Open Sesamoid: Medial Forefoot Pain In A Soccer Player - Page #4
 

Working Diagnosis:
Displaced Tibial Sesamoid Fracture

Treatment:
Open reduction and internal fixation of the sesamoid with one 2mm Case Photo #4 screw was done at approximately 2 weeks after injury.

Outcome:
At four months post-op, the patient was able to run without pain. Case Photo #3

Editor's Comments:
Sesamoid fractures are notorious for non-union. Nuclear studies are helpful in differentiating between bipartite sesamoids and acute fracture. Non-operative treatment consists of 6 weeks in a non-weight-bearing cast that extends to the distal tip of the toe to prevent dorsiflexion. Due to the high incidence of delayed union, non-union, and recurrence, early surgical intervention is indicated for patients involved with high intensity activities such as soccer. Other potential causes to consider may be gout or Lyme's disease if there is joint swelling and corresponding effusion.

References:
Boden BP and Osbahr DC. High Risk Stress Fractures: Evaluation and Treatment. J Am Acad Orthop Surg. 2000; 8:344-353.

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NOTE: For more information, please contact the AMSSM, 11639 Earnshaw, Overland Park, KS 66210, (913) 327-1415.
 

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