Irreducible Proximal Interphalangeal Dislocation of the Fourth Toe: A Case Report

Abstract

Dislocation of the interphalangeal joints of the lesser toes is an uncommon injury, and complex (irreducible) dislocation has rarely been reported. All previous reports note that, during open reduction, the volar plate is interposed within the joint, thereby blocking reduction. In this case, the medial collateral ligament was the primary obstruction to reduction. Clinically, these dislocations are difficult to appreciate. It is recommended that x-ray studies be performed so that this diagnosis is not overlooked.

Irreducible Fracture of the Proximal Interphalangeal Joint of the Fifth Toe

“…On physical examination, one may find visible deformity, deviation of the toe, sometimes a clinically apparent dislocation, rotation, impaired active movement, and a notably tender joint (2,3,5,8). It is also important to check for intact skin, normal sensation, and normal capillary refill (2).…”

“…Dislocation of the interphalangeal joint of the toe is an uncommon injury (3)(4)(5)(6). Reduction is usually accomplished through manual traction, and unsuccessful reduction is rare (4,5).…”

“…In terms of the surgical approach, the dorsal route is preferred because the obstructing pathology can be readily visualized, managed easily, and it is safer because no digital nerves are in jeopardy (3,5,6). If the reduction is unstable, then pin fixation is needed (2).…”

“…Interphalangeal joint dislocations are primarily treated by closed manipulation and taping to an adjacent toe (2). However, closed reduction can be unsuccessful in these injuries (2,3,5).…”

“…Reduction is usually accomplished through manual traction, and unsuccessful reduction is rare (4,5).…”