP joint dislocation in the second and third toes

Traumatic irreducible dislocation of the fifth metatarsophalangeal joint in pediatrics: case report and clinical experience

Dislocation of the metatarsophalangeal joint (MTPJ) by trauma commonly occurs in adults. Most dislocations of the MTPJ could be reduced by closed reduction. However, isolated traumatic irreducible dislocation of the fifth MTPJ is an extremely rare injury, particularly in children. We report the case of a 10-year-old boy with irreducible dislocation of the fifth MTPJ who presented with a dorsiflexion injury of the right foot 1 year previously. Closed reduction was attempted but failed. Computed tomography showed the dorsolateral dislocation of the fifth MTPJ. We performed an open reduction and metatarsal bone osteotomy, with a short osteotomy at approximately 0.8 cm. The osteotomy was adjusted to a reduction of the MTPJ and fixation by a lock compression plate. The distal growth plate in the metatarsal bone was protected to avoid pre-closure of the growth plate. There were no instances of dislocation or signs of avascular necrosis of the head of the metatarsal bone. The results of this study demonstrated that open reduction and metatarsal bone osteotomy could be an optional treatment for irreducible dislocation of the fifth MTPJ in children. We should pay more attention to the distal growth plate in the metatarsal bone to avoid pre-closure of the growth plate.

Dorsal Dislocation of the First and Second Metatarsophalangeal Joint: A Case Report and Literature Review

Dorsal dislocation of the toes is an infrequent injury that can result in severe pain and deformity. Timely diagnosis and appropriate management are paramount for optimizing patient outcomes. This case report illustrates a 53-year-old male patient who suffered dorsal dislocation of the first and second metatarsophalangeal (MTP) joints due to a crush injury. We present the clinical manifestation, radiographic findings, and management approach for this unique isolated first and second ray MTP joint dorsal dislocation, without any associated fractures. This case report underscores several critical observations: firstly, hallux dorsal dislocation can potentially coincide with other injuries; secondly, it can stem from crushing trauma to the big toe; and thirdly, successful closed reduction, when followed by effective immobilization and early rehabilitation, can yield outstanding outcomes. Additionally, the report emphasizes the importance of pursuing another closed reduction attempt under general anesthesia, if the initial attempt in the emergency room proves unsuccessful, before contemplating open reduction.

Neglected Metatarsophalangeal Joint Dislocation of the Lesser Toe with Associated Metatarsal Fracture Malunion in a 4-Year-Old Child: A Case Report

CASE

A 4-year-old girl presented with a 5-week-old, neglected fourth metatarsophalangeal (MTP) joint dislocation with malunion of the fourth metatarsal. A previous attempt at closed reduction had failed. The reduction was hindered by dynamic stabilizing of soft tissues around the MTP joint. Open reduction of the fourth MTP joint dislocation and corrective osteotomy of the fourth metatarsal was performed. The patient was pain-free without any cosmetic deformity at the 1-year follow-up.

CONCLUSION

Prompt recognition of a MTP dislocation is vital. The long extensor tendon to the toe can hinder the closed reduction of the MTP dislocation. Osteotomy of the metatarsal malunion is necessary for stable reduction.

LEVEL OF EVIDENCE

4.

A Rare Case of Neglected Fifth Metatarsophalangeal Joint Dislocation

The dislocation of the metatarsophalangeal joint of lesser toes is a rare entity. There is a dearth of literature on the same. Also, there is no case described for neglected fifth metatarsophalangeal dislocation in the literature. We present a case of neglected lesser toe dislocation, its natural course, and its outcome after surgical management. Our patient is an eight-year-old child with a neglected dislocation of the fifth metatarsophalangeal joint two years back. The patient did not seek treatment because he has no problem walking. Gradually, there is an abnormal growth of the metatarsal which causes pressure soreness and difficulty walking. The patient was managed surgically with open reduction and K-wire fixation with good long-term results.

The dislocation of fifth metatarsophalangeal dislocation is rare and may not cause difficulty in walking due to less weight-bearing. But prompt treatment is necessary, especially in children as the bones have remaining growth potential and may lead to abnormal bone growth.

Irreducible fifth metatarsophalangeal joint after car crush injury

Metatarsophalangeal joint dislocations are uncommon injuries. Herein, an irreducible dislocation of fifth metatarsophalangeal joint with fractures on the second, third, and fourth metatarsal head was reported. Joint reduction could not be achieved which necessitated open reduction. Six months after surgery the patient was walking and doing his daily activities without any complaints. He had returned to his pretrauma functional level.

