Department of Orthopaedic Surgery, Altnagelvin Hospital, Londonderry, Northern Ireland, U.K.
Department of Orthopaedic Surgery, Al-Kindi Specialised Hospital, Manama, Bahrain.
JBJS Case Connect. 2020 Dec 24;10(4):e20.00388. doi: 10.2106/JBJS.CC.20.00388.
A 22-year-old man sustained closed dislocation of the hallucal interphalangeal joint (HIPJ). Painful limitation of movements persisted 2 months after closed reduction. Magnetic resonance imaging revealed dislocation of the hallucal interphalangeal joint sesamoid (HIPJS) from its intra-articular attachment on the superior surface of the plantar plate to an extra-articular subcutaneous location, plantar and lateral to the flexor hallucis longus tendon. The HIPJS was enucleated through a plantar approach, and the foot remains pain-free 18 months later.
This case represents an unusual combination of HIPJ dislocation and extra-articular dislocation of its sesamoid. Raised awareness of the HIPJS, its normal anatomical location, and configuration will avoid delayed diagnosis.
一名 22 岁男性发生踇趾近节趾间关节（HIPJ）闭合性脱位。闭合复位后 2 个月，仍持续存在疼痛性活动受限。磁共振成像显示，HIPJ 籽骨从跖板上表面的关节内附着处脱位至位于踇长屈肌腱的足底和外侧的关节外皮下位置。通过足底入路切除 HIPJS，18 个月后足部仍无痛。
本例为 HIPJ 脱位和籽骨关节外脱位的罕见组合。提高对 HIPJS 的认识，包括其正常解剖位置和形态，将避免延迟诊断。
