Traumatic Fifth Toe Proximal Interphalangeal Joint Dislocation in a Pediatric Patient: Management with Open Reduction Internal Fixation and Kirschner Wire Fixation

Traumatic dislocations of the proximal interphalangeal joint (PIPJ) of the lesser toes are rare injuries in the pediatric population, with limited literature available to guide management decisions. We report the case of a 5-year-old male who presented with irreducible dorsolateral dislocation of the right fifth toe PIPJ following trauma during play activities. Clinical examination revealed swelling, tenderness, and restricted movement of the affected digit. Plain radiographs confirmed the dislocation without associated fractures. Initial attempts at closed reduction under procedural sedation were unsuccessful, leading to the decision for surgical intervention. The patient underwent open reduction and internal fixation under general anesthesia. A dorsal longitudinal incision was made over the affected joint, revealing soft tissue interposition preventing reduction. The interposed tissue was carefully removed, anatomical reduction achieved, and joint stability maintained with Kirschner wire (K-wire) fixation. Postoperative management included appropriate analgesia, antibiotic prophylaxis, and immobilization. Regular follow-up demonstrated satisfactory healing without complications. This case demonstrates that irreducible pediatric toe PIPJ dislocations can be successfully managed with open reduction and K-wire fixation when closed reduction fails. Early recognition and appropriate surgical intervention are crucial for optimal outcomes. The rarity of these injuries necessitates high clinical suspicion and prompt specialist consultation to prevent potential complications and ensure proper treatment.