scholarly journals Irreducible Dislocation of the Great Toe Interphalangeal Joint Secondary to an Incarcerated Sesamoid

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Hamid Rahmatullah Bin Abd Razak ◽  
Zi-Yang Chia ◽  
Hwee-Chye Andrew Tan
Keyword(s):  
Outpatient Clinic ◽  
Orthopaedic Surgery ◽  
Kirschner Wire ◽  
Axial Loading ◽  
Interphalangeal Joint ◽  
Return To Sports ◽  
Great Toe ◽  
Field Hockey ◽  
Kirschner Wire Fixation ◽  
Specialist Outpatient Clinic

Irreducible dorsal dislocation of the interphalangeal (IP) joint of the great toe is rare. We report a case of a 29-year-old gentleman who presented to the Orthopaedic Surgery Specialist Outpatient Clinic with an irreducible IP joint of the great toe that had been untreated for 4 weeks. The mechanism of injury is believed to be a combination of axial loading with a hyperdorsiflexion force when the patient fell foot first into a drain. As the patient did not report severe symptoms and a true lateral radiograph was not ordered, the dislocation was missed initially at the emergency department. The patient had continued to run and play field hockey prior to visiting us. Incarceration of the sesamoid became a block to manipulation and reduction at the specialist outpatient clinic 3 weeks later. The patient was treated with open surgical exploration, resection of the interposed sesamoid, and Kirschner-wire fixation of the IP joint followed by occupational therapy for mobilization exercises. The operative course was uneventful. At 6 months after surgery, the patient could walk, run, and return to sports.

Arthrodesis of the Interphalangeal Joint of the Hallux

2001 ◽  
Vol 91 (8) ◽  
pp. 427-434 ◽  
Author(s):  
Gerard V. Yu ◽  
Frank E. Vargo ◽  
Joel W. Brook
Keyword(s):  
Simple Technique ◽  
Functional Unit ◽  
Screw Fixation ◽  
Kirschner Wire ◽  
Interphalangeal Joint ◽  
Kirschner Wires ◽  
Effective Technique ◽  
Kirschner Wire Fixation ◽  
Wire Fixation ◽  
Common Problems

The authors present a simple and effective technique to achieve arthrodesis of the hallucal interphalangeal joint. Stabilization is achieved by external fixation with crossing Kirschner wires joined together to create a single functional unit, a technique that avoids common problems often associated with Kirschner-wire fixation. The authors propose that this simple technique be considered for patients in whom it has been determined that screw fixation should not be used to obtain fusion of the interphalangeal joint. (J Am Podiatr Med Assoc 91(8): 427-434, 2001)

The Treatment of Dorsal Fracture-Dislocation of the Proximal Interphalangeal Joint by Closed Reduction and Kirschner Wire Fixation: A 16-Year Follow Up

2001 ◽  
Vol 26 (6) ◽  
pp. 537-540 ◽  
Author(s):  
D. P. NEWINGTON ◽  
T. R. C. DAVIS ◽  
N. J. BARTON
Keyword(s):  
Closed Reduction ◽  
Articular Surface ◽  
Kirschner Wire ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Fracture Dislocation ◽  
Long Term Results ◽  
Kirschner Wire Fixation ◽  
Wire Fixation

Ten patients who had sustained 11 unstable dorsal fracture-dislocations of finger proximal interphalangeal joints were reviewed at a mean follow-up of 16 years. All had been treated acutely by closed reduction and transarticular Kirschner wire fixation of the proximal interphalangeal joint, without any attempt at reduction of the fracture of the base of the middle phalanx, which probably involved 30–60% of the articular surface. Seven of the ten patients complained of no finger pain or stiffness, and none complained of severe pain. There was a mean fixed flexion deformity of 81 at the proximal interphalangeal joint, which had a mean arc of movement of 851. Although subchondral sclerosis and mild joint space narrowing were observed in some instances, there were no severe degenerative changes. These results confirm that this technique is a reliable treatment method for these injuries, and produces satisfactory long-term results.

Arthrodesis of the Interphalangeal Joint of the Great Toe—An Improved Technique

Foot & Ankle ◽  
1980 ◽  
Vol 1 (1) ◽  
pp. 26-29 ◽  
Author(s):  
Thomas C. Shives ◽  
Kenneth A. Johnson
Keyword(s):  
Cancellous Bone ◽  
Mayo Clinic ◽  
Kirschner Wire ◽  
Interphalangeal Joint ◽  
Great Toe ◽  
Bone Screw ◽  
Improved Technique

At the Mayo Clinic between 1950 and 1975, initial fusion of the interphalangeal joint of the great toe was attempted 166 times in 139 patients utilizing a Kirschner wire for stabilization. Follow-up examination of these patients disclosed an overall pseudarthrosis rate of 44%. Because of these disappointing results, a technique involving use of a longitudinal mini-cancellous bone screw was devised which provides increased stability and compression at the arthrodesis site. With this method, used 20 times in 18 patients, the pseudoarthrosis rate was decreased to 10%.

