Mansoor Ahmed
Plantar plate - fibrocartilagenous thickening of the plantar aspect of the fibrous capsule. Sesamoids divide the plantar plate into the phalangeal-sesamoid ligaments, metatarsal-sesamoid ligaments, and the intersesamoid ligaments. Loose attachment to the metatarsal neck, and a strong attachment to the metatarsal head.
Collateral ligaments - tubercle on the metatarsal head to the tubercles of the proximal phalanx base, medial and lateral.
Metatarsophalangeal suspensory ligaments - tubercle on the metatarsal head to the sides of the plantar plate, medial and lateral.
The tendons give fibers that mix with the capsule, and this further strengthens and reinforces the fibrous capsule. The fibrous capsule and tendon fibers are really just one continuous structure, working as a unit to stabilize the joint.
Mechanism of Injury - hyperextension of the MTPJ
Type 1 - rupture of the proximal attachment of the plantar plate. Sesamoids are drawn distal and dorsal relative to the metatarsal head, proximal phalanx dorsiflexes, and there is reciprocal plantarflexion of the metatarsal head. The tendons become taut, holding the metatarsal head in place, thereby requiring open reduction.
Type 2 - continuation of type 1, with rupture of intersesamoid ligament
2A - increase in the space between the sesamoids, they remain relatively apposed, or in alignment
2B - avulsion fracture of tibial or fibular sesamoid
Note, it is possible to have a 2B without a 2A. 2B does not necessarily require 2A.
2C - combination of 2A and 2B
Type 3 - Dislocation of only the proximal phalanx, with proximal retraction of the sesamoids
Негізгі бет Jahss 1st MTP Dislocation - Anatomy and Biomechanics
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