Pathomechanics of complex dislocations of the first metatarsophalangeal joint

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.

Dorsal Dislocation of the First and Second Metatarsophalangeal Joint: A Case Report and Literature Review

Dorsal dislocation of the toes is an infrequent injury that can result in severe pain and deformity. Timely diagnosis and appropriate management are paramount for optimizing patient outcomes. This case report illustrates a 53-year-old male patient who suffered dorsal dislocation of the first and second metatarsophalangeal (MTP) joints due to a crush injury. We present the clinical manifestation, radiographic findings, and management approach for this unique isolated first and second ray MTP joint dorsal dislocation, without any associated fractures. This case report underscores several critical observations: firstly, hallux dorsal dislocation can potentially coincide with other injuries; secondly, it can stem from crushing trauma to the big toe; and thirdly, successful closed reduction, when followed by effective immobilization and early rehabilitation, can yield outstanding outcomes. Additionally, the report emphasizes the importance of pursuing another closed reduction attempt under general anesthesia, if the initial attempt in the emergency room proves unsuccessful, before contemplating open reduction.

National Athletic Trainers' Association Position Statement: Immediate Management of Appendicular Joint Dislocations

OBJECTIVE

To provide certified athletic trainers (ATs) with recommendations and guidelines for the immediate management of patients with joint dislocations.

BACKGROUND

One of the primary responsibilities of ATs is to provide immediate injury care for active individuals. Although ATs are confronted with managing patients who have many kinds of injuries, the onsite management of a joint dislocation presents challenges in evaluation and immediate treatment. The critical concern in managing a dislocation is deciding when a joint can be reduced onsite and when the patient should be splinted and transported for reduction to be performed in the hospital or medical setting. Factors that influence the decision-making process include the following: whether the AT possesses a documented protocol that is supported by his or her supervising physician(s), employer documents, and respective state regulations; the AT's qualifications and experience; the dislocated joint; whether the dislocation is first time or recurrent; the patient's age and general health; and whether associated injuries are present.

RECOMMENDATIONS

These guidelines are intended to provide considerations for the initial care of specific joint dislocations. They are not intended to represent the standard of care and should not be interpreted as a standard of care for therapeutic or legal discussion.

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.

Neglected dorsolateral dislocation of the first metatarsophalangeal joint: A case report

INTRODUCTION

Although the first metatarsophalangeal (MTP) joint is frequently injured, Complete dislocation of the first MTP joint represents a relatively rare traumatic injury.

PRESENTATION OF CASE

A 46-year-old gentleman presented with a traumatic first MTP joint dislocation resulting from an automobile accident. Due to coronavirus outbreak in the hospital at that time, patient was referred to another hospital. Six months later, reduction was achieved surgically and fixation of the MTP with K-wires was done.

DISCUSSION

Only few case reports have described the injury, and the ideal treatment along with the long-term result of the injury has yet to be further studied because reports are rare in this regard.

CONCLUSION

Functional range of motion may result even after 6 months of delayed treatment with ORIF and osteopenia may result.

A variant neglected Type IIIA dorsal dislocation of first metatarsophalangeal joint. A case report

We present a rare injury consisting of a neglected, irreducible, dislocation of the first metatarsophalangeal joint that was diagnosed 4 months after the injury. An open reduction was necessary from the beginning. Patient returned to full activity without pain or disability, so a good prognosis despite the delayed diagnosis was achieved. We are unaware of previous reports in the literature describing this unusual variant.

Advances in forefoot trauma

Forefoot traumas, particularly involving the metatarsals, are commonly occurring injuries. There have been several advances in management of these injuries. These advances include updates in operative technique, internal fixation options, plating constructs, and external fixation. In addition, the advances of soft tissue management have improved outcomes. This article outlines these injuries and provides an update on techniques, principles, and understanding of managing forefoot trauma.

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.

Fracture-dislocation of the second metatarsophalangeal joint: a case report

Traumatic second metatarsophalangeal dislocation is extremely rare. This article reports a case of traumatic second metatarsophalangeal dislocation associated with fracture of the second metatarsal shaft. Anatomical reduction is indispensable to preserve the function of the metatarsophalangeal joint and to avoid joint ankylosis and chronic foot pain. The patient was treated with open reduction of the fracture without violating the joint to decrease postoperative stiffness. He was followed-up for 6 months. The patient resumed full activity 3 months after surgery, with his joint attaining full range of movement. He reported no pain or joint stiffness during his last visit. To our knowledge, no similar injury has been reported previously.