HEMI-HAMATE ARTHROPLASTY VERSUS TRANSARTICULAR KIRSCHNER WIRE FIXATION FOR UNSTABLE DORSAL FRACTURE-DISLOCATION OF THE PROXIMAL INTERPHALANGEAL JOINT IN THE HAND

Hand Surgery ◽  
2015 ◽  
Vol 20 (01) ◽  
pp. 115-119 ◽  
Author(s):  
R. C. Barksfield ◽  
B. Bowden ◽  
A. J. Chojnowski
Keyword(s):  
Bone Grafting ◽  
Kirschner Wire ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Fracture Dislocation ◽  
Kirschner Wire Fixation ◽  
Wire Fixation ◽  
Fracture Dislocations ◽  
Fixed Flexion Deformity

Following the introduction of the hemi-hamate arthroplasty (HHA) technique to our unit, we sought to evaluate the early clinical outcomes achieved with this method of fixation and compare these with simple trans-articular Kirschner wire (K-wire) fixation for dorsal fracture dislocations (DFD) of the proximal interphalangeal joint (PIPJ). Ninteen patients underwent fixation of these injuries with either K-wire fixation (12/19) or hemi-hamate bone grafting (7/19) between 2005 and 2011. At a mean follow-up of 14 weeks median arc of movement at the PIPJ was 65° (range 31° to 108°) following HHA and 56° (range 9° to 85°) (p = 0.82) following temporary transarticular K-wire fixation. Median fixed flexion deformity (FFD) was 20° and 15° for hemi-hamate bone grafting and K-wire fixation respectively. Based upon our findings, transarticular K-wire fixation produced equivalent outcomes to HHA for unstable DFD of the PIPJ in the hand.

Dorsal Fracture–Dislocation of the Proximal Interphalangeal Joint: A Comparative Study of Percutaneous Kirschner Wire Fixation Versus Open Reduction and Internal Fixation

2005 ◽  
Vol 30 (2) ◽  
pp. 120-128 ◽  
Author(s):  
A. ALADIN ◽  
T. R. C. DAVIS
Keyword(s):  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Kirschner Wire ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Fracture Dislocation ◽  
Cerclage Wire ◽  
Kirschner Wire Fixation ◽  
Wire Fixation

Nineteen patients with a dorsal fracture–dislocation of the proximal interphalangeal joint of a finger were treated with either closed reduction and transarticular Kirschner wire fixation (eight cases) or open reduction and internal fixation, using either one or two lag screws (six cases) or a cerclage wire (five cases). At a mean follow-up of 7 (range 6–9) years, most patients reported satisfactory finger function, even though some of the injuries healed with proximal interphalangeal joint incongruency (seven cases) or subluxation (four cases). Those treated by open reduction complained of more “loss of feeling” in the affected finger and those specifically treated by cerclage wire fixation reported more cold intolerance and had a significantly larger fixed flexion deformity (median, 30°: range 18–38°) and a smaller arc of motion (median, 48°: range 45–60°) at the proximal interphalangeal joint, despite having the best radiological outcomes. Closed reduction and transarticular Kirschner wire fixation produced satisfactory results, with none of the eight patients experiencing significant persistent symptoms despite a reduced arc of proximal interphalangeal joint flexion (median=75°; range 60–108°). The results of this relatively simple treatment appear at least as satisfactory as those obtained by the two techniques of open reduction and internal fixation, both of which were technically demanding.

Stabilization of the Interphalangeal Joint of the Big Toe: Comparison of Three Methods

Foot & Ankle ◽  
1992 ◽  
Vol 13 (4) ◽  
pp. 181-187 ◽  
Author(s):  
Rajan Asirvatham ◽  
Ronald J. Rooney ◽  
H. G. Watts
Keyword(s):  
Screw Fixation ◽  
Kirschner Wire ◽  
Interphalangeal Joint ◽  
Kirschner Wire Fixation ◽  
Extensor Hallucis Longus ◽  
Group A ◽  
C 32 ◽  
Group B ◽  
Intramedullary Screw ◽  
Extensor Digitorum Brevis

Three methods of stabilizing the IP of the big toe were compared. In group A, 10 patients underwent tenodesis of the extensor hallucis longus to the extensor digitorum brevis tendon. All of them developed a toe-drop; two patients had significant symptoms that required IP fusion. In group B, 19 patients underwent IP fusion using smooth or threaded intramedullary Kirschner wire fixation. There were nine nonunions, three requiring refusion. In group C, 32 patients underwent IP fusion using intramedullary screw fixation. There was one nonunion with screw failure that required revision. Although none of our patients considered the toe-drop after extensor hallucis longus tenodesis cosmetically unacceptable, this may not be so in other cultures. All complications following IP fusion with screw fixation were technical and are avoidable. When stabilization of IP is required, we recommend fusion of IP with screw fixation.

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