Bilateral sacroiliac fracture-dislocation

Abstract

A 16-year-old presented to the accident and emergency department, having crushed his left great toe with a heavy cannon ball. External appearance was typical of a crushed toe with swelling, tenderness and bruising. Passive movements of the interphalangeal joint were very painful. Radiographs of the great toe showed an accessory sesamoid bone dislocated into the interphalangeal joint (Figure I). Radiographs of the opposite toe revealed a similar accessory bone at the head of the proximal phalanx of the great toe (Figure 2). Under ring block, manipulation was undertaken by holding the toe at the base and manipulating the distal phalanx. Closed reduction was successful, and radiographs after manipulation showed satisfactory reduction of the interphalangeal joint (Figure 3). A boot plaster was applied for 3 weeks. Recovery was uneventful. Intra-articular sesamoid dislocation is a rare injury and may lead to difficulty in reduction and diagnosis. Sesamoid injuries have been reported in the index metacarpophalangeal joint (Sweterlitsch et al., 1969) and in the first metatarsophalangeal joint (Deluca and Kenmore, 1975), both of which needed open reduction. Diagnosis in adolescents may cause problems, as it could be mistaken for an epiphyseal injury (Figure I). The interphalangeal sesamoid of the hallux is only present in approximately 13 per cent of the population (Burrnan and Lapidus, 1931; Jahss, 1981). Bamett et al. (1979) reported a similar case, but their efforts at closed manipulation were unsuccessful and open reduction was very difficult, necessitating excision of the sesamoid. Dislocation of a sesamoid bone into the interphalangeal joint of a great toe without fracture is unusual. Although surgery may be required for these cases, we would recommend closed reduction in the first instance.