- Email: [email protected]
Plantar dislocation of first metatarsophalangeal joint
Accepted Manuscript Title: Plantar Dislocation Of First Metatarsophalengeal Joint Author: Selahattin Ozyurek Ozkan Kose PII: DOI: Reference:
S0958-2592(13)00068-0 http://dx.doi.org/doi:10.1016/j.foot.2013.11.001 YFOOT 1297
To appear in:
The Foot
Received date: Accepted date:
19-10-2013 4-11-2013
Please cite this article as: Ozyurek S, Dislocation Of First Metatarsophalengeal Joint, http://dx.doi.org/10.1016/j.foot.2013.11.001
Kose The
O, Foot
Plantar (2013),
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ip t
PLANTAR DISLOCATION OF FIRST METATARSOPHALENGEAL JOINT
an
us
Keywords: Dislocation, Hallux, Metatarsophalangeal, Plantar
cr
Abstract: Plantar dislocation of the first metatarsophalangeal joint is an extremely rare injury. There are previous reports in the literature of an isolated dislocation of this type requiring open reduction and surgical repair. We made a review of literature of this unusual injury.
M
Re: ‘‘Isolated plantar dislocation of the 1st metatarsophalangeal joint” [The Foot
Dear Editor,
ed
(2013), http://dx.doi.org/10.1016/j.foot.2013.08.001]
We read the case report entitled “Isolated plantar dislocation of the 1st
pt
metatarsophalangeal joint” by Lomax A et al [1] in the issue of The Foot 2013 with great
Ac ce
interest. We would like to commend the authors for their clinically relevant work. However, we believe that some important additional comments and observations seem necessary to be contributed through this study. In this article, the authors stated that, there are only two case reports in the literature of a true plantar dislocation of the 1st metatarsophalangeal joint (MTPJ) and to the best of their knowledge, their case was the first description of an isolated, closed plantar dislocation of the 1st MTPJ. Nevertheless, we would like to call the attention of the readers to the fact that that there are several other studies related with this topic in English literature.
Page 1 of 8
Traumatic dislocations of first MTPJ is a rare pathology and associated with road traffic accidents and infrequently falls from height [2]. Dislocations are almost invariably dorsal, although plantar and atypical medial and lateral dislocations have been reported
ip t
[2,3]. Most of these dislocations had been treated conservatively. Surgical intervention had been recommended for nonreducible cases [2,3].
cr
Plantar dislocation of the first MTPJ is an extremely rare injury. In this type of
us
injury, intersesamoid ligament and sesamoids are intact and closed reduction is sufficient nearly in all patients [3].
an
In 1988, Biyani et al. [4]. reported a case of severe open plantar panmetatarsophalangeal joint dislocation in association with an extensive dorsal wound and
M
fractures of second and third metatarsal bases of right foot. The mechanism of injury, which they described, was a severe hyperflexion injury following a fall from 20 feet
ed
height. Successful management was achieved with immediate reduction of dislocations as well as prompt and proper wound care and adequate physiotherapy.
pt
The first isolated closed plantar dislocation of the MTPJ was reported by Garcia
Ac ce
Mata et al. [5] which occurred in a lactating lady following minor trauma. They noted the presence of physiological ligamentous laxity associated with normal increase in progesterone in lactating ladies. It was treated successfully by closed reduction. In 2003, Kasmaoui el H et al [6] reported a late (19 days) case of concomitant
plantar Lisfranc dislocation and plantar MTPJ dislocation of the hallux in association with fractures of the neck of the second and third metatarsal in 28 year-old-man. Open reduction on the proximal side and closed reduction on the distal side, in addition to internal fixation proximally and distally, gave good results in this case.
Page 2 of 8
Clark et al. [7,8] reported a case of dorsal displacement of the first metatarsal head out of the MTPJ in association with displaced fracture of the neck of the first metatarsal and trapped extensor hallucis tendon in a longstanding paralysed foot. The
ip t
mechanism of injury in their case was a minor low-energy trauma as the patient only stubbed her big toe against the floor after a fall. Prasad [6] pointed out that neither the
cr
mechanism nor the resultant injury is representative of plantar dislocation because of the
us
pre-existent foot drop and can only be construed as a pathological injury.
