An Open Hallux Interphalangeal Joint Dislocation: A Rare Case

Prem Kumar Kothimbakkam; Anantharamakrishnan Ganesh; Arun Kumar Chandhuru; Vijayashankar Murugesan

doi:10.18502/jost.v9i3.13037

Prem Kumar Kothimbakkam Associate Professor, Department of Orthopedics, Chettinad Hospital and Research Institute, Kelambakkam, India
Anantharamakrishnan Ganesh Assistant Professor, Department of Orthopedics, Chettinad Hospital and Research Institute, Kelambakkam, India
Arun Kumar Chandhuru Assistant Professor, Department of Orthopedics, Indira Medical College and Hospital, Thiruvallur, India
Vijayashankar Murugesan Professor, Department of Orthopedics, Chettinad Hospital and Research Institute, Kelambakkam, India

DOI: https://doi.org/10.18502/jost.v9i3.13037

Keywords: Hallux Interphalangeal Joint Dislocation; Miki Type; Case Study

Abstract

Background: The interphalangeal (IP) joint dislocation of hallux is a rare occurrence probably due to the presence of strong ligamentous attachments around it. Closed reduction of this kind of dislocation proves to be unsatisfactory. Herein, we are presenting a case of an open dorsomedial type of IP joint dislocation following a road traffic accident.

Case Report: A 36-year-old woman with injury to her right great toe following a road traffic accident presented in the casualty of Chettinad Hospital, Kelambakkam, India. On examination, there was a 3 × 2 cm laceration present over the medial-plantar aspect. The bone was exposed. Hallux varus deformity was noted due to the dislocation of the IP joint. The reduction of IP joint dislocation was quite unstable and was fixed with two 1mm Kirschner wires (K-wires) under fluoroscopic guidance. The patient was sequentially followed up on the 4th and 6th weeks post-op. Joint integrity and stability were assessed which were found to be satisfactory after the removal of K-wire on the 6th week post-op.

Conclusion: Open IP dislocations of the hallux Miki type 2 are unstable types of injury to deal with. Closed reduction in these injuries is difficult owing to the impinging sesamoid bone along with other soft tissues. These types of injuries should be reduced and fixed with K-wires to have better stability followed by long-term immobilization of around 3 to 4 weeks.