Sesamoidectomy for Hallux Sesamoid Fractures

Abstract

Background: Hallux sesamoid fractures are challenging to treat. Symptomatic nonunion is a common problem after nonoperative treatment. Surgical fixation of the fracture can result in successful union, but is technically challenging and can be associated with prolonged return to activities (RTA). Sesamoidectomy is an alternative surgical option that may provide reliable outcomes and allow an earlier RTA in athletes. The purpose of this case-series study was to evaluate a cohort of athletic patients with a hallucal sesamoid fracture treated with sesamoidectomy. Methods: A total of 24 patients with 24 sesamoid fractures that failed to respond to nonoperative measures were treated surgically with sesamoidectomy. Patients’ age, level of activity, fractured bone, surgical approach, time required to RTA, and postoperative complications were recorded. Pre- and postoperative pain was assessed with a visual analog scale ranging from zero (no pain) to 10 (intense pain). Five patients were classified as elite athletes playing at an intercollegiate level and 19 were classified as active individuals performing an athletic activity at least three times per week. The mean patient age was 32.2 ± 10.4 (range, 17 to 54) years. The 24 patients were reviewed at a mean follow-up of 35 ± 21 (range, 8 to 70) months. Results: A total of 22/24 patients (91.6%) returned to activities at a mean time of 11.6 ± 3.87 (range, 8 to 24) weeks. Mean preoperative pain level was 6.2 ± 1.4 and the pain level improved after treatment to a mean of 0.7 ± 1. One patient developed a symptomatic hallux valgus deformity after the resection of the medial sesamoid. Conclusions: This case series demonstrates good results after sesamoidectomy for sesamoid fractures in athletic individuals with reliable pain relief and RTA within 11.6 weeks. Progressive hallux valgus remains a concern after medial sesamoidectomy, with an incidence of 1 in 24 cases in this study. Level of Evidence: IV, Retrospective Case Series