Fracture-dislocation of the first metatarsophalangeal joint: open reduction through a medial incisional approach

First Metatarsal Headphones-Like Lesion: A Case of Unreducible Sesamoid Complex Dislocation

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.

Dislocation of the First Metatarsophalangeal Joint: A Case Report and Suggested Classification System

Dislocation of the first metatarsophalangeal joint is a relatively rare and still poorly known injury. The current classification includes only the dorsal variety of this lesion; thus, as further cases of other varieties are reported, a larger understanding of this entity is required. We report the case of a young male with dorsal dislocation of the first metatarsophalangeal joint treated by closed reduction. The clinical outcome at the 2-year follow-up point is reported. A review of the published data of the variations of this injury reported to date is included, and a new summarizing classification is suggested.

Dorsal dislocation of the great toe in a professional football player: case report

Level of Evidence: V, Expert Opinion

Dorsal dislocation of the first metatarsophalangeal joint associated with fractured second metatarsal head

Traumatic dislocations of the first metatarsophalangeal joint were first described by Mouchet in 1931. The anatomical complexity of the first metatarsophalangeal joint makes this injury one of a kind. There have been a limited number of case reports of this injury. The ability to reduce the dislocation by nonoperative measures depends largely on the type of dislocation and involvement of the sesamoid complex. We report a case of a 35-year-old male with complete dorsal dislocation of the first metatarsophalangeal joint with second metatarsal head fracture. On review at 12 months he was pain free, fully mobile and pleased with the result. The papers principle message is that significant injuries to the metatarsophalangeal joint may be associated with fractures of adjacent bone segments, which may change diagnostic and therapeutic approaches. Also, the evolution of patients with this kind of injury after reduction is not well know today, at short, medium and long term. Thus could be considered to be a further development of Jahss's classification.

Hallux, sesamoid, and first metatarsal injuries

Hallux, sesamoid, and first metatarsal injuries are common foot injuries and have implications in the biomechanical functionality of the first ray and foot. They are essential for propulsion in normal gait. As part of the first ray, it is an important contributor to normal locomotion. Any structure disruption or injury can create angular changes or arthritis, which can have biomechanical implications, including pain, disability, compensation, swelling, and reduced range of motion.

Anatomy of the plantarmedial hallucal nerve in relation to the medial approach of the first metatarsophalangeal joint

BACKGROUND

The medial approach has been widely utilized for various pathologies of the first metatarsophalangeal joint. Injury to the plantarmedial hallucal nerve has been cautioned but never been reported. This study evaluated the proximity of the plantarmedial hallucal nerve to the midline and the vertical capsulotomy through the medial approach.

MATERIALS AND METHODS

Nine fresh cadaver legs were dissected under loupe magnification after AP radiographs were obtained. The distances from the plantarmedial hallucal nerve to the midline and to the plantar extent of the vertical capsulotomy were measured. The nerves were documented for their course, branching, and integrity.

RESULTS

The average hallux valgus angle was 10.3 +/- 3.8 degrees (Mean +/- SD). The distances from the nerve to the midline and to the plantar extent of the vertical capsulotomy averaged 10.6 +/- 3.2 mm and 2.4 +/- 1.6 mm. One specimen demonstrated a partial nerve transection. All the nerves were found underneath the crural fascia and covered by vertical fibers investing the plantar fat pad at the level of the metatarsophalangeal joint. They gave off an average of seven terminal branches toward the pulp and tip of the hallux.

CONCLUSION

The plantarmedial hallucal nerve is at risk for injury with the vertical capsulotomy during a medial approach to the first metatarsophalangeal joint due to its proximity to the plantar extent of the vertical capsulotomy.

CLINICAL RELEVANCE

Surgeons should be vigilant in doing the vertical capsulotomy of the first metatarsophalangeal joint especially if the plantarmedial hallucal nerve is not identified.

Traumatic dislocation of the first metatarsophalangeal joint with entrapment of the flexor hallucis longus tendon

A case of traumatic dislocation of the first metatarsophalangeal joint with concomitant fibular sesamoid fracture and thoracic vertebral fracture is presented. The first metatarsophalangeal joint was repaired by means of open reduction with collateral ligament repair. At 12 months following the operation, the patient displayed nonpainful and unrestricted first metatarsophalangeal joint motion.

First metatarsophalangeal joint dislocation with open fracture of tibial and fibular sesamoids

Traumatic dislocations of the first metatarsophalangeal joint were first described by Mouchet in 1931. The anatomical complexity of the first metatarsophalangeal joint makes this injury one of a kind. There have been only been a limited number of case reports of this injury, but none in combination with open fractures of both sesamoids. We would like to report 1 case of an open traumatic dislocation of the first metatarsophalangeal joint with open fracture of the fibular and tibial sesamoid. Open reduction and internal fixation of the injury led to a successful outcome.