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Mazzotti A, Cassanelli E, Artioli E, Zielli SO, Arceri A, Di Liddo M, Faldini C. First Metatarsal Headphones-Like Lesion: A Case of Unreducible Sesamoid Complex Dislocation. JBJS Case Connect 2024; 14:01709767-202406000-00040. [PMID: 38788057 DOI: 10.2106/jbjs.cc.23.00518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
CASE A 34-year-old woman sustained a direct trauma to the left hallux during a fall. Radiographs showed a dorsal dislocation of the first metatarsophalangeal joint and a wide separation of sesamoid complex. Closed reduction was tried: postreduction radiographs displayed reduction of first metatarsophalangeal joint and a complete sesamoid complex dislocation. The patient was scheduled for surgery. Through a medial approach, open reduction together with plantar structures release and repair were performed. Functional and radiographic outcomes were satisfactory at the last follow-up. CONCLUSION In case of a "headphones-like lesion" surgery is required, together with plantar structures repair.
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Affiliation(s)
- A Mazzotti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna
| | - E Cassanelli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - E Artioli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna
| | - S O Zielli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Arceri
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M Di Liddo
- Unit of Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee Implants, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - C Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna
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Bassil GF, Nader F, Lajmi A, Missaoui Z. Dorsal Dislocation of the First and Second Metatarsophalangeal Joint: A Case Report and Literature Review. Cureus 2023; 15:e45407. [PMID: 37854726 PMCID: PMC10579970 DOI: 10.7759/cureus.45407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 10/20/2023] Open
Abstract
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.
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Affiliation(s)
- Georges F Bassil
- Orthopedic Surgery, Grand Hôpital de l'Est Francilien - Site de Meaux, Meaux, FRA
| | - Fadi Nader
- Orthopedic Surgery, Grand Hôpital de l'Est Francilien - Site de Meaux, Meaux, FRA
| | - Achraf Lajmi
- Orthopedic Surgery, Grand Hôpital de l'Est Francilien - Site de Meaux, Meaux, FRA
| | - Zied Missaoui
- Orthopedic Surgery, Grand Hôpital de l'Est Francilien - Site de Meaux, Meaux, FRA
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Cho BK, Woo KJ. Lateral Collateral Ligament Reconstruction Using Suture-tape for Chronic Varus Metatarsophalangeal Instability of The Hallux. J Foot Ankle Surg 2021; 59:1062-1065. [PMID: 32571727 DOI: 10.1053/j.jfas.2020.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/15/2020] [Accepted: 02/18/2020] [Indexed: 02/03/2023]
Abstract
Chronic varus instability or recurrent subluxation following isolated metatarsophalangeal dislocation of the hallux is a rare injury. A young Judo athlete with a history of repetitive sport injuries complained of recurrent medial dislocation of the hallux for 3 years. For prior injuries, he underwent manual reduction under local anesthesia and recovered with splint immobilization. Physical examination and fluoroscopic radiograph demonstrated the reducible but unstable first metatarsophalangeal joint to slight varus stress, and magnetic resonance imaging revealed an insufficient remnant of the lateral collateral ligament. For patients with the failed conservative treatment, no consensus has been reached regarding the best joint-salvage procedure to achieve a restoration of metatarsophalangeal stability and a fast return to sport activity. We report a case who achieved satisfactory clinical outcome through the collateral ligament reconstruction using a suture-tape.
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Affiliation(s)
- Byung-Ki Cho
- Professor, Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea; Surgeon, Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, Korea.
