Barefoot stubbing injuries to the great toe in children: a new classification by injury mechanism.

Abstract:

OBJECTIVE:This study was conducted to categorize barefoot stubbing injuries to the great toe in children by injury mechanism to differentiate benign stubbing injuries from more complex injuries necessitating surgery. DESIGN:Prospective clinical series of consecutively treated patients. SETTING:Tertiary university hospital setting. PATIENTS:Forty-one children who had sustained an indirect injury to the great toe during barefoot sports activities between January 2001 and December 2009 were included. INTERVENTION:Conservative or surgical treatment was done according to clinical and radiological findings. MAIN OUTCOME MEASUREMENT:Information regarding injury mechanism was collected from patients, parents, and coaches using skeletal models and assessed by a pediatric orthopedic surgeon. Mechanisms of injury were identified and grouped as follows: hyperabduction-flexion, hyperflexion, hyperabduction-extension, hyperextension, and hyperextension-adduction. RESULTS:Hyperabduction-flexion was the most common mechanism (n = 16), in which interphalangeal joint dislocation and skin disruption was noted in most cases. The second most common mechanism was hyperabduction-extension (n = 14) in which avulsion fracture of the lateral volar condyle of the proximal phalanx was noted in most cases. This avulsion fracture had the worst prognosis after conservative care. CONCLUSIONS:Based on these results, we have created a grading system and treatment protocol for indirect hallux sports injuries in children. Avulsion fracture of the lateral condyle of the proximal phalanx, a result of hyperabduction-extension, is a high-risk sign of nonunion and should be aggressively treated, contrary to previous guidelines. LEVEL OF EVIDENCE:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

journal_name

J Orthop Trauma

authors

Park DY,Han KJ,Han SH,Cho JH

doi

10.1097/BOT.0b013e31828e5d39

subject

Has Abstract

pub_date

2013-11-01 00:00:00

pages

651-5

issue

11

eissn

0890-5339

issn

1531-2291

journal_volume

27

pub_type

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