Ultrasound assisted arthroscopic approach for removal of basilar sesamoid fragments of the proximal sesamoid bones in horses.
Authors: Barrett Elizabeth J, Rodgerson Dwayne H
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Basilar sesamoid fractures in young Thoroughbreds present a surgical challenge, particularly when fragments remain non-articular but risk becoming problematic during training. Barrett and Rodgerson evaluated a combined ultrasound and arthroscopic technique for fragment removal in seven yearlings identified during pre-sale screening, using a palmar/plantar approach to access the fetlock joint with real-time ultrasonographic guidance to localise and confirm complete removal. The surgical protocol successfully eliminated all fragments using rongeurs and radiofrequency-assisted soft tissue dissection, with no intra- or postoperative complications recorded and imaging confirmation of complete clearance. At 6–8 months post-operatively, no fragment recurrence or secondary bony proliferation occurred, suggesting the technique provides reliable definitive management. For practitioners managing pre-sale or young performance horses with basilar sesamoid fragments, this approach offers improved visualisation and confirmation of complete removal compared to arthroscopy alone, potentially reducing the risk of future complications during the animal's athletic career.
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Practical Takeaways
- •Ultrasound guidance significantly improves surgeon confidence and accuracy when removing non-articular sesamoid fragments, allowing real-time visualization during arthroscopic procedures
- •This surgical approach is particularly valuable in pre-sale yearling examinations where early detection and treatment of sesamoid fragments can prevent performance-limiting complications
- •The combination of arthroscopic and ultrasonographic techniques achieves complete fragment removal without long-term sequelae, supporting its use as a definitive treatment option
Key Findings
- •Ultrasound-guided arthroscopic removal of basilar sesamoid fragments was successful in all 7 Thoroughbred yearlings with complete fragment removal confirmed by imaging
- •No intra- or postoperative complications occurred in any of the cases
- •At 6-8 months follow-up, no fragment recurrence or bony proliferation was observed at the sesamoid base