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Very unusual great toe injury in a motorcyclist: simultaneous ipsilateral hallucial metatarsophalangeal and interphalangeal joint dislocations
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  1. Lorna Mooney,
  2. Darren Moloney,
  3. Ryan Roopnarinesingh and
  4. John McKenna
  1. Department of Orthopaedic Surgery, St. James's Hospital, Dublin, Ireland
  1. Correspondence to Dr Lorna Mooney; mooneyl2{at}tcd.ie

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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.

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.

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.

Ethics statements

Patient consent for publication

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.

References

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.