Equis ISSN 2398-2977

Proximal sesamoid: fracture - arthroscopic removal

Contributor(s): Jessica A Kidd-Millar, Janice Sojka, Vetstream Ltd

Introduction

  • Some apical, abaxial and basal sesamoid fractures are not suitable for repair and can be removed arthroscopically.
  • Prognosis generally decreases with an increase in the size of the fragment removed although not to the extent previously thought. 
  • Failure to stabilize the fracture may result in non-union, and may increase risk of ongoing lameness or osteoarthritis in fetlock joint.
  • Arthroscopic   Joint: arthroscopy - overview  removal is less traumatic than arthrotomy.
  • Electrosurgical techniques during arthroscopy can shorten surgery times and improve visualization.

Uses

Advantages

  • Decreased operative time (with experience).
  • Avoids sequelae such as fibrous non-union and fetlock joint disease   MCP / MTP joint: disease - overview  .
  • Compared to arthrotomy:
    • Good visualization of intra-articular structures.
    • Reduced periarticular soft tissue trauma.
    • Improved post-operative comfort.
    • Easier post-operative care.
  • Using electrocautery techniques:
    • Improved hemostasis.
    • Precise dissction of soft tissue attachments to apical fragments, regardless of chronicity of fracture or size of fragment(s).
    • Minimal soft tissue trauma.

Disadvantages

  • Requires arthroscopic equipment and more skill than arthrotomy.
  • Some abaxial fragments are hard to visualize with arthroscope and some are non-articular.
  • Time involved and soft tissue trauma may not be reduced if technical difficulties are encountered.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Good for small fragments.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Schnabel L V et al (2007) Racing performance after arthroscopic removal of apical sesamoid fracture fragments in Thoroughbred horses age <2 years: 151 cases (1989-2002). Equine Vet J 39 (1), 64-68 PubMed.
  • Schnabel L V et al (2006) Racing performance after arthroscopic removal of apical sesamoid fracture fragments in Thoroughbred horses age > or =2 years: 84 cases (1989-2002). Equine Vet J 38 (5), 446-451 PubMed
  • Southwood L L & McIlwraith C W (2000) Arthroscopic removal of fracture fragments involving a portion of the base of the proximal sesamoid bones in horses: 26 cases (1984-1997). JAVMA 217 (2), 236-240 PubMed.
  • Boure L et al (1999) Use of electrocautery probes in arthroscopic removal of apical sesamoid fracture fragments in 18 standardbred horses. Veterinary Surgery 28, 226-232 PubMed.
  • Southwood et al (1998) Arthroscopic removal of abaxial fracture fragments of the proximal sesamoid bones in horses: 47 cases (1989-1997). JAVMA 213 (7), 1016-1021 PubMed.

Other sources of information

  • Southwoodet al(2000)Arthroscopic removal of apical fractures of the proximal sesamoid bones in horses: 98 cases (1989-1999).In:Proc 46th AAEP Congress. pp 100-101.
  • McIlwraith C W (1990)Diagnostic and Surgical Arthroscopy in the Horse.2nd edn. Lea & Febiger, Philadelphia.


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