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

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.

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.

Rare Case Report of Closed Traumatic Dislocation of Second to Fifth Metatarsophalangeal Joints

Closed traumatic dislocation of multiple metatarsophalangeal joints is a rare injury. Until now only one case of simultaneous dislocation of all five metatarsophalangeal joints has been reported in peer-reviewed studies. The complex anatomy of the metatarsophalangeal joints prevents the relocation of the joints in a closed manner in maximum cases. We are reporting a case of dorsal dislocation of the second to fifth metatarsophalangeal joints in the left foot after road traffic accident. Bony prominence over the plantar aspect and increased web space between toes on presentation, then incongruity of metatarsophalangeal joints has to be thoroughly checked on radiograph. Since closed reduction attempts failed open reduction was done through dorsal approach using two incisions. Button holing of the capsule with interposition of capsule and plantar plate was noted. Dorsal approach avoids damage to the plantar plate and surrounding soft tissues.

Metatarsal Shaft Fracture with Associated Metatarsophalangeal Joint Dislocation

Metatarsophalangeal joint dislocations of lesser toes are often seen in the setting of severe claw toes. Traumatic irreducible dislocations have been reported in rare cases following both low-energy and high-energy injuries to the forefoot. In this case report, I present a previously unreported association of a metatarsal shaft fracture with metatarsophalangeal joint dislocation of a lesser toe.

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.