Locked floating first metatarsal: open reduction and no fixation - case report

Bipolar Dislocation of the Proximal Phalanx of Toe: A Rare Injury

We report a very rare case of bipolar fracture with dislocation of the proximal phalanx or floating proximal phalanx of the toe. The literature has shown that closed reduction gives a lesser chance of success considering the inherent anatomy of the foot. We report a case of a 40-year-old male with an open injury to his right foot involving bipolar dislocation of the proximal phalanx of the third toe with extensor digitorum longus tendon injury and fracture of the neck of the fourth proximal phalanx of the right foot. With the realization that open reduction and Kirschner wire fixation are good options in patients with such a presentation, a prompt and accurate diagnosis with a treatment plan was made, which lead to clinical success.

Three floating metatarsals and a half-floating cuneiform

Floating metatarsals are rare and complex injury patterns in the world of foot trauma. The injury is typically characterised by concomitant dislocations of the metatarsals from both articular ends ('bipolar dislocations'). Fascination arises from the fact that there have been only 15 cases reported in the English literature from 1964 to date. The first metatarsal has been more frequently reported than the lesser metatarsals. More than one floating metatarsal is also extremely uncommon. Inter-cuneiform diastasis is another rare entity seen in low velocity injuries and sports injuries; this condition is very difficult to diagnose clinically and radiologically. The occurrence of these two injury patterns in isolation is itself rare, making their combination even more unique.