Proximal sesamoid bone: fracture repair – lag screw
Introduction
- Midbody fractures of the sesamoids Proximal sesamoid: fracture require internal fixation to ensure sufficient bone strength is present for function of the suspensory apparatus and fetlock.
- Tension from the suspensory apparatus prevents adequate healing without internal fixation for compression of fragment to parent bone.
Uses
- Proximal sesamoid bone fractures Proximal sesamoid: fracture that are not amenable to fragment removal, usually large apical fractures or midbody fractures.
Advantages
- Rigid fixation of fracture with restoration of sesamoid bone continuity.
Disadvantages
- Technically difficult.
- Sesamoid heals poorly and is under constant tension.
Alternative techniques
- Fragment removal Proximal sesamoid: fracture - arthroscopic removal for small fractures.
- Wiring.
- Casting immobilization - heals by fibrous union
- Conservative - salvage only.
Time required
Preparation
- 30 min.
Procedure
- 60 min.
Decision taking
Criteria for choosing test
- Proximal sesamoid bone fracture Proximal sesamoid: fracture .
- Radiographic assessment of size of fragment.
- Other fetlock injuries, eg MCIII fracture MC / MT 3: fracture , proximal phalanx fracture Proximal phalanx: fracture .
Requirements
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Preparation
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Technique
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Aftercare
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Busschers E et al (2008) Surgical repair of mid-body proximal sesamoid bone fractures in 25 horses. Vet Surg 37 (8), 771-780 PubMed.
- Eddy A L et al (2004) A biomechanical comparison of headless tapered pitch compression and AO cortical bone screws for fixation of a simulated midbody transverse fracture of the proximal sesamoid bone in horses. Vet Surg 33 (3), 253-262 PubMed.
- Woodie J B, Ruggles A J & Litsky A S (2000) In vitro biomechanical properties of 2 compression fixation methods for midbody proximal sesamoid bone fractures in horses. Vet Surg 29 (4), 358-363 PubMed.
- Henninger R W et al (1991) Lagscrew and cancelluos bone graft fixation of transverse proximal sesamoid bone fractures in horses - 25 cases (1983-1989). JAVMA 199, 606-612 PubMed.
Other sources of information
- Bertone A L (1996) Fractures of the proximal sesamoid bones. In: Equine Fracture Repair. Ed: Nixon A J. W B Saunders, USA.