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PubMed1997

Pseudomonas osteomyelitis of the metatarsal sesamoid bones.

It is unusual for osteomyelitis of the sesamoid bones to occur after a puncture wound to the foot. When the puncture occurs through tennis shoes, the risk of Pseudomonas infection is increased. Pseudomonas was the causative organism in 7 of 22 cases reported in the literature. This report will explore the causes and natural history, as well as the treatment, of these infections. Initially, basic wound care principles should be adhered to when treating these wounds. Patient awareness and close follow-up is important to ensure complete healing. Treatment of this case involved intravenous antibiotics and medial sesamoidectomy. Foot deformities can occur with sesamoid osteomyelitis and sesamoid excision. Hallux valgus deformity was noted to occur with the osteomyelitis and worsen with sesamoid excision. Preservation of surrounding structures during excision is important to prevent deformity.

Adolescent↗
PubMed2006

Fungal osteomyelitis of the axial border of the proximal sesamoid bones in a horse.

CASE DESCRIPTION: A 12-year-old Standardbred gelding was referred for swelling of the right metacarpophalangeal joint. CLINICAL FINDINGS: Ultrasonography of the right metacarpal area revealed hypoechoic areas in the right digital sheath and metacarpophalangeal joint consistent with synovial effusion. Radiography of the right metacarpophalangeal joint revealed lysis of the axial border of the proximal sesamoid bones. Aspergillus fumigatus was detected on fungal culture of synovial fluid. TREATMENT AND OUTCOME: Regional limb perfusion (150 mg of amikacin in 60 mL of saline [0.9% NaCl] solution perfused for 30 minutes) was performed 2 and 4 days after admission. Itraconazole (5 mg/kg [2.27 mg/lb], PO, q 24 h) was administered for approximately 9 weeks. Joint lavage with amikacin (500 mg) in 1 L of saline solution was performed 4 times. Three months after discharge, the owner reported that the horse was mildly lame during trotting but was moving freely and comfortably during all gaits and had gained a considerable amount of weight. Because the osteoarthritis was not expected to improve and because it was recommended that the horse not return to purposeful exercise, the owner decided to retire the horse from racing. CLINICAL RELEVANCE: Various diagnostic imaging methods and fungal cultures are useful for diagnosing fungal osteomyelitis of the axial borders of the proximal sesamoid bones in horses. Fungal osteomyelitis of the sesamoid bones and erosive arthritis should be considered as a differential diagnosis for horses in which corticosteroids have been administered intra-articularly.

Animals↗
PubMed2007

Incidence and ossification of sesamoid bones in the hands and feet: a radiographic study in an Arab population.

The incidence and ossification of sesamoid bones in the hands and feet were studied in 922 radiographs (400 hands and 522 feet) in an Arab population from Bahrain, 5-83 years of age and consisting of 549 adults (393 men and 156 women) and 373 children (286 boys and 97 girls). All radiographs of the hand and foot in the adult population showed two sesamoid bones in the thumb metacarpophalangeal (MCP) joint and in the hallucal metatarsophalangeal (MTP) joint, respectively. Only 2.3% and 1.5% of hands showed sesamoids at the MCP joints of the middle and ring fingers respectively compared to a reported incidence of 7.1% for each digit in Caucasians. The incidence of sesamoids in the MTP joints of third and fourth toes (0.6% each) and inferior to the hallucal interphalangeal joint (3.1%) is probably the lowest reported so far in the literature. In the hands, ossification commenced first in the thumb sesamoids, at the age of 10 years in females and 11 years in males and was completed by the age of 13 and 14 years, respectively. In the feet, ossification began first in the hallucal sesamoids at the age of 8 years in females and 9 years in males and was completed by the age of 10 years in both sexes. The incidence and ossification of sesamoids in the hands and feet in the Arab population from Bahrain seem to differ considerably from reports in other populations. The clinical significance of our findings is discussed.

Adolescent↗
PubMed1992

Brief communication: the popliteal sesamoid bone (cyamella) in primates.

A study of 246 adult nonhuman primates belonging to 34 genera indicates that a popliteal sesamoid bone is always present in the tendon of the popliteus muscle in Prosimii and Callitrichidae. The bone occurs only variably in Atelidae and Pongo, and is usually absent in Gorilla. The bone is absent, or very rare, in Cebus, Cercopithecidae, Hylobatidae, Pan, and humans. When the bone is present, it articulates with the posterior part of the articular surface of the lateral condyle of the tibia, and lies very close to the head of the fibula, at the angulated part of the popliteal tendon, near the tendomuscular junction. The presence of the popliteal sesamoid bone in primates is a primitive character.

