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Injuries to the hallucal sesamoids in the athlete.

The sesamoids of the great toe, which are small and seemingly insignificant bones, can be the site of disabling pathology for the athlete. Sesamoiditis, osteochondritis, partite sesamoids with stress fractures, displaced fractures, and osteomyelitis have all been reported in the athlete. Bursitis beneath the tibial sesmoid and flexor hallucis brevis tendonitis also occur in the athlete and may be confused with sesamoid injury. Excision of the involved bone is the recommended treatment for displaced fractures and for less severe conditions such as sesamoiditis, osteochondritis, and nondisplaced fractures, if conservative management fails to relieve symptoms.

Adult↗

Which investigations are required in stress fracture of the great toe sesamoids?

For the athlete a stress fracture of the great toe sesamoid is an injury of fundamental significance. As radiographic findings and bone scintigraphy are not specific, these fractures have the longest delay between first symptoms and definitive diagnosis. Apart from magnetic resonance imaging, the only accurate investigation for early diagnosis is the longitudinal bone scan.

Adolescent↗

Tibial sesamoid planing for intractable plantar keratoses.

Partial tibial sesamoidectomy or sesamoid planing is an alternative to complete sesamoidectomy or nonoperative maintenance of a plantar keratosis. It can be performed through a very small incision and is a relatively uncomplicated, yet effective, procedure for relieving the effects of abnormal shearing forces from a prominent or malpositioned medial sesamoid. A retrospective study of 13 patients extending for 10 years representing 17 procedures was conducted.

Adult↗

Bone scanning of the foot for unexplained pain.

This paper reports the results of bone scans on 78 painful feet. Scanning helped in the diagnosis of persistent foot pain following injury and it enabled stress fractures, fractures of the sesamoids and subtalar arthritis to be diagnosed earlier. It reliably excluded bone infection and was useful as a screening test when radiographs were normal.

Adolescent↗

Hallucal sesamoid pain: causes and surgical treatment.

The hallucal sesamoids, although small and seemingly insignificant, play an important role in the function of the great toe by absorbing weight-bearing pressure, reducing friction, and protecting tendons. However, the functional complexity and anatomic location of these small bones make them vulnerable to injury from shear and loading forces. Injury to the hallucal sesamoids can cause incapacitating pain, which can be devastating to an athlete. Although traumatic injuries usually can be diagnosed easily, other pathologic conditions may be overlooked. Careful physical and radiologic examinations are necessary to determine the cause of pain and allow a recommendation of the optimal treatment. Surgical treatment may include partial or complete resection of the sesamoid, shaving of a prominent tibial sesamoid, or autogenous bone grafting for nonunion. Excision of both sesamoids should be avoided if possible.

Athletic Injuries↗

Stress fractures of the great toe sesamoids.

Stress fractures of the great toe sesamoids have not been previously confirmed as a clinical entity. In this report, we present four such cases, and document the diagnosis by histological sections. All of the patients had experienced the insidious onset of activity-related forefoot pain, and had radiographs that demonstrated a sesamoid fracture. None of the fractures healed with 6 weeks of immobilization and prolonged (4-6 months) inactivity. In all cases, the fractured sesamoid was excised, and the hematoxylin and eosin sections of the fracture segments documented the prefracture stress and incomplete repair characteristic of a stress fracture.

Adolescent↗

Disorders of the thumb sesamoids.

The subsesamoid joints of the thumb are a common site of arthritis, but their small size makes diagnosis of disorders challenging. The sesamoid and subsesamoid joints may also be injured acutely with the volar plate complex during hyperextension injuries, and may sometimes produce mechanical dysfunction. Simple excision of chronically painful sesamoids provides excellent relief.

Arthritis↗

Excision of the fractured os peroneum: a report on five patients and review of the literature.

Five patients sustained fractures of the os peroneum after supination and plantarflexion injuries. Two of the injuries involved the knee in hyperflexion and the foot under the buttock. Four of the five were treated with immobilization for 6 weeks. All five required operative excision of the fractured sesamoid 8 months to 8 years after the initial injury. Three fractures were bipartite and there were two multipartite fractures. At 12- to 28-month follow-up, all patients were pain-free over the lateral midfoot and four patients returned to preinjury activity levels.

Adult↗

Haematogenous osteomyelitis of the first metatarsal sesamoid. A case report and review of the literature.

A rare case of haematogenous osteomyelitis of the sesamoid of the first metatarsophalangeal-joint visualized by a CT-scan have been presented. The characteristics of this disease have been stressed. When the diagnosis had been considered treatment should be surgical drainage with debridement of all infected tissues. Previous authors recommend antibiotic treatment, but it was not given to this patient. There was total cure after three months.

Child↗

Sesamoid and toe fractures.

Injuries of the toes and sesamoids of the first metatarsophalangeal joint comprise a wide spectrum of traumatic entities. Despite the fact that a majority of lesions may well respond to nonsurgical treatment and exhibit an excellent prognosis, appropriate clinical and imaging analysis is mandatory to select those injuries that require specific therapeutic and surgical measures to avoid long-term sequelae of functional disability.

Fractures, Stress↗

Sesamoid pain secondary to a plantar neuroma.

Two cases are presented in which the necessity of a plantar incision for removal of a fibular sesamoid led to the incidental finding of an undiagnosed plantar neuroma and bursal sac. The first case presented a hypertrophic fibular sesamoid fused to the plantar aspect of the first metatarsal head. The second case presented a dystrophic fibular sesamoid consistent with a healing fracture or avascular necrosis. Plantar neuromas are a known cause of pain in the forefoot. The authors review the literature concerning plantar neuromas and provide a discussion of their etiology, clinical findings, and surgical treatment. Attention is directed to the use of a plantar incision as a viable alternative to the dorsal approach for excision of a fibular sesamoid and associated soft tissue masses.

