Executive Editor: Joseph Schatzker, Richard Buckley

Authors: Michael Castro, Richard Buckley, Andrew Sands, Christina Kabbash

Phalanges - 2nd-5th row, proximal phalanx, base, intraarticular T-type

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Glossary

1 Nonoperative treatment top

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Nonoperative treatment may involve manual reduction, buddy taping and hard-sole shoe until non-tender.

2 Closed reduction and K-wire fixation top

Principles

Surgical treatment involves percutaneous pinning across the MTP joint to maintain alignment and stability. In rare cases, open debridement of bone fragments from the joint prior to pinning is required.


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Manual traction and pinning

Manual traction is applied on the toe. A 1.25 mm or 1.6 mm K-wire is then placed into the tip of the toe just plantar to the nail, across the DIP and PIP joints, and reduced MTP joint.

Fluoroscopic assistance during this procedure is necessary.


Fixation following debridement

If debridement of bone fragments from the joint is required, a dorsal approach to the MTPJ may be utilized prior to pinning. Loose bodies are removed and the joint is irrigated.


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In this case, the double ended K-wire may be inserted retrograde into the proximal phalanx exiting the tip of the toe, and anterograde into the corresponding metatarsal head and shaft.

v2.0 2017-03-23