Prasad Kodali Siva RK et al [2] reported the first case of closed plantar and
an
lateral dislocation of the first MTPJ in association with closed comminuted fractures of the mid-shafts of the second and third metatarsals, segmental fracture of the fourth and
M
undisplaced fracture of the neck of the fifth metatarsal. The non-professional nonlactating female dancer sustained after a ballet-like fall and a classic severe primary
ed
hyperflexion injury of forefoot in a with no pre-existent deformities or muscular imbalances. Immediate and closed reduction of first MTPJ under an ankle block was
pt
performed. After the swelling diminished, open reduction and intramedullary fixation
Ac ce
using Kirschner wires was performed through a dorsal incision, stabilising the second and third metatarsals. On review at 8 months she was pain free, fully mobile and pleased with the result.
Clanton et al. [9] described the association of athletic injuries and classified the
metatarsophalangeal sprains: Grade I—local tenderness, minimal swelling or ecchymosis. GradeII—diffuse tenderness, marked swelling and ecchymosis and Grade III— capsuloligamentous tearing and subluxation/dislocation that reduce spontaneously. Prasad et al proposed [10] a new comprehensive biomechanical classification of
Page 3 of 8
the hallux MTPJ injuries with further additions to the classification of hallux metatarsophalangeal sprains by Clanton et al. Grade IV—frank dislocation represents the irreversible extreme of the pattern of injury. This progression of the local injury beyond
ip t
spontaneous structural reversal represents the end of linear direction, action and reaction of the initial incriminating force. Grade V—transcends the local barrier and raises the
cr
spectre of dynamic cascade of multidirectional transmission of the operative forces
us
resulting in complex injuries. They analysed the dynamic progression of forces in the reported clinical scenarios of plantar dislocation of the first metatarsophalangeal joint in
an
orthopaedic literature to facilitate strategic understanding of the sequence of forces contributing to the injury and provide the clinician with a clear plan for execution of
M
management. They concluded that plantar dislocation of the first MTPJ is best described as Dancer’s dislocation from the classic sur les pointe through their modification of the
ed
classification of Clanton et al.
In 2004, Sarban S et al [3] reported a case of neglected irreducible plantar
pt
dislocation of first MTPJ with partially ruptured medial collateral ligament and
Ac ce
dorsomedial capsule. They described a 17-year-old male patient with bilateral postaxial polydactly and traumatic plantar dislocation of the right first MTPJ which was untreated for three months. In the patient’s history he had a dorsal direct trauma (a heavy object—a stove—fell onto the hyperflexed forefoot in a flexible tennis shoe) to the right first MTPJ three months previously. The patient was treated with amputation of both supernumerary toes and open reduction of the first MTPJ by means of medial and dorsal first web space insicions and intramedullary K-wire fixation. This was the second case of dislocated hallux plantarly and the first case treated by open surgery in literature. Sarban S et al
Page 4 of 8
concluded that isolated medial, lateral and plantar dislocations of the first MTPJ represent significant capsuloligamentous avulsion and they are in unclassified groups. For this reason, they suggested that Jahss’ classification must be revised, considering not only
ip t
sagital plane lesions, but also coronal plane lesions to optimize the treatment. As a conclusion, we agree with the authors that hyperflexion injury of the forefoot incriminated
as
the
primary
mechanism
in
plantar
dislocation
cr
is
of
the
us
metatarsophalangeal joint[2,3,4,8,10] and want to add the classification of MTPJ dislocations should be revised for optimizing the diagnosis and the treatment[3,10].
an
We would like to congratulate the authors on their great success in the
M
management of this uncommon clinical disorder.
ed
REFERENCES
pt
1. Lomax A, Miller RJ,Kumar CS. Isolated plantar dislocation of the 1st metatarsophalangeal
joint,
The
Foot
2013,
Ac ce
http://dx.doi.org/10.1016/j.foot.2013.08.001
2. Prasad Kodali Siva RK, Parekh S, Zafiropoulos G. Plantar dislocation of the first metatarsophalangeal joint. Foot Ankle Surg 2004;10/2:85–7.
3. Sarban S, Erol O, Yazar M, Isikan UE. A neglected plantar dislocation of the first metatarsophalangeal joint: a case report. Foot Ankle Surg 2004;10.4: 227-230. 4. Biyani A, Sharma JC, Mathur NC. Plantar panmetatarsophalangeal dislocation: a hyperflexion injury. J Trauma 1988;28(6):868–9. 5. Garcia Mata S, Ovejero AH, Grande MM. Plantar dislocation of the first
Page 5 of 8
metatarsophalangeal joint during lactation: a case report. Int Orthop 1995;19:65– 6. 6. Kasmaoui el H, Bousselmame N, Bencheba D, Boussouga M, Lazrek K, Taobane
ip t
H. The floating metatarsal. A rare traumatic injury. Acta Orthop Belg 2003;69(3):295-7.
us
metatarsophalangeal joint. Injury 2000;31:465–6.
cr
7. Clark CJM, Reddy C, Kitson J. Case report: fracture dislocation of the first
8. Prasad Kodali Siva RK. Fracture-dislocation of the first metatarsophalangeal
an
joint. Clark et al. [Injury 31 (2000) 465–466]. Is this dislocation plantar, Jahss IV dorsal or pathological? Injury 2003; 34(6):465–6.
