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Irreducible dislocation of the great toe interphalangeal joint secondary to an incarcerated sesamoid.

Bin Abd Razak HR, Chia ZY, Tan HC - Case Rep Orthop (2015)

Bottom Line: Incarceration of the sesamoid became a block to manipulation and reduction at the specialist outpatient clinic 3 weeks later.The patient was treated with open surgical exploration, resection of the interposed sesamoid, and Kirschner-wire fixation of the IP joint followed by occupational therapy for mobilization exercises.The operative course was uneventful.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore 169608.

ABSTRACT
Irreducible dorsal dislocation of the interphalangeal (IP) joint of the great toe is rare. We report a case of a 29-year-old gentleman who presented to the Orthopaedic Surgery Specialist Outpatient Clinic with an irreducible IP joint of the great toe that had been untreated for 4 weeks. The mechanism of injury is believed to be a combination of axial loading with a hyperdorsiflexion force when the patient fell foot first into a drain. As the patient did not report severe symptoms and a true lateral radiograph was not ordered, the dislocation was missed initially at the emergency department. The patient had continued to run and play field hockey prior to visiting us. Incarceration of the sesamoid became a block to manipulation and reduction at the specialist outpatient clinic 3 weeks later. The patient was treated with open surgical exploration, resection of the interposed sesamoid, and Kirschner-wire fixation of the IP joint followed by occupational therapy for mobilization exercises. The operative course was uneventful. At 6 months after surgery, the patient could walk, run, and return to sports.

No MeSH data available.


Related in: MedlinePlus

This is a clinical picture depicting open exploration of the IP joint of the left great toe with an interposed sesamoid rendering the dislocation irreducible.
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fig3: This is a clinical picture depicting open exploration of the IP joint of the left great toe with an interposed sesamoid rendering the dislocation irreducible.

Mentions: The left great toe IP joint was approached with a midline dorsal incision and split of the extensor expansion. Intraoperative radiographs confirmed the diagnosis of a dorsal dislocation of the IP joint with an interposed sesamoid (Figure 3). The interposed sesamoid was found in the IP joint space and resected (Figure 4). The IP joint was then ranged to be free from any mechanical block. However, spontaneous reduction of the IP joint was not possible likely due to soft tissue contractures owing to the subacute presentation. Decision was made for temporary fixation of the IP joint by Kirschner-wires. A 2.5 mm Kirschner-wire was driven percutaneously to hold the IP joint in its native reduction. An image-intensifier was used to confirm that the IP joint was in good alignment and reduction. The extensor expansion was repaired and layered closure performed.


Irreducible dislocation of the great toe interphalangeal joint secondary to an incarcerated sesamoid.

Bin Abd Razak HR, Chia ZY, Tan HC - Case Rep Orthop (2015)

This is a clinical picture depicting open exploration of the IP joint of the left great toe with an interposed sesamoid rendering the dislocation irreducible.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4385599&req=5

fig3: This is a clinical picture depicting open exploration of the IP joint of the left great toe with an interposed sesamoid rendering the dislocation irreducible.
Mentions: The left great toe IP joint was approached with a midline dorsal incision and split of the extensor expansion. Intraoperative radiographs confirmed the diagnosis of a dorsal dislocation of the IP joint with an interposed sesamoid (Figure 3). The interposed sesamoid was found in the IP joint space and resected (Figure 4). The IP joint was then ranged to be free from any mechanical block. However, spontaneous reduction of the IP joint was not possible likely due to soft tissue contractures owing to the subacute presentation. Decision was made for temporary fixation of the IP joint by Kirschner-wires. A 2.5 mm Kirschner-wire was driven percutaneously to hold the IP joint in its native reduction. An image-intensifier was used to confirm that the IP joint was in good alignment and reduction. The extensor expansion was repaired and layered closure performed.

Bottom Line: Incarceration of the sesamoid became a block to manipulation and reduction at the specialist outpatient clinic 3 weeks later.The patient was treated with open surgical exploration, resection of the interposed sesamoid, and Kirschner-wire fixation of the IP joint followed by occupational therapy for mobilization exercises.The operative course was uneventful.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore 169608.

ABSTRACT
Irreducible dorsal dislocation of the interphalangeal (IP) joint of the great toe is rare. We report a case of a 29-year-old gentleman who presented to the Orthopaedic Surgery Specialist Outpatient Clinic with an irreducible IP joint of the great toe that had been untreated for 4 weeks. The mechanism of injury is believed to be a combination of axial loading with a hyperdorsiflexion force when the patient fell foot first into a drain. As the patient did not report severe symptoms and a true lateral radiograph was not ordered, the dislocation was missed initially at the emergency department. The patient had continued to run and play field hockey prior to visiting us. Incarceration of the sesamoid became a block to manipulation and reduction at the specialist outpatient clinic 3 weeks later. The patient was treated with open surgical exploration, resection of the interposed sesamoid, and Kirschner-wire fixation of the IP joint followed by occupational therapy for mobilization exercises. The operative course was uneventful. At 6 months after surgery, the patient could walk, run, and return to sports.

No MeSH data available.


Related in: MedlinePlus