Irreducible Lateral Proximal Interphalangeal Joint Dislocation of the Fifth Toe in a Two-Year-Old Child: A Case...

Proximal interphalangeal (PIP) joint dislocations of the lesser toes are uncommon injuries, particularly in the pediatric population. Irreducible dislocations, where closed reduction fails due to interposed soft tissue, present a unique diagnostic and therapeutic challenge. We report a rare case of an irreducible lateral PIP joint dislocation of the fifth toe in a two-year-old child with a six-year follow-up. The child presented with blunt trauma to the right foot resulting from an abduction force to the fourth and fifth toes. Radiographs revealed a lateral dislocation of the right fifth toe PIP joint with an associated valgus angulated fracture of the proximal phalanx. Closed reduction failed in the emergency department. Open reduction under general anesthesia via a dorsal midline incision revealed the medial collateral ligament avulsed and interposed within the joint space, acting as a mechanical block. The ligament was removed, the joint reduced, and transarticular Kirschner wire (K-wire) fixation (1.6 mm) was performed. The K-wire was removed at three weeks. At six-year follow-up, clinical evaluation revealed no angular deformity, shortening, or scar tethering, with full range of motion and participation in age-appropriate activities. This case highlights that prompt open reduction, removal of interposed soft tissue, and temporary K-wire fixation can yield excellent long-term functional and cosmetic outcomes. Early recognition and timely surgery are essential in pediatric irreducible PIP joint dislocations to prevent chronic deformity.