Journal of Musculoskeletal Trauma

Original Article

Surgical Treatment of Pediatric Intra-Articular Proximal Phalangeal Head Fracture of the Big Toe: Yeun Soo Kim, Geunwu Gimm, Il ung Hwang, Goo Hyun Baek, Jihyeung Kim; J Korean Fract Soc 2020;33(1):9-15. Published online January 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.1.9

Abstract PDF: PURPOSE
Pediatric intra-articularproximal phalangeal head fractures of the big toe are very rare and few studies on this have been published. The purpose of this study is to present the diagnostic approach and surgical management of these extremely rare fractures, which might be easily underestimated or misdiagnosed.
MATERIALS AND METHODS
The study retrospectively reviewed all the patients who were diagnosed as intra-articular proximal phalangeal head fracture of the big toe and who underwent surgical intervention in our institution. The size of the bony fragment and hallux valgus interphalangeus angle were measured on the preoperative X-rays. The size and rotation of the osteochondral fragment, the presence of avascular necrosis, ligamentous injury and soft tissue entrapment were assessed on the preoperative magnetic resonance images (MRIs). The radiologic and functional evaluation were performed at 1 year postoperatively.
RESULTS
The average size of the bony fragments measured on the X-rays was 4.1 mm in width and 2.3 mm in length. Two cases showed hallux valgus interphalangeus. Preoperative MRI was performed in four cases and the average size of any osteochondral lesion was 5.3 mm in width, 3.9 mm in length, and 4.7 mm in height. Rotation of the osteochondral fragment was observed in one patient, and soft tissue entrapment was noted in two patients. Postoperatively, successful bony union was achieved in all the patients and the average time to union was 74.4 days.
CONCLUSION
Intra-articular proximal phalangeal head fractures of the big toe are very rare and often neglected due to incomplete ossification in the pediatric population. It is important to suspect the presence of this intra-articular fracture and to appropriately implement further evaluation. Nonunion of chronic cases as well as acute fractures can be successfully treated through open reduction and internal fixation using multiple K-wires.

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Case Report

Irreducible Dislocation of the Interphalangeal Joint of the Great Toe with Lateral Collateral Ligament Entrapment: A Case Report: Duke Whan Chung, Bi O Jeong; J Korean Fract Soc 2009;22(2):110-113. Published online April 30, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.2.110

Dislocations of the interphalangeal joint of the great toe that are irreducible are very rare. Invagination of the plantar plate or the sesamoid bone into the IP joint, which prevents reduction. To our knowledge, however, dislocations of the IP joint of the great toe that were irreducible because of lateral collateral ligament entrapment, not invagination of the plantar plate or the sesamoid bone, have not been reported by any English literature. We report a 29-year-old ballet dancer who sustained an irreducible dislocation of the interphalangeal joint of the great toe owing to lateral collateral ligament entrapment.

Citations

Citations to this article as recorded by

Open Reduction of a Dislocation of the Interphalangeal Joint of the Great Toe Neglected for 6 Weeks
Jae Kwang Kim, Rag-Gyu Kim
Journal of the Korean Orthopaedic Association.2011; 46(5): 426. CrossRef

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