Open reduction for irreducible dislocation of hallux interphalangeal joint: case report and literature review


  • Martinus V. Tjandra General Practitioner, Tarakan Hospital, Jakarta
  • Margaretta S. Yolanda Orthopedic Surgeon, Bintaro Hospital, Jakarta
  • Jafri Hasan Sport Consultant of Orthopedic Surgeon, Tarakan Hospital, Jakarta, Indonesia



Dislocation of hallux, interposed hallucal sesamoid, K-wire



Irreducible dorsal dislocation of the interphalangeal (IP) joint of the great toe is an uncommon entity. Most reported cases reviewed metatarsophalangeal joint injury as the most common location for trauma of forefoot. Closed reduction of hallux IP joint is difficult when accompanied by sesamoid bone and plantar plate interposition.

Case Presentation:

A twenty two year-old man complaining of painful swelling of the left big toe for five days after falling from skateboarding. The big toe was suffered from axial loading and hyperdorsoflexion. Local examination showed bruised, hyperextended deformity, and swelling of the left hallux. X-ray revealed interposed hallucal sesamoid between the IP joint from anteroposterior view and the dorsal dislocation from oblique view. Attempt for closed reduction was unsuccessful. The patient underwent dorsal-approach open reduction, resection of the interposed sesamoid, and K-wire fixation.


Intra-articular entrapment of the sesamoid may result in irreducible dislocation of the hallux IP joint. The challenge is likely to be the result of the interposed plantar capsule with the sesamoid. Open reduction of the left great toe IP joint was approached with midline dorsal incision and split the extensor expansion. Dorsal-approach has been performed in some cases, it’s easy to perform and can be used to confirm and reposition the interposed tissue. The K-wire removed at the third week after surgery. Postoperative radiograph revealed satisfactory reduction of the joint.


Dorsal-approach open reduction and fixing with K-wire shows good result for dislocation of hallux IP joint. The patient could walk without discomfort and returned to daily activities after four weeks postoperative.


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Rahmatullah H, Chia Z, Andrew Tan HC. Irreducible dislocation of the great toe interphalangeal joint secondary to an incarcerated sesamoid. NCBI. 2015 March; PubMed PMID: 25874146

Ab-Rahman S, Sulaiman AR, Muzaffar T. Irreducible dorsal dislocation of interphalangeal joint of the big toe: a case report. Trauma Case Reports. 2016 April; 3: 32-5. Pub Med PMID: 29942842

Imao K, Miwa H, Watanabe K, et al. Dorsal approach open reduction for irreducible dislocation of interphalangeal joint: a case series. International Journal of Surgery. 2018; 53: 316-21. PubMed PMID: 30469143

Hamdy KA, Almosalamy MH, Mekky AH. Irreducible dislocation of the hallucal interphalangeal joint: a rare case report and literature review. Kuwait Medical Journal. 2015; 47(3): 257-60

Liberson A, Nyska M, Klenerman L. Irreducible interphalangeal dislocation of the big toe: the plantar surgical approach. The Foot. 1993; 3(1): 28-30

Singh R, Rohilla R, Siwach R. Irreducible dislocation of the interphalangeal joint of the great toe in a collegiate football player due to sesamoid bone interposition – a case report and literature review. The Journal of Orthopedic Surgery. 2009; 14(1)

Y York PJ, Wydra FB, Hunt KJ. Injuries to the great toe. New York: Foot and Ankle Sport Medicine. 2017: 10(1), 104–12

Colin YW. Dislocation of the interphalangeal joint of the great toe: is percutaneous reduction of an incarcerated sesamoid an option? A report of two cases. JBJS. 2010: 92: 1257-60

Miki T, Yamamuro T, Kitai T. An irreducible dislocation of the great toe: a report of two cases and review of the literature. Clin Orthop Relat Res. 1998; 230: 200-6. PubMed PMID: 3284677

Hatori M, Goto M, Tanaka K, et al. Neglected irreducible dislocation of the interphalangeal joint of the great toe: a case report. The Journal of Foot and Ankle Surgery. 2006 July; 45(4): 271-4

Ward SJ, Sheridan RP, Kendall IG. Sesamoid bone interposition complicating reduction of a hallux joint dislocation. Journal of Accident & Emergency Medicine. 1996; 13(4): 297-8

Peng J, Kit He J, Christie M, et al. Tibial sesamoidectomy: indications and outcome. Annals of Joint. 2019: Volume 4

Kit He J, Christie M, Robin J, et al. Tibial sesamoidectomy: indications and outcomes. Foot & Ankle Orthopaedics. 2019: Volume 4(4).

Y York PJ, Wydra FB, Hunt KJ. Injuries to the great toe. New York: Foot and Ankle Sport Medicine. 2017: 10(1), 104–12

Hartog B, Doorn PF, Rijik PC. Sesamoid bone interposition in the interphalangeal joint after dislocation of the hallux: a case report. The Foot and ankle Online Journal. 2009; 2(7): 3

Bichara DA, Henn RF, Theodore GH. Sesamoidectomy for hallux sesamoid fractures. The American Orthopedic Foot and Ankle Society. 2012; 33(9): 704-6. PubMed PMID: 22995255

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