SLR - November 2013 - Jason Kayce
Injury on Hallux: A New Classification by Injury Mechanism
Reference: Park, DY, Han KJ, Han SH, Cho JH. Barefoot Sports Injury
on Hallux: A New Classification by Injury Mechanism. J Orthop Trauma. 2013 Feb 28 Epub.
Reviewed by: Jason Kayce, DPM
stubbing injuries to the hallux are relatively common in children, yet there is
limited information within the literature regarding this type of injury. This particular study categorizes barefoot
stubbing injuries to the great toe in children by injury mechanism, allowing
the practitioner to differentiate benign injuries from more complex trauma necessitating
prospective clinical series was established that involved 41 children under the
age of 17 who sustained an indirect injury to the hallux during barefoot
activities between January 2001 and December 2009. Inclusion criteria required both the patient
and all guardians present to recall the mechanism of injury utilizing a
skeletal foot model to reenact the incident.
Patients were excluded who were lost to follow-up or if a third person
had not directly observed the injury. A
combination of radiographic data and reported mechanism of injury were utilized
to create five different force vector categories: hyperabduction-flexion,
hyperflexion, hyperabduction-extension, hyperextension, and
hyperextension-adduction. Treatment was
implemented based on severity, mechanism, and fracture pattern. When applicable, basic principles of open
fracture management were met.
injuries were the most common (n=16). The majority of these cases displayed interphalangeal joint dislocation
and skin disruption. Hyperabduction-extension injuries were the second most common (n=14) in
which an avulsion fracture of the lateral volar condyle of the proximal phalanx
was commonly appreciated. This avulsion
fracture pattern had the worst prognosis after conservative care, as three
cases developed a non-union.
patients in the hyperabduction-flexion, hyperflexion, hyperextension, and
hyperextension-adduction groups were complication-free with AOFAS scores of 100
by eight weeks after treatment. Patients in
the hyperabduction-extension displayed mixed results.
Conclusions: This prospective study provides insight to the
podiatric physician in treating indirect hallux injuries among the pediatric
population. The avulsion fracture of the
lateral condyle of the proximal phalanx is a common sequela of a
hyperabduction-extension injury. This
avulsion fragment is at high risk of non-union and should be aggressively
treated, contrary to previous guidelines. Percutaneous reduction, open reduction and pinning, and removal of the
avulsion fragment are viable treatment options. Limitations within this study include the small sample size and the
inability to recreate the fracture patterns based on mechanism of injury within
a cadaveric model.