Irreducible Dislocation of the Great Toe Interphalangeal Joint, Dorsal, and Plantar. Management and Long-term Evolution.

INTRODUCTION: Irreducible dislocation of the great toe interphalangeal (IP) joint is a rare injury that has scarcely been reported in dorsal direction, but no reported in plantar direction. Closed reduction usually leads to sesamoid incarceration, making the reduction impossible. The purpose of this article is to review the management of irreducible IP dislocation of the great toe presenting three new patients who cover several forms: Open and closed dorsal Miki Type 2 dislocation and one chronic neglected plantar dislocation.

CASE REPORT: These three new cases demonstrate different presentations of IP (adolescents or young adults, open or closed, acute or chronic, dorsal, and plantar). Usually, Miki's Type I is the result of a failed IP dorsal Miki's 2 dislocation reduction. Closed reduction without traction is not usually sufficient, thus percutaneous reduction with K-wire fixation or open reduction should be employed. Open reduction was required in these cases. A Kirschner wire was used to for temporal immobilization in two of the cases and a buddy strapping securing to the second toe for 3 weeks in the three cases.

CONCLUSION: In dorsal dislocations the reduction must be performed without axial traction and only by pressure in the base of the phalanx. Secondary to the trial of orthopedic reduction or spontaneously, incarceration of the sesamoids bones is the rule (Miki 1). In this situation, percutaneous or open reduction must be performed. Plantar dislocation does not provoque intra-articular sesamoid interposition. This article describes the first reported case of neglected plantar dislocation that required open reduction, similar management adding that the long-term functional prognosis is good.