|Return to athletic function|
Apex fractures of the proximal sesamoid bone are not amenable to internal fixation and in most cases are best removed surgically under arthroscopic supervision.
In rare occasions, where displacement is minimal, possibly caused by an incomplete fracture, conservative management using pressure bandages and stall rest combined with some hand walking may lead to complete fracture healing.
Left: lateromedial radiographic view of a minimally displaced apex fracture.
Right: 3-month followu p lateromedial radiographic view of the same fracture. Fracture healing is progressing very nicely and the lameness has subsided.
Intraoperative arthroscopic view of the apex fracture shown above. The fracture is easily recognizable.
Intraoperative arthroscopic view of the same proximal sesamoid as shown above following apex fragment removal. The fracture surface of the parent bone is easily visible.
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|