Animals↗
PubMed2003

Interphalangeal sesamoid bones of the great toe: an anatomic variant demanding careful scrutiny of radiographs.

We describe a patient who was found to have two sesamoid bones at the interphalangeal joint of the right great toe after radiographs for dislocation of the joint. Recognition of the sesamoids required careful scrutiny of the films. Interphalangeal sesamoids may cause painful callosities plantar to the joint or may become incarcerated in a dislocated joint. Our patient made a good recovery. The presence of sesamoid bones on the medial and lateral sides of the joint was unusual.

Adult↗
PubMed1987

Fracture of the thumb sesamoid bones.

Two cases of sesamoid fracture of the thumb are reported. The condition is presumably underdiagnosed because of incomplete ossification of the bone. If pain persists after immobilization, excision of the bone is curative.

Adolescent↗
PubMed1995

Bipartite distal sesamoid bones in a Holstein-Friesian calf.

Bipartite distal sesamoid bones were observed in the medial digits of both forelimbs of a six-month-old Holstein-Friesian calf. This paper describes the clinical and radiological (including computed tomographic) findings, and the therapy and follow-up of the case.

Animals↗
PubMed1991

Quantitative evaluation of the remodeling response of the proximal sesamoid bones to training-related stimuli in Thoroughbreds.

Eight untrained 2-year-old Thoroughbred horses were used in a study of the remodeling response of the proximal sesamoid bone (PSB) to training-related stimuli. Two horses each were assigned to 1 of 4 groups: group 1, untrained, pasture turnout (control); group 2, modified-classically trained, dirt track; group 3, classically trained, dirt track; and group 4, classically trained, wood chip track. Horses were given fluorochromic bone labels every 28 days during training. All horses were euthanatized after 5 months of training, and the proximal sesamoid bones (PSB) were removed. A midsagittal section of bone 85- to 95-microns thick was prepared for histomorphometric analysis by use of computerized image analysis and epifluorescent microscopy. Porosity (percent), trabecular width (micrometer), extent of anisotropy (percent), mineralizing surface (percent), fractional mineralizing surface (percent), and mineral apposition rate (micrometers per day) were determined at 5 circular regions of each specimen. Region 1 was located within the apex of the PSB, regions 2, 3, and 4 were subjacent to the subchondral plate, and region 5 was within the basilar articular margin. Data were pooled to allow comparison by training group and by region. The PSB from horses trained on dirt tracks (groups 2 and 3) had significantly (P less than 0.05) lower porosities and greater trabecular width, compared with the control group. The PSB from all training group specimens had significantly larger mineralizing surfaces than control group specimens. The fractional mineralizing surface revealed a rapid and vigorous response of the endosteal surface of the PSB in horses trained on dirt tracks.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Fractures of the sesamoid bones of the thumb.

Stability of the thumb metacarpophalangeal joint is provided by the collateral ligament proper, the accessory collateral ligament, the proximal and distal palmar ligaments, and the palmar plate. The adductor pollicis and flexor pollicis brevis muscles also provide soft tissue support and insert on the proximal phalanx of the thumb by way of the sesamoid bones. Fractures of the metacarpophalangeal joint sesamoid bones are uncommon but are often associated with sporting injuries during which the joint is acutely hyperextended. Routine anteroposterior and lateral radiographs may be unremarkable, and oblique views are often necessary to document the fracture. We report eight cases of fracture of the thumb metacarpophalangeal joint sesamoid. Seven were isolated sesamoid fractures, and one was associated with a metacarpophalangeal joint dislocation. None of the fractures were evident on anteroposterior radiographs, but all were seen in the oblique projection. Six fractures were treated with splint or cast immobilization for 2 to 3 weeks, and two were taped. Clinical followup of the seven patients with isolated sesamoid fracture at 6 to 8 weeks revealed pain-free normal function. One patient could not be reached for followup.

Adult↗
PubMedDate not supplied

An in vitro biomechanical comparison of two fixation methods for transverse osteotomies of the medial proximal forelimb sesamoid bones in horses.