M
9. Clanton TO, Butler JE, Eggert A. Injuries to the metatarsophalangeal joints in athletes. Foot Ankle 1986;7(3):162-176.
ed
10. Prasad Kodali Siva RK, Parekh S, Zafiropoulos G . Clinical pathodynamics of plantar dislocation of the first metatarsophalangeal joint: Dancer's dislocation.
Ac ce
pt
The Foot, 2005, 15.1: 29-32.
Page 6 of 8
PLANTAR DISLOCATION OF FIRST METATARSOPHALENGEAL JOINT
Re: ‘‘Isolated plantar dislocation of the 1st metatarsophalangeal joint” [The Foot (2013),
ip t
http://dx.doi.org/10.1016/j.foot.2013.08.001]
cr
Selahattin OZYUREK, MD
Marmaris/Mugla/TURKEY
an
Ozkan KOSE, MD, FEBOT, Associate Professor
us
Department of Orthopaedics and Traumatology, Aksaz Military Hospital,
Department of Orthopaedics and Traumatology, Antalya Education and Research Hospital
M
Antalya/TURKEY
ed
Disclaimer: None
pt
Corresponding author: Selahattin OZYUREK MD
Ac ce
Department of Orthopaedics and Traumatology, Aksaz Military Hospital, 48700 Marmaris/Mugla/Turkey Phone
: +90 2524210161
[email protected]
Page 7 of 8
Abstract: Plantar dislocation of the first metatarsophalangeal joint is an extremely rare injury. There are previous reports in the literature of an isolated dislocation of this type requiring open reduction
ip t
and surgical repair. We made a review of literature of this unusual injury. Keywords
Ac ce
pt
ed
M
an
us
cr
First metatarsophalangeal, Plantar dislocation
Page 8 of 8
S0958-2592(13)00068-0 http://dx.doi.org/doi:10.1016/j.foot.2013.11.001 YFOOT 1297
To appear in:
The Foot
Received date: Accepted date:
19-10-2013 4-11-2013
Please cite this article as: Ozyurek S, Dislocation Of First Metatarsophalengeal Joint, http://dx.doi.org/10.1016/j.foot.2013.11.001
Kose The
O, Foot
Plantar (2013),
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ip t
PLANTAR DISLOCATION OF FIRST METATARSOPHALENGEAL JOINT
an
us
Keywords: Dislocation, Hallux, Metatarsophalangeal, Plantar
cr
Abstract: Plantar dislocation of the first metatarsophalangeal joint is an extremely rare injury. There are previous reports in the literature of an isolated dislocation of this type requiring open reduction and surgical repair. We made a review of literature of this unusual injury.
M
Re: ‘‘Isolated plantar dislocation of the 1st metatarsophalangeal joint” [The Foot
Dear Editor,
ed
(2013), http://dx.doi.org/10.1016/j.foot.2013.08.001]
We read the case report entitled “Isolated plantar dislocation of the 1st
pt
metatarsophalangeal joint” by Lomax A et al [1] in the issue of The Foot 2013 with great
Ac ce
interest. We would like to commend the authors for their clinically relevant work. However, we believe that some important additional comments and observations seem necessary to be contributed through this study. In this article, the authors stated that, there are only two case reports in the literature of a true plantar dislocation of the 1st metatarsophalangeal joint (MTPJ) and to the best of their knowledge, their case was the first description of an isolated, closed plantar dislocation of the 1st MTPJ. Nevertheless, we would like to call the attention of the readers to the fact that that there are several other studies related with this topic in English literature.
