Davos Courses

Executive Editor: Jörg Auer

Authors: Patricia Hogan

Phalanges Proximal sesamoid bones, Apex

back to skeleton

Glossary

Fragment removal
Main indication Skill Equipment
Return to athletic function Highly experienced and skilled surgeon Full specialized surgical and imaging resources
 Apex fractures of the proximal sesamoid bone

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.

Apex fractures of the proximal sesamoid bone

Intraoperative arthroscopic view of the apex fracture shown above. The fracture is easily recognizable.

Apex fractures of the proximal sesamoid bone

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.

*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.3 2013-11-20