title: A Case of Simultaneous Traumatic Dorsal Dislocation of All Five Metatarsophalangeal Joints Treated Successfully With Closed Reduction.
abstract: Simultaneous dislocation of multiple metatarsophalangeal joints is a rare injury, because of the impediment presented by the anatomy of the lesser metatarsophalangeal joints. To the best of our knowledge, only 1 case of simultaneous dislocation of all 5 metatarsophalangeal joints has been previously reported in peer-reviewed studies. Owing to the same anatomic structures that obstruct relocation, closed reduction has been known to fail in a large proportion of cases. We report a case of simultaneous dorsal dislocation of all 5 metatarsophalangeal joints of the right foot after a motor vehicle accident. The highlight of our case was successful closed reduction after application of the reduction maneuver to all lesser metatarsophalangeal joints simultaneously in the second attempt with the patient under anesthesia. On confirming the stability of the reduction, the foot was immobilized in a short-leg, posterior slab cast for 3 weeks without placing Kirschner wires across the joints. At the 3-month follow-up evaluation, the patient had reacquired their preinjury level of activity with a good range of motion . At the 2-year follow-up evaluation, this range of motion was maintained with no radiologic evidence of arthrosis. We have inferred that the reduction was successful the second time because the maneuver freed the soft tissue structures from the contiguous impingement in the metatarsophalangeal joints by the exact reversal of the mode of injury using simultaneous application of the maneuver to all the lesser metatarsophalangeal joints. We encourage a trial of this modification of the closed reduction method in the emergency setting before proceeding to open reduction, because the results of closed reduction can be biologically rewarding without the risks associated with open surgical dissection.
authors.affiliation: Resident, Department of Orthopaedics, Government Kilpauk Medical College and Hospital, Chennai, India. Electronic address: bhide.pushkar@gmail.com.
authors.forename: Pushkar P
authors.initials: PP
authors.lastname: Bhide
authors.affiliation: Assistant Professor, Department of Orthopaedics, Government Kilpauk Medical College and Hospital, Chennai, India.
authors.forename: Chinnadurai
authors.initials: C
authors.lastname: Anantharaman
authors.affiliation: Assistant Professor, Department of Orthopaedics, Government Kilpauk Medical College and Hospital, Chennai, India.
authors.forename: Ganesan
authors.initials: G
authors.lastname: Mohan
authors.affiliation: Professor, Department of Orthopaedics, Government Kilpauk Medical College and Hospital, Chennai, India.
authors.forename: Karuppanna
authors.initials: K
authors.lastname: Raju
mesh_terms: D000063:Accidents, Traffic; D002370:Casts, Surgical; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008349:Manipulation, Orthopedic; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging / Q000293:injuries*; D008875:Middle Aged
keywords: closed reduction; forefoot; manipulation; pan-metatarsophalangeal; toe; trauma