Surgical Repair of an Unstable Third Metatarsophalangeal Joint Dislocation via Direct Plantar Plate Repair: A Simple and Effective Technique

Abstract

Traumatic dislocation of a lesser metatarsophalangeal (MTP) joint is a rare case for a foot and ankle surgeon to encounter. These dislocations can be difficult to reduce due to the surrounding connective tissues that may be interposed in the joint space. These include the plantar plate, deep transverse metatarsal ligament, flexor tendons, and lumbricals. When the clinician is unable to reduce the phalanx, surgery is required to prevent sequelae such as further swelling, ecchymosis, joint damage, and impingement of the neurovascular bundle. In this case report, we present the case of a 53-year-old female who suffered a traumatic dislocation after a low-energy trip and fall injury. The MTP joint was found to be unstable, and therefore, we managed the dislocation through open reduction and direct repair of the plantar plate via a plantar approach. We feel the plantar plate repair makes our case unique as well as superior because it allows better visualization and obviates the need for further fixation with a K-wire.

Rare Case Report of Closed Traumatic Dislocation of Second to Fifth Metatarsophalangeal Joints

“…A plantar incision has the advantage of being able to repair the deeply situated transverse metatarsal ligament and the tense plantar plate. Ideally if the repair of plantar plate is not carried out, then stabilization of the joint using K wire has been suggested [6,7]. In our patient the reduction was stable and hence no internal fixation was used.…”