Surgical Repair of Mid-Body Sesamoid Bone Fractures

Mid-body sesamoid fractures remain surgical challenges. Non-displaced fractures can be successfully managed by extended periods of rest, although nonunion and refracture are fairly common. Displaced fractures should be surgically repaired if an athletic career is desired. The most common techniques for repair are lag screw fixation +/- graft or tension band wiring +/- graft. In most fractures lag screw fixation is superior but wiring can also be successful and is a useful technique to have available if screw fixation proves impossible for some reason (rare).

Arthroscopically assisted lag screw fixation
I prefer to do these in lateral recumbency with the fractured sesamoid up. The foot should be carefully cleaned and the thinnest possible sterile adhesive materials used to drape the foot. Any bulky materials over the heel will further complicate the positioning of the screw. It is ESSENTIAL to have long drill bits and taps. It is highly desirable to have hex-head screwdrivers of different lengths.  [...]