Percutaneous Screw Fixation of Hallux Sesamoid Fractures

Abstract

Total sesamoid excision is a powerful tool to cure recalcitrant sesamoid pain, but it has its shortcomings: excision of the lateral sesamoid led to a hallux varus, and excision of the medial sesamoid to a hallux valgus deformity in 10–20% of cases.¹–⁵ Excision of both sesamoids may cause cock up deformity of the hallux.²,⁴,⁶,⁷ Each sesamoid is invested in the corresponding tendon sheath of the flexor hallucis brevis. The attachment of the tendon to the base of the proximal phalanx is crucial for the balance of the first metatarsophalangeal (MTP) joint. Injuries to these structures during total excision cause hallucal deviation. In addition, loss of preloading and elevation of the first metatarsal head due to sesamoid excision may lead to transfer metatarsalgia and loss of big toe push off.⁸,⁹

Alternative procedures have been invented to reconstruct the anatomy.¹⁰–¹⁴ The following technique of percutaneous screw fixation of sesamoid bone fractures is one of these procedures. Moreover, the skin incisions used to approach the two sesamoid bones have been connected with adverse effects: the lateral plantar approach was reported to be associated with painful plantar scar formation, and the lateral dorsal approach with accidental harm to the intrinsic hallucal muscles and interdigital nerve neuroma. The medial approach is only useful to reach the medial sesamoid bone.²–⁴,⁶ The percutaneous technique needs only a stap incision distal to the weight-bearing area of the sesamoid bone. Sterile strips are used for wound closure.