Intra-articular fracture of proximal phalanx of great toe accompanied by valgus deformity associated with sports activities

Kim, Sung‐Soo; Lee, Myoungjin; Seok, Sangyun

doi:10.1177/2309499017690324

Cited by 4 publications

(10 citation statements)

References 12 publications

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“…[26][27][28] The recommendation of an operative approach and method fixation is usually based on the surgeon experience, fracture pattern, and size of fragments; they have been addressed in few studies. 5,6,9,10 Medial longitudinal approach This classic approach is recommended for fractures of the two phalanx of the hallux with or without joint involvement. However, this approach can also be used for open reduction and internal fixation (ORIF) of the medial sesamoid bone and distal fractures of the first metatarsal, as well as for treating complications.…”

Section: Surgical Treatment Indications Approaches and Fixation Optionsmentioning

confidence: 99%

“…Patients with a fracture of proximal phalanx of the great toe complain more about valgus deformity than about severe pain. 10 Valgus deformity progresses gradually and can result in hallux valgus and interphalangeal hallux valgus according to the fracture site.…”

Section: Complicationsmentioning

confidence: 99%

“…9 Fracture of the lateral side of the proximal phalanx head and/or diaphysis, and the medial side of the proximal phalanx base can result in valgus deformity. 10 Treatment can be performed with arthrodesis or corrective osteotomy, depending on the degree of joint degeneration of the interphalangeal joint (IPJ).…”

Section: Complicationsmentioning

confidence: 99%

“…Degenerative arthritis of the hallux IPJ may occur following hallux proximal phalanx fracture, more frequent in the proximal phalanx head and/or diaphysis. 9,10 IPJ osteoarthritis is grading by radiographic system. 31 • Grade I shows no degenerative change;…”

Section: Hallux Interphalangeal Joint Osteoarthritismentioning

confidence: 99%

“…When the principles of treatment for diaphyseal and intra-articular fractures are not respected, complications such as valgus deformity, decreased range of motion and interphalangeal joint (IPJ) osteoarthritis can lead to significant functional loss. [8][9][10] The objective of our review is to describe the surgical treatment of fractures that involve the hallux interphalangeal joint, current indications and management options.…”

Section: Introductionmentioning

confidence: 99%

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Hallux Proximal Phalanx Fracture in Adults: An Overlooked Diagnosis

et al. 2020

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Objectives: To describe the surgical treatment of fractures that involves the hallux interphalangeal joint, current indications and management options. Methods: we performed a literature review of relevant clinical studies in multiple databases, including PubMed, MedLine and Scopus, from January 1989 to October 2020. Results: There is consensus for surgical treatment of intra-articular fractures with a deviation greater than 2 mm, metadiaphyseal fractures with malrotation and/or malangulation, open fractures and unstable fractures. Conclusion: The use of more rigid implants allow alignment maintenance during healing process and lower risk of reduction loss. Valgus deformity and interphalangeal joint osteoarthritis are possible complications that must be avoided. Level of Evidence III, Systematic review of Level III studies.

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Section: Surgical Treatment Indications Approaches and Fixation Optionsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Hallux Interphalangeal Joint Osteoarthritismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hallux Proximal Phalanx Fracture in Adults: An Overlooked Diagnosis

et al. 2020

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Surgical Treatment of Pediatric Intra-Articular Proximal Phalangeal Head Fracture of the Big Toe

et al. 2020

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Pediatric intra-articularproximal phalangeal head fractures of the big toe are very rare and few studies on this have been published. The purpose of this study is to present the diagnostic approach and surgical management of these extremely rare fractures, which might be easily underestimated or misdiagnosed. Materials and Methods:The study retrospectively reviewed all the patients who were diagnosed as intraarticular proximal phalangeal head fracture of the big toe and who underwent surgical intervention in our institution. The size of the bony fragment and hallux valgus interphalangeus angle were measured on the preoperative X-rays. The size and rotation of the osteochondral fragment, the presence of avascular necrosis, ligamentous injury and soft tissue entrapment were assessed on the preoperative magnetic resonance images (MRIs). The radiologic and functional evaluation were performed at 1 year postoperatively. Results:The average size of the bony fragments measured on the X-rays was 4.1 mm in width and 2.3 mm in length. Two cases showed hallux valgus interphalangeus. Preoperative MRI was performed in four cases and the average size of any osteochondral lesion was 5.3 mm in width, 3.9 mm in length, and 4.7 mm in height. Rotation of the osteochondral fragment was observed in one patient, and soft tissue entrapment was noted in two patients. Postoperatively, successful bony union was achieved in all the patients and the average time to union was 74.4 days. Conclusion:Intra-articular proximal phalangeal head fractures of the big toe are very rare and often neglected due to incomplete ossification in the pediatric population. It is important to suspect the presence of this intra-articular fracture and to appropriately implement further evaluation. Nonunion of chronic cases as well as acute fractures can be successfully treated through open reduction and internal fixation using multiple K-wires.

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Delayed Correction of Intra-articular Lateral Head Fracture of the Proximal Phalanx of the Great Toe in Children

Kim,

Cho,

Kim

2024

Clin Orthop Surg

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Backgroud Conservative treatment of intra-articular lateral head fracture of the proximal phalanx (LHFPP) of the great toe in young children has a high rate of nonunion, leading to hallux valgus interphalangeus (HVIP). This study presents a case series of surgically managed, late-diagnosed LHFPP, highlighting the difficulties of the surgery and presenting satisfactory results. Methods Nine unilateral cases (8 late-diagnosed and 1 acute) were treated by open reduction and Kirchner wire fixation. The average time from trauma to surgery was 2.9 years (range, 0.5–10.1 years) in our late-diagnosed cases. The average age at the time of operation was 9.2 years (range, 3.4–16.3 years). The causes of injury were various. Intraoperative findings were reviewed through medical records and photographs. Pre- and postoperative HVIP angle, American Orthopedic Foot and Ankle Society (AOFAS) score, and range of motion of the interphalangeal joint were measured and compared statistically. Results Progressive HVIP was a chief complaint in all 8 late-diagnosed cases. Bony fragment size depended on the time elapsed after trauma (fragments increased in size due to ossification of cartilage) with a mean of 23.5% articular involvement. Four cases required bone graft, and union was achieved in all cases. The mean HVIP angle improved from a mean of 17.8° to 10.5°. The average AOFAS score and range of motion were significantly improved after surgery. Conclusions Although LHFPP is rare and difficult to diagnose, even cases detected long after the initial trauma can be successfully treated, albeit with difficulty. All 9 of our patients had successful outcomes when treated by open reduction and internal fixation.

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Intra-articular fracture of proximal phalanx of great toe accompanied by valgus deformity associated with sports activities

Abstract: Hallux valgus was mostly found on the fracture of the medial side of the proximal phalanx base, while hallux valgus interphalangeus was mostly found on the fracture of the lateral side of the proximal phalanx head.

Cited by 4 publications

References 12 publications

Hallux Proximal Phalanx Fracture in Adults: An Overlooked Diagnosis

Hallux Proximal Phalanx Fracture in Adults: An Overlooked Diagnosis

Surgical Treatment of Pediatric Intra-Articular Proximal Phalangeal Head Fracture of the Big Toe

Delayed Correction of Intra-articular Lateral Head Fracture of the Proximal Phalanx of the Great Toe in Children

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