Summary
Over a period of 11 years 15 cases of stress fractures of the sesamoid bones of the first metatarsophalangeal (MTP) joint were treated in athletes. The mean age of the patients was 22.3 years, and there were 9 males and 6 females in the series. All patients were athletes, who began to suffer from the symptoms during training without any trauma. Eight fractures were located in the medial, six in the lateral sesamoid bone, and in one case both sesamoids were affected. The diagnosis was performed on the basis of the history, symptoms, clinical examination, and radiological, or isotope scanning findings. Ten of the patients were treated conservatively by prescribing an avoidance of excessive physical activity and better training shoes. In five cases surgical excision of the fragmented painful sesamoid bone was performed. There were no complications in the series and the athletes could start gradually training 6–8 weeks after the operation. The histology showed fibrotic non-union at the fracture site and supported the diagnosis of stress fracture. Three of the conservatively treated athletes had mild symptoms in intensive training, others had a good end result.
Zusammenfassung
In einem Zeitraum von 11 Jahren wurden 15 Fälle von Ermüdungsfrakturen des Sesambeines am I. MTP-Gelenk diagnostiziert und behandelt. Das Durchschnittsalter betrug 22,3 Jahre, die Geschlechtsverteilung: 6 Frauen und 9 Männer. Alle Patienten waren Sportler, bei denen die Beschwerden während des Trainings auftraten, ohne direktes Trauma. In 8 Fällen befand sich die Fraktur im medialen, in 6 im lateralen Sesamoid und in einem Fall waren beide Sesambeine betroffen. Zur genauen Diagnose kam man durch die Anamnese, wie auch durch die Röntgen- und Isotopenuntersuchung. 10 Patienten wurden konservativ behandelt, Vermeidung excessiver Belastung und das Tragen von besseren Trainingsschuhen wurden vorgeschrieben. In 5 Fällen mußte chirurgisch vorgegangen werden, das fragmentierte, Schmerz verursachende Sesambein wurde entfernt. Die Nachbehandlung verlief komplikationslos und die Sportler konnten ihr Training nach 6 bis 8 Wochen post Op wieder aufnehmen. Die histologische Untersuchung der extirpierten Sesambeine ergab: fibrotisch veränderte Frakturflächen, was die Diagnose einer Stressfraktur bestätigte. 3 der konservativ behandelten Sportler haben immer noch leichte Beschwerden bei intensivem Training, die anderen sind beschwerdefrei.
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References
Beck O, Soukup P (1972) Seltene Lokalisationen der juvenilen aseptischen Osteochondronekrosen. Beitr Orthop Traumatol 19:592–600
Christensen SE, Cetti R, Niebuhr-Jorgensen U (1983) Fracture of the fibular sesamoid of the hallux. Br J Sports Med 17:177–179
Devas MB (1960) Stress fractures of the patella. J Bone Joint Surg [Br] 42:71–78
Devas MB (1963) Stress fractures in children. J Bone Joint Surg [Br] 45:528–541
Golding C (1960) The sesamoids of the hallux. J Bone Joint Surg [Br] 42:840–843
Helal B (1981) The great toe sesamoid bones: the lus or lost soles of Ushaia. Clin Orthop 106:83–87
Inman VT (ed) (1973) Du Vries' surgery of the foot, 3rd edn. Mosby, Saint Louis
Jahss MH (1981) The sesamoids of the hallux. Clin Orthop 106:88–97
Kirkup JR, Vidigal E, Jacoby RK (1977) The hallux and rheumatoid arthritis. Acta Orthop Scand 48:527–544
Matzen P-F, Fleissner HK (1970) Orthopedic roentgen atlas. Thieme, Stuttgart
Meurman KOA (1981) Stress fractures in soldiers. An analysis of 986 consecutive cases. Thesis, Acta Universitatis Ouluensis, Medica 78
Orava S, Myllyki T (1982) Stressfrakturen der Sesambeine des ersten Metatarsophalangealgelenks — Bericht über fünf Fälle bei Sportlern. Med Sport 22:154–158
Orava S, Puranen J, Ala-Ketola L (1978) Stress fractures caused by physical exercise. Acta Orthop Scand 49:19–27
Scranton PE Jr (1981) Pathologic anatomical variations in the sesamoids. Foot Ankle 1:321–326
Seder JI (1974) Sesamoiditis. J Am Pod Assoc 64:444–446
Sugiura Y, Ikuta Y, Mutoh Y (1977) Stress fractures of the patella in athletes. J Jpn Orthop Assoc 51:1421–1427
Sutton D (1969) A textbook of radiology. Livingstone, Edinburgh
Turek SL (1977) Orthopedics. Principles and their applications. 3rd edn. Lippincott, Philadelphia
Van Hal ME, Keene JS, Lange TA, Clancy WG Jr (1982) Stress fractures of the great toe sesamoids. Am J Sports Med 10:122–128
Weissman SD (1983) Radiology of the foot. Williams & Wilkins, Baltimore
Williams JGP (1980) A colour atlas of injury in sports. Wolfe Medical, London
Zinman H, Keret D, Reis ND (1981) Fracture of the medial sesamoid bone of the hallux. J Trauma 21:581–582
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Hulkko, A., Orava, S., Pellinen, P. et al. Stress fractures of the sesamoid bones of the first metatarsophalangeal joint in athletes. Arch. Orth. Traum. Surg. 104, 113–117 (1985). https://doi.org/10.1007/BF00454250
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DOI: https://doi.org/10.1007/BF00454250