Avulsion fracture in distal phalanx of left great toe: a rar
The present case has been reported in the Journal of Current Surgery.

A 35-year-old man, who is a specialized general surgeon used to practice karate as a regular workout, felt that his left great toe was stuck with the griping mat and developed sudden severe pain in his left great toe with difficulty to move interphalangeal (IP) joint while practicing frequent and repeated karate front kick (mae giri).

After taking a rest the intensity of pain was reduced and he continued his practice and went home. The next day with nonsteroidal anti-inflammatory drug (NSAID) and cold compression he continued medical job, but could not practice karate. On the second day he had persistent pain and swelling and bruise around the IP joint of the left great toe. Then he consulted with an orthopedic surgeon with an X-ray film of the affected site which revealed avulsion fracture of distal phalanx due to pulling of extensor hallucis longus (EHL) tendon but no mallet deformity.

As the fracture involved the distal phalanx, it was difficult to stabilize with plaster. So, a mallet splint was applied and he was advised for movement restriction for 3 weeks. With the splint and rest, persistent pain was controlled.

Repeat X-ray of that foot after 4 weeks revealed a little gap between the fragments but possibly the bone piece was hooked with the joint capsule and soft tissue and no mallet deformity was noted. The surgeon could resume regular operation after 2 weeks and practice karate after the fourth week.


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