An eighteen-year-old male student fell from a height onto the left foot, hyperextending the great toe. There was swelling and tenderness with hyperextension of the distal phalanx and dimpling of the skin over the interphalangeal joint. Radiographs revealed a Miki1 type-II dislocation of the interphalangeal joint (Fig. 1-A) and an entrapped sesamoid.
Closed reduction, done with the patient under general anesthesia and with fluoroscopic guidance, was unsuccessful (Fig. 1-B), and percutaneous reduction of the incarcerated sesamoid was performed (Fig. 1-C). In view of perceived joint laxity, the joint was opened dorsally and the interphalangeal joint space was examined to confirm that no residual tissue was interposed between the phalanges. The incision was closed, and the joint was immobilized with a 1.25-mm Kirschner wire, which was removed at four weeks.
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