Recurrent lateral proximal interphalangeal joint dislocation of the fifth toe in adult-why and when to operate

Abstract

Recurrent lateral proximal interphalangeal (PIP) joint dislocation of the 5^th-toe is a rare injury and is debilitating unless the appropriate treatment is provided. We report the case of a 32-year-old woman who presented with a history of multiple dislocations of the PIP joint of right 5^th toe, over the past 10 years following trivial trauma, treated conservatively via strapping every time. This has eventually resulted in a painful, chronic, irreducible dislocation of the PIP joint of the fifth toe. The joint was accessed via a dorsal incision and it was found that the joint capsule and medial collateral ligament were interposed in the PIP joint space. The capsule and medial collateral ligament were reconstructed, and stabilized by a transarticular Kirschner wire for 6 weeks. The joint was found to be stable, anatomically-aligned and pain-free at the end of 12-months post-surgery. While PIP dislocations are generally managed conservatively via closed reduction and strapping, in certain cases this method fails due to soft tissue interposition in the affected joint. Such cases need to be managed surgically. This approach provides a good and functional outcome even in cases of long-standing injury.