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

Abstract

Introduction:

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.

Discussion:

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.

Conclusion:

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.