OBJECTIVE: This study compared the mechanical properties of the normal intact suspensory apparatus and two methods of fixation for repair of transverse, midbody fractures of the proximal sesamoid bones of adult horses: transfixation wiring (TW) and screws placed in lag fashion (LS). STUDY DESIGN: An in vitro, paired study using equine cadaver limbs mounted in a loading apparatus was used to test the mechanical properties of TW and LS. ANIMAL OR SAMPLE POPULATION: Seventeen paired (13 repaired, 4 normal) equine cadaver limbs consisting of the suspensory apparatus third metacarpal bone, and first and second phalanges. METHOD: The two methods of repair and normal intact specimens were evaluated in single cycle-to-failure loading. Yield failure was defined to occur at the first notable discontinuity (>50 N) in the load-displacement curve, the first visible failure as evident on the videotape, or a change in the slope of the moment-fetlock angle curve. Ultimate failure was defined to occur at the highest load resisted by the specimen. Corresponding resultant force and force per kg of body weight on the suspensory apparatus, fetlock joint moment, and angle of fetlock dorsiflexion were calculated by use of specimen dimensions and applied load. These were compared along with specimen stiffness, and ram displacement. RESULTS: Load on the suspensory apparatus, load on the suspensory apparatus per kg of body weight, moment, applied load, and angle of fetlock dorsiflexion at yield failure were significantly greater for the TW-repaired than for the LS-repaired specimens. A 3 to 5 mm gap was observed before yield failure in most TW-repaired osteotomies. CONCLUSIONS: Transfixation wiring provided greater strength to yield failure than screws placed in lag fashion in single cycle load-to-failure mechanical testing of repaired transverse osteotomized specimens of the medial proximal forelimb sesamoid bone.

Animals↗
PubMed2004

[A long-distance runner with a painful sesamoid bone in the forefoot].

A 38-year-old long-distance runner presented with pain in the left medial forefoot. In the presence of such symptoms, consideration should be given to a disease of or injury to a sesamoid bone. Radiology revealed a fracture line through the medial sesamoid bone under the first metatarsophalangeal joint. Conservative treatment was initially ineffective. Ultimately, local injections of lidocaine-methylprednisolone at the site of the pain, in the metatarsophalangeal joint and in the fracture line brought relief. In the diagnosis of patients with pain in the medial forefoot, apart from the patient's history and a physical examination, a skyline X-ray can be helpful to reveal a fractured or bipartite sesamoid. Almost all conditions affecting the sesamoids improve in the long run with conservative treatment. Besides reduction of weight-bearing pressure on the affected sesamoid, NSAIDs and ice massage, special attention should be paid to the foot (postural deformities), the shoe (inlays, sesamoid pad, shock absorption, stiff sole) and running on a soft surface. Insufficient therapeutic results may be due to osteonecrosis or non-union. These and persistent pain may, as a last resort, require surgical intervention such as screw fixation in case of a fracture or sesamoidectomy.

Adult↗
PubMed1982

[Critical analysis of the diagnostic value of the first sesamoid bone of the thumb as an indicator of bone development in puberty].

Although the appearance of the first sesamoid of the thumb has been widely reported as being a good indicator of puberty, it should be noted that this finding has only been confirmed in cross-sectional studies. When trying to determine this relationship through a longitudinal study, we see that, although the correlation indices come within the limits of statistical significance, the wide range of variability in appearance reduces its practical usefulness. The sesamoid bone normally appears during puberty but neither the initial moment of this occurrence nor the exact stage of the child's development at that time can be assessed.

Adolescent↗
PubMed1992

Excision of the distal sesamoid bone for treatment of infection of the digit in a heifer.

An 8-month-old Holstein heifer was evaluated for right hind limb lameness of 3 weeks' duration. Diagnoses were osteomyelitis and fracture of the distal sesamoid bone, septic arthritis of the distal interphalangeal joint, and osteomyelitis of the third phalanx. After excision of a section of tissue from the plantar aspect of the digit and partial section of the deep digital flexor tendon, the distal sesamoid bone was excised. The third phalanx was curetted, and the surgical wound was lavaged. Twenty months after surgery, the heifer was fully weightbearing on the affected digit. Surgical exploration of the digit should be considered an alternative to claw amputation in cattle that have severe digital infections.

Animals↗