Dorsal dislocation of the first metatarsophalangeal joint associated with fractured second metatarsal head

A variant neglected Type IIIA dorsal dislocation of first metatarsophalangeal joint. A case report

“…Traumatic dislocation of the first MTPJ is a rare injury [1][2][3][4][5]9]. Our case appears to be the first case of a neglected Type IIIA MTPJ dislocation with rupture of the intersesamoidal ligament, reported in literature.…”

“…Many authors confirmed that dorsal approach is considered to be more direct and safer approach than the plantar approach [9,11], with better visualization of the sesamoids conjoint tendon complex and better access for releasing tightened structures [4,12]. This would be the approach of choice for the Type I dislocation [11].…”

“…Hallux rigidus has been reported as another complication of dislocation. Some authors showed early phase of hallux rigidus [9], with limitation of first MTPJ movement, but satisfaction of the patients. In our case, the patient reported a return to full activity without pain or disability and no additional degenerative changes at 12 months postoperatively.…”

“…Operative reduction can be performed via plantar [3,9,10], dorsal [11] or medial approach [11]. Many authors confirmed that dorsal approach is considered to be more direct and safer approach than the plantar approach [9,11], with better visualization of the sesamoids conjoint tendon complex and better access for releasing tightened structures [4,12].…”

National Athletic Trainers' Association Position Statement: Immediate Management of Appendicular Joint Dislocations

“…122 Irreducible first MTP joint dislocations have been attributed to the type of dislocation, involvement of the sesamoid complex, and interposition or locking of the abductor hallucis or flexor hallicus longus tendons. [123][124][125][126] However, not all hallux MTP joint dislocations are resistant to closed management 61,122 Additionally, the location for successful reduction of a hallux MTP dislocation differed in the literature. 61,122 In a 2000 publication, Watson et al 122 recommended attempting reduction of all closed dislocations, regardless of type, in the emergency department after a physical examination is conducted, appropriate radiographs are obtained, and adequate anesthesia is administered.…”