http://www.jfas.org/article/S1067-2516(16)30483-5/abstract
Metatarsophalangeal Joint Dislocation
Sprains are common, but dislocations are rare. Usually result from high energy trauma (eg car accident) as joint is inherently stable. Frequently associated with multiple fractures and occur in motor vehicle accidents or fall from great heights.
Most dislocations are dorsal and are due to a hyperextension force. Sesamoid collateral ligament rupture
Types of dislocations (depends on integrity of sesamoid apparatus):
Type 1
• interosseous sesamoid ligament is still intact, but displaced dorsally
Type 2:
• 2A – rupture of interosseous ligament
• 2B – fracture of medial sesamoid fragment move distally
Clinical features:
• Severe pain and swelling
• Hyper-extended position of joint
• Plantar ecchymosis
• Dimple in the skin over dorsomedial aspect of joint
• Blanching over plantar surface as the skin stretched over met head
Management:
Depends on type
Type 1: surgical reductionsas closed often unsuccessful.
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