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.

First ray injuries

The first ray differs from the other rays in its position and its importance with weight bearing. Because it is a critical structure in the formation of the tripod of the foot, injuries to this ray can cause critical alterations in the biomechanics of the foot. This allows for pathologic weight-bearing points of contact and deformity that lead to a disabling gait. Physicians who are involved in the care of the foot and ankle should be familiar with the spectrum of injuries that concern the first ray. These injuries, their management, and sequelae are reviewed.

The floating first metatarsal: a case report

Complete dislocation of the first metatarsal represents an infrequent injury. The authors present the case of a 48-year-old man who sustained dislocation of the first metatarsal from both the metatarsophalangeal and tarsometatarsal joints in a motor vehicle accident. After open reduction, the first metatarsophalangeal joint was temporarily fixated with a Kirschner wire to maintain reduction, while the first metatarso-cuneiform joint was fixated with two cannulated screws. A discussion of the pertinent literature regarding this rare injury is also included.

A mechanism of injury to the forefoot in car crashes

OBJECTIVE

The purpose of this study was to determine a mechanism of injury of the forefoot due to impact loads and accelerations as noted in some frontal offset car crashes.

METHODS

The impact tests conducted simulated knee-leg-foot entrapment, floor pan intrusions, whole-body deceleration, muscle tension, and foot/pedal interaction. Specimens were impacted at speeds of up to 16 m/s. To verify this injury mechanism research was conducted in an effort to produce Lisfranc type injuries and metatarsal fractures. A total of 54 lower legs of post-mortem human subjects were tested. Two possible mechanisms of injury were investigated. For the first mechanism the driver was assumed to be braking hard with the foot on the brake pedal and at 0 deg plantar flexion (Plantar Nominal Configuration) and the brake pedal was in contact with the foot behind the ball of the foot. The second mechanism was studied by having the ball of the foot either on the brake pedal or on the floorboard with the foot plantar-flexed 35 to 50 deg (Plantar Flexed Configuration).

RESULTS

The Plantar Nominal injury mechanism yielded few injuries of the type the study set out to produce. Out of 13 specimens tested at speeds of 16 m/s, three had injuries of the metatarsal (MT) and tarsometatarsal joints. The Plantar Flexed Configuration injury mechanism yielded 65% injuries at high (12.5-16 m/s) and moderate (6-12 m/s) speeds.

CONCLUSION

It is concluded that Lisfranc type foot injuries are the result of impacting the forefoot in the Plantar Flexed Configuration. The injuries were consistent with those reported by physicians treating accident victims and were verified by an orthopedic surgeon during post impact x-ray and autopsy. They included Lisfranc fractures, ligamentous disruptions, and metatarsal fractures.

Concomitant plantar tarsometatarsal (Lisfranc) and metatarsophalangeal joint dislocations

We report an unusual case of concomitant plantar tarsometatarsal (Lisfranc) and 1st and 2nd metatarsophalangeal (MTP) joint dislocations and fracture of the neck of the third metatarsal bone which has never been reported before. The plantar dislocation of the Lisfranc joint was treated by open reduction and fixation with K-wires; the dislocations of the MTP joints and neck fracture of the third metatarsal bone were treated by closed reduction and percutaneous fixation with K-wires and immobilized with a plaster cast. At the 5 year follow-up examination, our patient had no complaints, but the radiograph showed degenerative changes of the Lisfranc and the 1st MTP joint.

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

A case of traumatic fracture-dislocation of the first metatarsophalangeal joint is reported. This type of injury is extremely rare. The injury was associated with complete disruption of the following anatomic structures: conjoined tendon of abductor hallucis and medial head of flexor hallucis brevis, plantar plate, and the intersesamoid ligament. Additionally, there was a transverse fracture of the tibial sesamoid. Excision of the fractured tibial sesamoid trapped within the joint and primary repair was achieved through a medial incisional approach. A complete description of the repair and rationale for the surgical procedure is discussed.