Melody Stouder Class of 2014 Tuspm
Melody Stouder Class of 2014 Tuspm
Melody Stouder Class of 2014 Tuspm
Class of 2014
TUSPM
Anatomy
Mechanism
Classification
Clinically
Diagnostictools
Closed reduction
Open reduction
Cases
Intrinsics:Abductor hallucis, adductor hallucis, FHB, EHB
Extrinsics: FHL, EHL
Sesamoid apparatus: embedded
within fibrous plantar plate
Intersesamoidal
ligament(1)
Phalangeosesamoidal ligaments(2)
Metatarsosesamoidal ligaments(2)
(suspensory)
Collateral ligaments (2)
DTML
Sarrafian, S.K. Syndesmology, ch. 4. In Anatomy of the foot and Ankle, 2nd ed. pp/211-212, edited by D. Patterson, M.E.
Dickmeyer, and E.A. Durang, J.B. Lippincot and Co., Philadelphia, 1993.
High energy
Forced hyperextension of 1st MPJ
Axial loading of midfoot/rearfoot
(Brunet 1996)
Type I: hallux dislocates dorsally
Sesamoid complex is intact*
“buttonholing of the met head”
Usually irreducible
Jahss, MH. Classic article: foot & ankle 1: 15, 1980 traumatic dislocations of the first
metatarsophalangeal joint. Foot Ankle Int. 2006 Jun;27(6):401-6
Theory:type 1 requires open reduction
<20 reported in last 80 years
According to Brunet:
11 type 1 dislocations
5/11 cases closed reduced effectively
Type 2a:
dorsal dislocation and rupture of intersesamoidal ligament
Easier to reduce
Type 2b:
Dislocation of hallux with transverse fracture of a sesamoid
(ligament intact)
Type 2c=combo of A and B
Disruption of intersesamoidal ligament AND fracture of a
sesamoid
Type 3:
Sesamoids maintain anatomical
position
Intact plantar plate
Complete rupture of medial +
lateral phalangeal sesamoidal
ligaments
Hallux sits dorsally
Dimple sign medially
Edema, ecchymosis
Hyperextend proximal phalanx
Distract
(Killian 1997)
http://www.youtube.com/watch?v=mTaBd_8RkGY
According to Sikka et al: (F&A INT 2012)
Closed reduction with splinting and immobilization 3-4 weeks
Early, active + passive ROM after one week
FHB
Allows for pre-op planning by
providing adequate
visualization of damaged
anatomical structures
Indications:
Failed closed reduction*
Continued instability of 1st MPJ*
Interpositioned soft tissue
Ruptured plantar plate/tendons
(Sikka 2012)
Medial approach
Dorso-lateral
Sensitive
plantar scars
Sesamoid tenderness
Brunet 1996
29y/o male dislocated hallux
during martial art of jujitsu
Closed reduction failed
2b Jahss
anchored sutures
Capsule repaired with suture
Capsule/Intersesamoidal ligament
repaired
NWB 3 weeks
- 0.062” k wire
Summary
Attempt closed reduction
Successful Unsuccessful
Open Reduction