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1Principles

Midbody fracture of the proximal sesamoid bone - screw fixation

Number of screws

The proximal sesamoid bone has a relatively small pyramidal shape that leaves little room for error with screw placement. Insertion of two screws would be ideal to increase the stability of the fixation and counteract torsional forces upon the fixation, but accurate placement requires significant skill and planning.
The author’s preference is a combination of a 4.5 mm and a 3.5 mm screw to optimize compression and counteract rotational forces within the space limitations of the bone.