Sesamoid: fracture

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Introduction

  • Cause : trauma.
  • Signs : acute onset lameness with soft tissue swelling and pain around sesamoid bones.
  • Reduced range of movement of metacarpo/metatarso-phalangeal joints.
  • Pain and crepitus on flexion and extension of the affected joint.
  • Diagnosis : history, signs, radiography.
  • Treatment : conservative support dressings adequate for pet dog; surgical removal of fractured sesamoid is usual in sporting dogs.
  • Prognosis : good.

Diagnosis

Clinical signs

  • Acute, severe pain and swelling of the area surrounding the sesamoid bone.
  • Focal pain is present for several weeks.
  • Crepitus and pain on manipulation of the affected metacarpo/metatarso-phalangeal joint.
  • Radiographs confirm diagnosis.

Differential diagnosis

Outcomes

Prognosis

  • Good.

Expected response to treatment

  • Monitor lameness and pain response to palpation of the affected sesamoid bone and flexion and extension of the affected metacarpo-phalangeal joint.

Reasons for treatment failure

  • Lameness still present after 6 weeks of conservative management → proceed to surgical excision.
  • Chronic cases may remain lame even after surgical resection due to degenerative osteoarthritis of the metacarpo/metatarso-phalangeal joint.
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