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Midbody fracture of the proximal sesamoid bone - screw fixation

Screw insertion

Standard lag technique is applied. Intraoperative diagnostic imaging is strongly encouraged to determine when the glide hole reaches the fracture plane and to prevent inadvertent overdrilling of part of the proximal fragment, which would result in a weakened fixation. It is critical not to lose contact with the drill hole when the drill guides are changed. Therefore a K-wire is used to fill the hole once the large drill is removed and to facilitate placement of the small drill guide in the glide hole.

Countersinking is not recommended because the screw head comes to lie in the natural concavity located at the base of the proximal sesamoid bone and origin of the different distal sesamoidean ligaments in the area.