Equis ISSN 2398-2977

Proximal sesamoid: fracture repair - wire

Contributor(s): Stephen Adams, Jessica A Kidd-Millar, Graham Munroe

Introduction

  • Midbody fractures of the proximal sesamoid bones   Proximal sesamoid: fracture  require internal fixation to achieve a bony union and to restore the function of the suspensory apparatus and fetlock joint.
  • Constant tension on the fracture line by the suspensory apparatus   →   instability with poor healing, often fibrous union and chronic pain in midbody fractures unless internal fixation is used.

Approaches

  • Arthroscopic - via the palmar pouch of the fetlock joint and the proximal digital flexor tendon sheath.
  • Arthrotomy - of the fetlock joints and synoviotomy of the digital flexor tendon sheath.

Uses

Advantages

  • Improves fracture stability   →   bony union and restoration of suspensory apparatus function.
  • Requires no special equipment.
  • Technically less demanding than lag screw fixation   Proximal sesamoid bone: fracture repair - lag screw   but requires good anatomical knowledge.

Disadvantages

  • Can be difficult to acheive good apposition and stable reduction.
  • Wires require removal after fracture healing.
  • Less stable than lag screw technique   Proximal sesamoid bone: fracture repair - lag screw   and consequently worse prognosis for successful repair.
  • Requires longer period of cast immobilization than lag screw fixation.

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

  • Guarded: for return to athletic career - average convalescence is 9-12 months and healing is slow.
  • Lag screw fixation carries a better prognosis for return to athletic function.

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.
  • Rothaug P G et al (2002) 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. Vet Surg 31 (5), 445-454 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.
  • Martin B B, Nunamaker D M, Evans L H et al (1991) Circumferential wiring of mid-body and large basilar fractures of the proximal sesamoid bone in 15 horses. Vet Surg 20, 9-14 PubMed.
  • Fretz P B et al (1984) Management of proximal sesamoid bone fractures in the horse. JAVMA 185 (3), 282-284 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, Philadelphia. ISBN 0-7216-6754-6.


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