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

Abstract

Closed traumatic dislocation of multiple metatarsophalangeal joints is a rare injury. Until now only one case of simultaneous dislocation of all five metatarsophalangeal joints has been reported in peer-reviewed studies. The complex anatomy of the metatarsophalangeal joints prevents the relocation of the joints in a closed manner in maximum cases. We are reporting a case of dorsal dislocation of the second to fifth metatarsophalangeal joints in the left foot after road traffic accident. Bony prominence over the plantar aspect and increased web space between toes on presentation, then incongruity of metatarsophalangeal joints has to be thoroughly checked on radiograph. Since closed reduction attempts failed open reduction was done through dorsal approach using two incisions. Button holing of the capsule with interposition of capsule and plantar plate was noted. Dorsal approach avoids damage to the plantar plate and surrounding soft tissues.

Keywords: dorsal approach; foot and ankle; irreducible closed reduction; lesser mtp joints dislocation; no internal fixation; open reduction.

Figure 1. X-Ray of left foot showing dislocations of second to fifth metatarsophalangeal joints with no associated fractures.

Figure 2. C arm picture showing reduced metatarsophalangeal joints

Figure 3. Immediate post operative X-ray shows stable reduction of all metatarsophalangeal joints.

Figure 4. Clinical pics of the patient after he was made to weight bear. He had no deformity or pain during walking.

Figure 5. Clinical pics of the patient after he was made to weight bear. He had no deformity or pain during walking.

Figure 6. Third month Post operative X rays stable metatarsophalangeal joints

Figure 7. Third month Post operative X rays stable metatarsophalangeal joints

Figure 8. 2 years Post operative X rays stable metatarsophalangeal joints