| | - Kyung-Jei Woo
- Researcher, Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
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Mizumoto K, Kimura T, Kubota M, Saito M. Dislocation of the first metatarsophalangeal joint concomitant with Lisfranc joint dislocation in a 45-year-old man. BMJ Case Rep 2021; 14:14/6/e243004. [PMID: 34167985 DOI: 10.1136/bcr-2021-243004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 45-year-old man presented with severe pinch-point crush injury to his left foot. Plain radiographs revealed dislocation of the first metatarsophalangeal joint and dorsolateral dislocation of the basal phalanx and sesamoids. The first tarsometatarsal joint was subluxed in the plantar direction and the second to fourth tarsometatarsal joints were subluxed dorsally. The sesamoids were displaced dorsolateral to the metatarsal head. There was a longitudinal tear of the joint capsule at the medial margin of the medial sesamoid, which was sutured together with the abductor hallucis tendon and collateral ligament. The Lisfranc and dorsal ligaments in the tarsometatarsal joint were torn and repaired after reduction and fixed with a plate. One year after surgery, there was contracture of the first metatarsophalangeal joint, but the patient had no pain and was able to run.
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Affiliation(s)
- Kanoko Mizumoto
- Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Tadashi Kimura
- Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Makoto Kubota
- Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan
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Vosoughi AR, Akbarzadeh A. Concomitant old complex fracture–dislocation of the first metatarsophalangeal, Lisfranc, and naviculocuneiform joints. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2019. [DOI: 10.1177/2210491719860246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Old simultaneous complex fracture–dislocation of the first metatarsophalangeal (MTP), Lisfranc, and naviculocuneiform joints as an overwhelming injury has not been reported in the literature yet. In a 29-year-old man, 6 months following the trauma, the medial column of foot was reconstructed using iliac tricortical bone graft from navicular to the first metatarsal. Arthrodesis of the second and third tarsometatarsal joints and resection arthroplasty of the first MTP joint were done. His clinical and radiographic evaluation after 18 months revealed an acceptable function with returning to pre-injury job but with some limitations in recreational activities. Level of evidence: level 4
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Affiliation(s)
- Amir Reza Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Akbarzadeh
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Hood CR, Riding PJ, Cook AC. Another Classification of First Metatarsophalangeal Joint Dislocation-Type 3: Review and Case Description of the Plantar Dislocation. J Foot Ankle Surg 2019; 58:534-539. [PMID: 30902493 DOI: 10.1053/j.jfas.2018.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Indexed: 02/03/2023]
Abstract
Plantar dislocation of the first metatarsophalangeal joint is a possible, albeit rare, injury to the foot. The mechanism has been attributed to a hyperflexion motion, with the hallux situated plantar to the first metatarsal head. In this article, we provide a case example of an open, plantar dislocation of the first metatarsophalangeal and perform a literature review of this rare injury. Based on x-ray analysis of the published cases, the sesamoids may or may not dislocate with the phalanx based off of the local capsuloligamentous anatomy. As a result, a modified Jahss classification (type 3A and type 3B) has been proposed to amend the existing system, adding plantar dislocations of the first metatarsophalangeal without (type 3A) and with (type 3B) sesamoid dislocation.
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Affiliation(s)
- Christopher R Hood
- Fellowship-Trained Foot and Ankle Surgeon, Premier Orthopaedics and Sports Medicine, Malvern, PA.
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Bohl DD, Hamid KS, Walton DM. Incarcerated Plantar Dislocation of the First Metatarsophalangeal Joint: Reduction Using Intra-articular Saline Injection. Foot Ankle Spec 2018; 11:467-470. [PMID: 29577748 DOI: 10.1177/1938640018766678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Plantar dislocation of the first metatarsophalangeal (MTP) joint is exceedingly rare, and in prior reported cases, simple closed manipulation easily enabled reduction. We present here the first reported plantar dislocation that failed closed manipulation. We also report a technique involving injection of saline into the joint to facilitate reduction. The saline insufflation likely relieves buttonholing of the metatarsal head through the dorsal joint capsule. For first MTP joint plantar dislocations that fail reduction with manipulation, we recommend attempting injection of the joint with saline prior to subjecting the patient to open reduction. LEVELS OF EVIDENCE Therapeutic, Level IV: Case report.
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Affiliation(s)
- Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois (DDB, KSH).,Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, Michigan (DMW)
| | - Kamran S Hamid
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois (DDB, KSH).,Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, Michigan (DMW)
| | - David M Walton
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois (DDB, KSH).,Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, Michigan (DMW)
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