Adult↗

The relationship of the position of the metatarsal heads and peak plantar pressure.

We test the premise that peak plantar pressure is located directly under the bony prominences in the forefoot region. The right foot of standing volunteers was examined in three different postures by a CT-scanner. The plantar pressure distribution was simultaneously recorded. The position of the metatarsal heads and the sesamoids could be related to the corresponding local peak plantar pressures. The metatarsal heads 1, 4, and 5 had a significantly different position than the local peak plantar pressures. The average difference in distance between the position of the metatarsal heads and the peak plantar pressure showed a significant correlation: on the medial side the head was located more distally to the local peak plantar pressure, on the lateral side more proximally. The findings suggest that normal plantar soft tissue is able to deflect a load. The observations might improve insight into the function of the normal forefoot and might direct further research on the pathological forefoot and on the design of footwear.

Adult↗

A comparison of ultra-high-molecular weight polyethylene cable and stainless steel wire using two fixation techniques for repair of equine midbody sesamoid fractures: an in vitro biomechanical study.

OBJECTIVE: To compare the monotonic tensile and fatigue strength of 16-gauge stainless steel wire (SSW) to ultra-high-molecular weight polyethylene (UHMWPE) cable using a transfixed cerclage technique in an in vitro midbody sesamoid osteotomy model. Endoscopic modifications to Martins transfixed cerclage technique were developed. A new suture technique of fixation was compared with the transfixed cerclage technique by measuring gap formation after cyclic testing. STUDY DESIGN: An in vitro biomechanical paired equine cadaver limb study. SAMPLE POPULATION: Twenty-one paired cadaveric adult equine forelimbs. METHODS: Uniaxial medial midbody sesamoid osteotomies were created in paired adult equine forelimbs. Monotonic tensile strength was measured on 10 forelimbs repaired by a transfixed cerclage technique using wire or cable. Fatigue testing to failure was performed on 4 forelimbs repaired using the transfixed cerclage technique by cycling the limbs between 500 N and 2,000 N. The limbs were initially repaired with wire, cycled until the wire broke, then repaired with cable and cycled again to failure. Fatigue testing for gap displacement was performed on 8 limbs repaired with either the transfixed cerclage technique or the suture technique. Limbs were cycled between 500 N and 2,000 N for 10,000 cycles. The limbs were repaired with wire initially, tested, and then repaired with cable and tested again. Twenty-two limbs were used for mechanical testing. The remaining limbs (20) were used to develop and practice the endoscopic transfixed cerclage (10 limbs) and suture (10 limbs) techniques. RESULTS: Ultimate tensile strength (UTS) of UHMWPE cable constructs was 34% greater than the UTS of SSW constructs. Fatigue strength was 2 to 20 times greater for UHMWPE cable constructs than SSW constructs. Separation of fragments was 153% less for limbs repaired by the suture technique compared with those repaired by the transfixed cerclage technique. CONCLUSIONS: UHMWPE cable shows promise for this clinical application because of its greater tensile and fatigue strength. The newly described suture technique significantly reduced gap formation compared with the transfixed cerclage technique. Osteotomy gap formation occurred early in cycling, suggesting that rigid support in the form of a cast may be needed during the early postoperative period for wiring techniques. CLINICAL RELEVANCE: Clinical testing of UHMWPE cable should eliminate problems of wire breakage seen with SSW. The endoscopic transfixed cerclage technique can be used by surgeons familiar with arthroscopic surgery. However, the suture technique needs to be tested in vivo to determine whether there is a clinical advantage compared with the transfixed cerclage technique.

Animals↗

Radiographical assessment of interphalangeal rotation in the evaluation of equine digital conformation.

This study is a part of a work to design a radiographical method to objectively define the conformation of an equine digit and to assess the individual appropriate trimming of a horse. Various angles were measured directly from the phalangeal bones. The authors observed that the bone relief of the sesamoid ligament insertions on the proximal phalanx was an essential landmark to determine the phalangeal alignment. The same angles were measured from specific radiographs and made it possible to quantify the rotation imposed to the proximal phalanx. The authors also noticed that the phalangeal rotation had little influence on the radiographic image of articular asymmetry.

Animals↗

Prevalence of, and factors associated with, musculoskeletal racing injuries of thoroughbreds.

All horses diagnosed by a commission veterinarian of the Kentucky Racing Commission as having sustained a musculoskeletal injury, defined as an obvious change in soundness immediately before, during, or after a race held between Jan 1, 1992 and May 31, 1993 were included in a study to determine the prevalence of and factors associated with racing injuries involving the musculoskeletal system of horses competing at 4 Thoroughbred racetracks in Kentucky. During the 17-month study, there were 35,484 racing starts among 7,649 horses in 3,824 official Kentucky Racing Commission races. During this period, 132 musculoskeletal racing injuries were diagnosed among 117 horses. Twenty-eight injured horses were male, 46 were geldings, and 43 were female. The prevalence of horses with racing injuries per racing start was 0.33% (117/35,484). The injuries of 51 horses were classified as catastrophic, and 66 as noncatastrophic. The prevalence of horses with catastrophic injuries per racing start was 0.14% (51/35,484). The proportion of horses with injuries of the left forelimb, sesamoid, and third metacarpal bone in the catastrophic group was significantly (P < or = 0.05) greater than those of horses in the noncatastrophic group. The proportion of horses with injuries of the superficial digital flexor tendon among those in the catastrophic group was significantly less than that of horses in the noncatastrophic group. The distance of the race was significantly shorter and the number of turns less among horses with catastrophic injuries than among horses with noncatastrophic injuries.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