Distal Phalanx Fracture of the Toe With Sesamoid Entrapment in the Interphalangeal Joint: A Case Report

Phalangeal fractures are common among foot injuries, with the majority amenable to conservative treatment. This case involved a fracture of the toe combined with intra-articular sesamoid entrapment. To prevent nonunion, surgical intervention was recommended. We present a rare case of distal phalanx fracture of the toe with interphalangeal joint sesamoid entrapment, review the intraoperative challenges encountered, and summarize postoperative insights with recommendations. We report a 41-year-old female construction worker who presented with a crush injury to her right great toe. Diagnosis was confirmed radiographically. She underwent closed reduction and internal fixation with Kirschner wire (K-wire) pinning. Follow-up examinations showed callus formation at 6 weeks, after which the K-wire was removed upon fracture healing. Sesamoid entrapment, where the sesamoid becomes lodged within the joint space, typically causes pain, swelling, and restricted motion and is clinically uncommon. Cases of distal phalangeal fractures of the toe complicated with sesamoid entrapment in the interphalangeal joint are rarely reported. There is no consensus on whether to remove the entrapped sesamoid. Preoperatively, we plan to perform an open excision of the sesamoid bone. Combined with the patient's preference and local soft tissue condition, open reduction would cause relatively large trauma to the soft tissues. After discussion, we decided to perform closed reduction of the fracture followed by fixation with a single 1.2-mm K-wire. However, intraoperatively, the entrapped sesamoid acted as a lever, preventing anatomical reduction. Given the lower reduction requirements for the distal phalanx, we proceeded with approximate reduction and K-wire fixation. Phalangeal fracture of the toe with interphalangeal joint sesamoid entrapment is rare. In cases requiring surgery, percutaneous K-wire fixation can achieve direct short-term efficacy, but it has long-term risks and limitations. Based on the practical difficulties encountered, we believe that open reduction combined with sesamoid excision is a better surgical option, providing patients with a more reliable long-term prognosis.