Page 1 of 8
Traumatic dislocations of first MTPJ is a rare pathology and associated with road traffic accidents and infrequently falls from height [2]. Dislocations are almost invariably dorsal, although plantar and atypical medial and lateral dislocations have been reported
ip t
[2,3]. Most of these dislocations had been treated conservatively. Surgical intervention had been recommended for nonreducible cases [2,3].
cr
Plantar dislocation of the first MTPJ is an extremely rare injury. In this type of
us
injury, intersesamoid ligament and sesamoids are intact and closed reduction is sufficient nearly in all patients [3].
an
In 1988, Biyani et al. [4]. reported a case of severe open plantar panmetatarsophalangeal joint dislocation in association with an extensive dorsal wound and
M
fractures of second and third metatarsal bases of right foot. The mechanism of injury, which they described, was a severe hyperflexion injury following a fall from 20 feet
ed
height. Successful management was achieved with immediate reduction of dislocations as well as prompt and proper wound care and adequate physiotherapy.
pt
The first isolated closed plantar dislocation of the MTPJ was reported by Garcia
Ac ce
Mata et al. [5] which occurred in a lactating lady following minor trauma. They noted the presence of physiological ligamentous laxity associated with normal increase in progesterone in lactating ladies. It was treated successfully by closed reduction. In 2003, Kasmaoui el H et al [6] reported a late (19 days) case of concomitant
plantar Lisfranc dislocation and plantar MTPJ dislocation of the hallux in association with fractures of the neck of the second and third metatarsal in 28 year-old-man. Open reduction on the proximal side and closed reduction on the distal side, in addition to internal fixation proximally and distally, gave good results in this case.
Page 2 of 8
Clark et al. [7,8] reported a case of dorsal displacement of the first metatarsal head out of the MTPJ in association with displaced fracture of the neck of the first metatarsal and trapped extensor hallucis tendon in a longstanding paralysed foot. The
ip t
mechanism of injury in their case was a minor low-energy trauma as the patient only stubbed her big toe against the floor after a fall. Prasad [6] pointed out that neither the
cr
mechanism nor the resultant injury is representative of plantar dislocation because of the
us
pre-existent foot drop and can only be construed as a pathological injury.
Prasad Kodali Siva RK et al [2] reported the first case of closed plantar and
an
lateral dislocation of the first MTPJ in association with closed comminuted fractures of the mid-shafts of the second and third metatarsals, segmental fracture of the fourth and
M
undisplaced fracture of the neck of the fifth metatarsal. The non-professional nonlactating female dancer sustained after a ballet-like fall and a classic severe primary
ed
hyperflexion injury of forefoot in a with no pre-existent deformities or muscular imbalances. Immediate and closed reduction of first MTPJ under an ankle block was
pt
performed. After the swelling diminished, open reduction and intramedullary fixation
Ac ce
using Kirschner wires was performed through a dorsal incision, stabilising the second and third metatarsals. On review at 8 months she was pain free, fully mobile and pleased with the result.
Clanton et al. [9] described the association of athletic injuries and classified the
metatarsophalangeal sprains: Grade I—local tenderness, minimal swelling or ecchymosis. GradeII—diffuse tenderness, marked swelling and ecchymosis and Grade III— capsuloligamentous tearing and subluxation/dislocation that reduce spontaneously. Prasad et al proposed [10] a new comprehensive biomechanical classification of
Page 3 of 8
the hallux MTPJ injuries with further additions to the classification of hallux metatarsophalangeal sprains by Clanton et al. Grade IV—frank dislocation represents the irreversible extreme of the pattern of injury. This progression of the local injury beyond
ip t
spontaneous structural reversal represents the end of linear direction, action and reaction of the initial incriminating force. Grade V—transcends the local barrier and raises the
cr
spectre of dynamic cascade of multidirectional transmission of the operative forces
us
resulting in complex injuries. They analysed the dynamic progression of forces in the reported clinical scenarios of plantar dislocation of the first metatarsophalangeal joint in
an
orthopaedic literature to facilitate strategic understanding of the sequence of forces contributing to the injury and provide the clinician with a clear plan for execution of
M
management. They concluded that plantar dislocation of the first MTPJ is best described as Dancer’s dislocation from the classic sur les pointe through their modification of the
ed
classification of Clanton et al.