Irreducible metatarsophalangeal joint dislocation of the lesser toes: a case report

Irreducible metatarsophalangeal joint dislocation of the lesser toes is a rare injury. We present a 37-year-old man who was injured in a motorcycle accident and dislocated the first to third metatarsophalangeal joints and fractured the fourth metatarsal head. The left first metatarsophalangeal joint was reduced successfully through the closed method, but multiple attempts at closed reduction under local anesthesia failed to reduce the dislocated second and third metatarsophalangeal joints. We performed a dorsal incision between the second and third metatarsals, and the metatarsal heads were found to be entrapped under the plantar plate. Dislocation reduction was performed without damage to the plantar plate, and one Kirschner wire was used to fix the fourth metatarsal head fracture. The pin was removed 8 weeks after surgery, and the patient regained normal gait and returned to work and his previous physical activity level without recurrent dislocation.

Stability of the metatarsophalangeal joint of the lesser toes: a cadaveric study

Dorsal instability of the metatarsophalangeal joint (MTPJ) of the lesser toes is an important cause of forefoot pain. Both conservative and surgical treatment options have been proposed. However, the role of each static stabilizing structure has not been elucidated. We hypothesized that isolated sectioning of the plantar plate (PP) would result in greater dorsal translation compared to isolated sectioning of the medial collateral ligaments (MCL) or lateral (LCL) collateral ligaments, or the extensor hood (EH), and that combined injury to two or more structures would result in greater dorsal translation compared to isolated PP injury. Fifty-four cadaveric lesser toe specimens were randomized into groups for individual and combined sectioning of the PP, EH, and LCL and MCL. A 30 N axial load was applied to each specimen in the plantar-dorsal direction and dorsal translation of the phalanx was measured for each condition. ANOVA was used to compare groups. A 19% change in MTP translation was found from intact after sectioning the PP. No significant difference in translation was seen after individual sectioning of the EH, MCL, or LCL. A significant increase in translation occurred from intact with the following sectioning combinations: MCL + LCL, 37%; EH + MCL + LCL, 45%; and PP + MCL + LCL, 63%. Thus, the PP is the main restraint for dorsal MTPJ translation. MCL and LCL have important partial contribution to MTPJ stability. Injury to the PP, individually, or combined injuries to the PP, EH, MCL, or LCL, appear to cause significant instability that may warrant more aggressive treatment.

Irreducible dislocation of all the lesser metatarsophalangeal joints of the foot: a case report

We report a case of irreducible dorsal dislocation of all the lesser metatarsophalangeal joints of the foot following injury at sport. Plantar plate prevented reduction at all the joints, which necessitated an open reduction and stabilization with K-wire. This report highlights the necessity of prompt open reduction and reviews the mechanism of injury and complex anatomy at metatarsophalangeal joint.

Irreducible dislocation of the fourth metatarsophalangeal joint--a case report

Traumatic dislocation of the metatarsophalangeal joint of an isolated lesser toe is an uncommon injury. We report a patient who presented 1 day after a dorsiflexion injury of the right foot. Physical examination showed a shortened and angulated right fourth toe resulting in scissoring of his digits. X-rays of the right foot confirmed complete dislocation of the fourth metatarsophalangeal joint. After failing 4 attempts at closed reduction, an orthopedic consult was made, and he underwent surgery. Six months after the operation, he developed avascular necrosis of the fourth metatarsal head. Reduction of the metatarsophalangeal of an isolated lesser toe is difficult due to the anatomical constraints imposed by the surrounding soft tissue. Failure at reduction after a single attempt by an experienced emergency physician should prompt the need for an orthopedic consult in view of likely surgery required. Avascular necrosis of the metatarsal head can also occur as a late complication after such injury.

Irreducible dislocation of the metatarsophalangeal joints of the fourth and fifth toes: a case report and anatomical study

Level of Evidence: V, Expert Opinion

Irreducible dorsal metatarsophalangeal joint dislocation of the fifth toe: a case report

The authors report a case of a dorsal dislocation of the fifth metatarsophalangeal joint that could not be reduced by closed manipulation, and instead required open reduction with Kirschner-wire fixation to maintain alignment. Although metatarsophalangeal joint dislocation is not unheard of, it is not common for the deformity to resist efforts at closed reduction and immobilization or percutaneous pin fixation. One year after surgery, the patient described in this article had returned to his baseline activity level, and was ambulating without pain while demonstrating full range of motion in the fifth metatarsophalangeal joint.

Fracture-dislocation of the second metatarsophalangeal joint: a case report

Traumatic second metatarsophalangeal dislocation is extremely rare. This article reports a case of traumatic second metatarsophalangeal dislocation associated with fracture of the second metatarsal shaft. Anatomical reduction is indispensable to preserve the function of the metatarsophalangeal joint and to avoid joint ankylosis and chronic foot pain. The patient was treated with open reduction of the fracture without violating the joint to decrease postoperative stiffness. He was followed-up for 6 months. The patient resumed full activity 3 months after surgery, with his joint attaining full range of movement. He reported no pain or joint stiffness during his last visit. To our knowledge, no similar injury has been reported previously.