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28 Jul 2025
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Open Great Toe Proximal Phalanx Fracture Dislocation with Blade Plate Fixation.

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Clinical Details

Clinical and radiological findings:  A 47-year-old male presented with an open fracture dislocation of the proximal phalanx of the great toe following a direct impact from a falling rock. The injury was characterized by significant soft tissue disruption, providing extensive exposure of the fracture site. Neurovascular examination details were not provided.

Preoperative Plan

Planning remarks:  The preoperative plan involved direct open reduction and internal fixation of the proximal phalanx fracture dislocation. Given the open nature of the injury, no additional incisions were necessary for exposure.

Surgical Discussion

Patient positioning:  Supine position with the affected foot elevated and prepared in a sterile field.

Anatomical surgical approach:  Direct approach to the great toe through the existing open wound, with careful debridement of devitalized tissue and irrigation. The fracture was reduced, and fixation was achieved using a blade plate.

Operative remarks: 

The surgeon noted the exceptional exposure due to the open nature of the injury, which facilitated direct visualization and manipulation of the fracture fragments. Concerns were raised regarding the viability of the toe due to the extent of soft tissue injury.

Postoperative protocol:   Postoperative protocol included immobilization in a protective splint with non-weight bearing status for 6 weeks, followed by gradual weight-bearing as tolerated.

Follow up:   Not specified.

Orthopaedic implants used:   Blade plate for internal fixation.

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