In 2004, Sarban S et al [3] reported a case of neglected irreducible plantar
pt
dislocation of first MTPJ with partially ruptured medial collateral ligament and
Ac ce
dorsomedial capsule. They described a 17-year-old male patient with bilateral postaxial polydactly and traumatic plantar dislocation of the right first MTPJ which was untreated for three months. In the patient’s history he had a dorsal direct trauma (a heavy object—a stove—fell onto the hyperflexed forefoot in a flexible tennis shoe) to the right first MTPJ three months previously. The patient was treated with amputation of both supernumerary toes and open reduction of the first MTPJ by means of medial and dorsal first web space insicions and intramedullary K-wire fixation. This was the second case of dislocated hallux plantarly and the first case treated by open surgery in literature. Sarban S et al
Page 4 of 8
concluded that isolated medial, lateral and plantar dislocations of the first MTPJ represent significant capsuloligamentous avulsion and they are in unclassified groups. For this reason, they suggested that Jahss’ classification must be revised, considering not only
ip t
sagital plane lesions, but also coronal plane lesions to optimize the treatment. As a conclusion, we agree with the authors that hyperflexion injury of the forefoot incriminated
as
the
primary
mechanism
in
plantar
dislocation
cr
is
of
the
us
metatarsophalangeal joint[2,3,4,8,10] and want to add the classification of MTPJ dislocations should be revised for optimizing the diagnosis and the treatment[3,10].
an
We would like to congratulate the authors on their great success in the
M
management of this uncommon clinical disorder.
ed
REFERENCES
pt
1. Lomax A, Miller RJ,Kumar CS. Isolated plantar dislocation of the 1st metatarsophalangeal
joint,
The
Foot
2013,
Ac ce
http://dx.doi.org/10.1016/j.foot.2013.08.001
2. Prasad Kodali Siva RK, Parekh S, Zafiropoulos G. Plantar dislocation of the first metatarsophalangeal joint. Foot Ankle Surg 2004;10/2:85–7.
3. Sarban S, Erol O, Yazar M, Isikan UE. A neglected plantar dislocation of the first metatarsophalangeal joint: a case report. Foot Ankle Surg 2004;10.4: 227-230. 4. Biyani A, Sharma JC, Mathur NC. Plantar panmetatarsophalangeal dislocation: a hyperflexion injury. J Trauma 1988;28(6):868–9. 5. Garcia Mata S, Ovejero AH, Grande MM. Plantar dislocation of the first
Page 5 of 8
metatarsophalangeal joint during lactation: a case report. Int Orthop 1995;19:65– 6. 6. Kasmaoui el H, Bousselmame N, Bencheba D, Boussouga M, Lazrek K, Taobane
ip t
H. The floating metatarsal. A rare traumatic injury. Acta Orthop Belg 2003;69(3):295-7.
us
metatarsophalangeal joint. Injury 2000;31:465–6.
cr
7. Clark CJM, Reddy C, Kitson J. Case report: fracture dislocation of the first
8. Prasad Kodali Siva RK. Fracture-dislocation of the first metatarsophalangeal
an
joint. Clark et al. [Injury 31 (2000) 465–466]. Is this dislocation plantar, Jahss IV dorsal or pathological? Injury 2003; 34(6):465–6.
M
9. Clanton TO, Butler JE, Eggert A. Injuries to the metatarsophalangeal joints in athletes. Foot Ankle 1986;7(3):162-176.
ed
10. Prasad Kodali Siva RK, Parekh S, Zafiropoulos G . Clinical pathodynamics of plantar dislocation of the first metatarsophalangeal joint: Dancer's dislocation.
Ac ce
pt
The Foot, 2005, 15.1: 29-32.
Page 6 of 8
PLANTAR DISLOCATION OF FIRST METATARSOPHALENGEAL JOINT
Re: ‘‘Isolated plantar dislocation of the 1st metatarsophalangeal joint” [The Foot (2013),
ip t
http://dx.doi.org/10.1016/j.foot.2013.08.001]
cr
Selahattin OZYUREK, MD
Marmaris/Mugla/TURKEY
an
Ozkan KOSE, MD, FEBOT, Associate Professor
us
Department of Orthopaedics and Traumatology, Aksaz Military Hospital,
Department of Orthopaedics and Traumatology, Antalya Education and Research Hospital
M
Antalya/TURKEY
ed
Disclaimer: None
pt
Corresponding author: Selahattin OZYUREK MD
Ac ce
Department of Orthopaedics and Traumatology, Aksaz Military Hospital, 48700 Marmaris/Mugla/Turkey Phone
: +90 2524210161
[email protected]
Page 7 of 8
Abstract: Plantar dislocation of the first metatarsophalangeal joint is an extremely rare injury. There are previous reports in the literature of an isolated dislocation of this type requiring open reduction
ip t
and surgical repair. We made a review of literature of this unusual injury. Keywords
Ac ce
pt
ed
M
an
us
cr
First metatarsophalangeal, Plantar dislocation
Page 8 of 8