Open surgical treatment of an acute, unstable bony mallet injury of the hallux

Mallet Hallux Injury Fixed With Extension Blocking Pin Technique: A Case Report

Mallet hallux injuries are relatively rare, and management can range from conservative treatment to surgical fixation. Only a few cases of surgically treated are reported, and there is no consensus on the superiority of one technique to others in surgical treatment. We reviewed various options for surgical fixation of Mallet hallux injury and presented a case of mallet hallux injury treated with Kirschner wires with an extension blocking technique.Level of Evidence: V.

Bony mallet toe of the hallux treated with screws: a case report

Traumatic avulsion fracture of the distal phalanx of the hallux, known as the bony mallet toe of the hallux, is rare, and there is no consensus regarding its treatment. Few reports of treatment methods exist, such as nonsurgical treatment using a splint, Kirschner wires, and suture anchors, but there are no reports of screw fixation. We describe the case of a 54-year-old man with a bony mallet toe of the hallux treated with screws and augmented with strong sutures. The interphalangeal joint of the hallux was fixed with a Kirschner wire for 4 weeks after surgery, and weight bearing was allowed on the hallux 5 weeks postoperatively. A total of 20 months after the surgery, the patient had no symptoms or complications. Because of screw fixation and augmentation with strong sutures, fixation strength increased. We showed the feasibility of this new technique for treating an uncommon bony mallet toe of the hallux.

HALLUX PROXIMAL PHALANX FRACTURE IN ADULTS: AN OVERLOOKED DIAGNOSIS

Objectives:

To describe the surgical treatment of fractures that involves the hallux interphalangeal joint, current indications and management options.

Methods:

we performed a literature review of relevant clinical studies in multiple databases, including PubMed, MedLine and Scopus, from January 1989 to October 2020.

Results:

There is consensus for surgical treatment of intra-articular fractures with a deviation greater than 2 mm, metadiaphyseal fractures with malrotation and/or malangulation, open fractures and unstable fractures.

Conclusion:

The use of more rigid implants allow alignment maintenance during healing process and lower risk of reduction loss. Valgus deformity and interphalangeal joint osteoarthritis are possible complications that must be avoided. Level of Evidence III, Systematic review of Level III studies.

Mallet hallux injury: A case report and literature review

Mallet injury is associated with variable degrees of extensor hallucis longus tendon tearing, ultimately leading to the well-known mallet toe deformity; this entity, commonly described at the lesser toes and fingers, has rarely been reported at the hallux. We present a surgically proven case of mallet hallux injury with radiographic and magnetic resonance imaging assessment and review the literature, including clinical and radiological findings, along with basic treatment concepts.

Mini thigthrope® fixation of unstable bony avulsion of the extensor hallucis longus tendon

Reports of isolated avulsion fracture of the distal phalanx of the hallux that comprise the functionality of the extensor hallucis longus tendon (EHL) are scarce and treatment for such injury has only been described in isolated single case reports. Two patients with an unstable avulsion fracture of the distal phalanx treated with reinsertion of the EHL with a Mini ThigthRope® system are presented in this paper. Two patients whom suffered an extreme plantarflexion mechanism sought attention in our clinic. Plain x-rays depicted a displaced and angulated bony avulsion fracture of the base of the distal phalanx of the hallux. The interphalangeal joint was in a slightly plantarflexed position and the patient was not able to perform active extension upon request. Surgical fixation performed with Mini ThigthRope® system without transarticular immobilization of the interphalangeal joint. In the two patients the Mini ThigthRope® system provided adequate reduction of the displaced articular fragment, restored the extensor function and allowed early postoperative mobilization of the IP joint. Removal of the implants was not necessary and patients were able to resume their previous activity levels. Level of Evidence: IV.

Modified Extension Block Technique for Bony Mallet Injury of the Hallux

Bony mallet injury of the hallux is uncommon. In the few reports of this injury, authors have described surgical treatments such as closed reduction with percutaneous pinning and open surgical fixation with Kirschner wires or a suture anchor. However, the appropriate surgical management for this injury remains controversial. In this article, we describe a case of bony mallet injury of the hallux repaired with the modified extension block techniqueusing 3 Kirschner wires. This method is an effective and simple treatment to allow anatomic reduction of the displaced articular fracture fragment without incision, residual hardware, or the complications associated with open surgical treatment.

Injuries to the great toe

PURPOSE OF REVIEW

Injuries to the great toe are common in athletes. While most are managed nonoperatively and allow return to sports activity, some great toe injuries are highly problematic and can impact function. The purpose of this review is to highlight several specific injuries and disease processes involving the hallux and to detail current recommendations and management options in order to help raise suspicion for injuries that can result in long-term dysfunction.

RECENT FINDINGS

Toe injuries have been found to represent nearly 10% of injuries presenting to fracture clinics. While most injuries can be treated nonsurgically, there are a number of specific injuries that require a high index of suspicion, careful management, and in some cases, surgical intervention. Injuries detailed in this review include turf toe, traumatic bunion, and hallux and sesamoid fractures. Additional pathologies that are covered include sesamoiditis and sesamoid avascular necrosis as well as hallux rigidus. Appropriate workup and current treatment recommendations are discussed. Injuries to the hallux can result in long-term pain and disability if not properly diagnosed and treated. A high index of suspicion is required.

Do Broken Toes Need Follow-Up in the Fracture Clinic?

Most toe phalangeal fractures can be successfully treated nonoperatively without any residual deformity and are usually clinically asymptomatic. Toe phalangeal fractures are nevertheless common fracture clinic referrals. Our aim was to evaluate the injury characteristics of patients with toe fractures attending a fracture clinic and to understand how current management affects the fracture clinic workload. We retrospectively evaluated all new referrals to a subspecialized foot and ankle fracture clinic during a 12-month period at our institution under the care of 1 consultant. Data were collected regarding patient demographics, fracture type, patient outcome, and the number of clinic appointments attended, cancelled, or not attended. A total of 707 new patients (mean age 39 ± 19 years; 345 males, 362 females) were seen in 47 foot and ankle fracture clinics within the study period. Seventy-four phalangeal fractures were identified in 65 patients. A total of 135 outpatient appointments were scheduled for these patients (initial and follow-up), with 93 (69%) attended, 25 (19%) not attended, and 15 (11%) cancelled and rescheduled at the patient's request. Seventeen patients (13%) failed to attend their first clinic appointment. The results of the present study highlight that 9% of all new patient referrals to a fracture clinic were for toe phalangeal fractures. Only 2 patients required surgery for significant loss of articular congruency or deformity. No patient subsequently developed a symptomatic malunion or required toe surgery during the following 2 years. We believe that undisplaced and stable toe phalangeal fractures do not need to be referred to the fracture clinic. This would result in a reduction of outpatient appointments for toe fractures by 52%.

Soft tissue 'mallet' injury to the hallux

We describe a case of a delayed presentation of a traumatic soft tissue mallet injury to the distal phalanx of the hallux in a teenager. Reports of this rare injury are sparse and there is no consensus in their treatment. This injury was treated with open repair of the tendon using a Mitek suture anchor, and stabilization with a 1.2-mm K-wire and extension splinting for 8 weeks. Following this treatment, she regained full power and a range of movement compared with the contralateral side, and achieved full function. We advocate surgical reconstruction of these injuries with suture anchors and stabilization of the interphalangeal joint.