Executive Editor: Jörg Auer

Authors: Patricia Hogan

Phalanges Proximal sesamoid bones, Comminuted

back to skeleton

Glossary

Nonsurgical management
Main indication Skill Equipment
Regain use of the limb Basic surgical experience, no specialized skills Basic equipment only
Comminuted fractures of the proximal sesamoid bone

Management of uniaxial comminuted fractures of the proximal sesamoid bone depends on the degree of comminution.
The presence of one or two small fragments (see 1 & 4 figure left), which can be removed not jeopardizing stable anatomic reduction, allows the repair by means of internal fixation.
In nearly all uniaxial, comminuted fractures of the proximal sesamoid bone, internal fixation is not recommended and conservative treatment is indicated. Depending on the degree of comminution, development of some degree of osteoarthritis of the fetlock joint is to be expected.

Legend:
1: apical fragment; 2: parent bone; 3: split small basilar fragments; 4: tiny fragment within tendon sheeth or calcifications of DDFT; 5: intact lateral proximal sesamoid bone;

The marked fragment displacement is indicative for a ruptured intersesamoidean ligament (see below same horse).

Comminuted fractures of the proximal sesamoid bone

The presence of a ruptured intersesamoidean ligament (white arrows) and marked displacement of the fragments dictates either a metacarpo/tarso-phalangeal arthrodesis or immediate humane destruction of the patient. The basilar fragment is split (yellow arrow).

Comminuted fractures of the proximal sesamoid bone

The combination of a displaced lateral condylar fracture with a vertical oblique proximal sesamoid fracture and an additional small apical fragment off the medial fragment also prevents a successful return of the patient to the track.
The medial fragment is still attached to the medial proximal sesamoid bone (red arrow) by means of the intact intersesamoidean ligament. The lateral major fragment is however detached and markedly displaced.
This patient should be treated with a metacarpophalangeal arthrodesis or immediate humane destruction. Conservative management is not an option.

*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