Description
Simultaneous dislocations of interphalangeal and metacarpophalangeal joints of the first ray are rare in the upper limb.1–3 Concurrent interphalangeal and metatarsophalangeal dislocations in the lower limb are less common.4 The lesser toes have traumatic interphalangeal dislocations more commonly.5 Metatarsophalangeal dislocations are most common in the great toe, but a rare injury overall.6–11 The authors believe that this is the only reported case of simultaneous interphalangeal and metatarsophalangeal joint dislocation of the great toe.
The man in question, a man in his 30s, attended the emergency department after a motorcycle versus stationary object road traffic incident. He had significant hip pain and was found to have a pelvic ring and acetabulum fracture on CT. Secondary survey revealed a great toe deformity, which was subsequently X-rayed. The X-ray showed simultaneous dorsolateral metatarsophalangeal dislocation and dorsomedial interphalangeal dislocation (figure 1). This was reduced expediently under conscious sedation. At 6 months, the patient presented with mild interphalangeal joint pain and his X-ray showed post-traumatic arthritis of both joints, radiologically worse in the metatarsophalangeal joint (figure 2). He was treated with footwear advice and was counselled on the risks and benefits of arthrodesis, but declined the same. He is currently attending a musculoskeletal radiologist for intra-articular steroid and local anaesthetic injections.
Figure 1.
Simultaneous dorsolateral metatarsophalangeal dislocation and dorsomedial interphalangeal dislocation of the right hallux.
Figure 2.
Post-traumatic arthritis of both interphalangeal and metatarsophalangeal joints of the right hallux.
Learning points.
The importance of secondary survey. This man had a severe distracting injury which was identified immediately. Thanks to a thorough secondary survey, this injury was identified and treated expediently.
The significant burden of post-traumatic sequelae. This man developed post-traumatic arthritis of both his interphalangeal and metatarsophalangeal joints. Although trauma is a fast-paced specialty, long-term outcomes can be significant for patients.
The X-rays don’t tell you everything, the patient does. This man had post-traumatic arthritis of the both joints. This was radiologically worse on the metacarpophalangeal joint. He distinctly described worse pain at the interphalangeal joint, highlighting the importance of an adequate and detailed history.
Acknowledgments
The authors thank the patient for allowing them to write a case report on his condition. The authors also thank all staff involved in his care at the time, including their radiographer colleagues who provided them with the images to include alongside this report.
Footnotes
Contributors: DM was a care provider for the patient. He established the initial concept of the case and drafted the original version of the report. LM contributed by writing and submitting the case report. RR reviewed and proof-read the report. JM was the supervisor and consultant care provider for the patient.
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests: None declared.
Provenance and peer review: Not commissioned; externally peer reviewed.
Ethics statements
Patient consent for publication
Consent obtained directly from patient(s)
References
- 1.Catalán-Amigo S, Pedemonte-Jansana J, Navarro-Quilis A. Simultaneous dislocation of both joints of the thumb with a fracture involving the interphalangeal joint. A case report and a review of the literature. Acta Chir Belg 2007;107:728–30. 10.1080/00015458.2007.11680161 [DOI] [PubMed] [Google Scholar]
- 2.Lee JC, See HF, Low CO. Simultaneous open dislocations of the interphalangeal and metacarpo-phalangeal joints in a thumb--a case report. Singapore Med J 1996;37:318–9. [PubMed] [Google Scholar]
- 3.Levy IM, Liberty S. Simultaneous dislocation of the interphalangeal and metacarpophalangeal joints of the thumb: a case report. J Hand Surg Am 1979;4:489–90. 10.1016/S0363-5023(79)80050-7 [DOI] [PubMed] [Google Scholar]
- 4.Vellingiri K, S NJ, Nazeer S. Bipolar dislocation of the proximal phalanx of toe: a rare injury. Cureus 2020;12:e10490. 10.7759/cureus.10490 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Yang IB, Sun KKW, Sha W-L, et al. Interphalangeal dislocation of toes: a retrospective case series and review of the literature. J Foot Ankle Surg 2011;50:580–4. 10.1053/j.jfas.2011.04.032 [DOI] [PubMed] [Google Scholar]
- 6.Miller M. Review of orthopaedics. ed 6. Philadelphia, PA: Elsevier/Saunders, 2012: 773. [Google Scholar]
- 7.Nelson TL, Uggen W. Irreducible dorsal dislocation of the interphalangeal joint of the great toe. Clin Orthop Relat Res 1981;1:110–2. 10.1097/00003086-198106000-00019 [DOI] [PubMed] [Google Scholar]
- 8.Salamon PB, Gelberman RH, Huffer JM. Dorsal dislocation of the metatarsophalangeal joint of the great toe. A case report. J Bone Joint Surg Am 1974;56:1073–5. 10.2106/00004623-197456050-00022 [DOI] [PubMed] [Google Scholar]
- 9.Bousselmame N, Rachid K, Lazrak K, et al. [New varieties of lateral metatarsophalangeal dislocations of the great toe]. Rev Chir Orthop Reparatrice Appar Mot 2001;87:162–9. [PubMed] [Google Scholar]
- 10.Nabarro MN, Powell J. Dorsal dislocation of the metatarsophalangeal joint of the great toe: a case report. Foot Ankle Int 1995;16:75–8. 10.1177/107110079501600204 [DOI] [PubMed] [Google Scholar]
- 11.Carmont MR, Cribb GL, Hay SM. Dorsal dislocation of the first metatarsophalangeal joint associated with fractured second metatarsal head: a case report and literature review. Foot and Ankle Surgery 2003;9:187–91. 10.1016/S1268-7731(03)00046-8 [DOI] [PubMed] [Google Scholar]