Irreducible Dislocation of the Great Toe Interphalangeal Joint, Dorsal, and Plantar. Management and Long-term Evolution.

Introduction: Irreducible dislocation of the great toe interphalangeal (IP) joint is a rare injury that has scarcely been reported in dorsal direction, but no reported in plantar direction. Closed reduction usually leads to sesamoid incarceration, making the reduction impossible. The purpose of this article is to review the management of irreducible IP dislocation of the great toe presenting three new patients who cover several forms: Open and closed dorsal Miki Type 2 dislocation and one chronic neglected plantar dislocation. Case Report: These three new cases demonstrate different presentations of IP (adolescents or young adults, open or closed, acute or chronic, dorsal, and plantar). Usually, Miki's Type I is the result of a failed IP dorsal Miki's 2 dislocation reduction. Closed reduction without traction is not usually sufficient, thus percutaneous reduction with K-wire fixation or open reduction should be employed. Open reduction was required in these cases. A Kirschner wire was used to for temporal immobilization in two of the cases and a buddy strapping securing to the second toe for 3 weeks in the three cases. Conclusion: In dorsal dislocations the reduction must be performed without axial traction and only by pressure in the base of the phalanx. Secondary to the trial of orthopedic reduction or spontaneously, incarceration of the sesamoids bones is the rule (Miki 1). In this situation, percutaneous or open reduction must be performed. Plantar dislocation does not provoque intra-articular sesamoid interposition. This article describes the first reported case of neglected plantar dislocation that required open reduction, similar management adding that the long-term functional prognosis is good.

Infantile Hemangioma and Cardiac Defects: a Puzzling Association. A Single-center Experience.

Objectives: to evaluate clinical chart of patients with IH who had cardiologic evaluation before propranolol therapy and to compare our findings with literature data. Introduction: Some studies have assessed the incidence of heart defects in children suffering from infantile hemangioma (IH) treated with propranolol, showing a possible higher prevalence of cardiac abnormalities in this group of patients. Methods: We retrospectively reviewed clinical charts of children with infantile hemangiomas referred to our dermatologic division from 2016 to 2021, who underwent our pediatric cardiology protocol screening before starting propranolol therapy. Results: A total of 60 infants were enrolled. Electrocardiograms were available for all the patients and echocardiography for 50/60 (83.3%) children. Electrocardiogram didn't reveal any alterations in most cases (pathologic in 2/60 ones, 3.3%) while echocardiograms revealed findings in 31/50 (51.7%) patients. Of these, persistent foramenovale, which was found in 14/50 patients (28%), was considered as non-pathologic. Interatrial septal defects were the main pathological finding in 15/50 patients (30%), as single defect or in association with other abnormalities. Conclusions: Our study confirms the presence of a higher rate of cardiologic findings in patients with infantile hemangioma evaluated before starting oral propranolol, compared to the known rate of those defects in healthy newborns. We also confirm that interatrial septal defects are the most frequent pathologic finding with a higher prevalence compared to published studies. Large prospective studies are needed to clarify a possible association of pathological cardiac findings in all patients with infantile hemangiomas and thereafter to evaluate the possible effect of propranolol therapy on these defects during time.

Simultaneous Ipsilateral Dislocation of the Hip and the Knee: A Case Report.

CASE: A patient was struck by an agricultural vehicle and sustained ipsilateral hip and knee dislocations. Closed reduction of the hip was accomplished in the emergency department; the patient required general anesthesia in the operating room to reduce the knee dislocation. Nonoperative treatment was used for both injuries, with a good long-term outcome. CONCLUSION: Simultaneous ipsilateral hip and knee dislocations are rare and complex injuries that usually result from high-energy trauma. In order to avoid severe neurovascular complications, they need prompt management. Nonoperative treatment followed by an intensive rehabilitation program should be considered as an alternative treatment to surgery in older patients with a low-demand lifestyle.