Surgical approach for removal of nonarticular base sesamoid fragments of the proximal sesamoid bones in horses.
Authors: Brokken Matthew T, Schneider Robert K, Tucker Russell L
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Surgical Management of Nonarticular Base Sesamoid Fragments Nonarticular fractures at the base of the proximal sesamoid bones represent a significant source of persistent lameness in performance horses, yet surgical options have been poorly documented in the literature. Brokken and colleagues describe a targeted surgical technique using a palmar/plantar approach through the digital flexor tendon sheath, with careful incision of the straight distal sesamoidean ligament to facilitate fragment removal whilst preserving the structural integrity of the ligamentous attachments. In their retrospective review of 11 horses (16 fragments total), 90% of animals with follow-up information successfully returned to their intended use following a 6-month rehabilitation period, with the right forelimb and medial sesamoid being most commonly affected. This "keyhole" approach offers a practical alternative to more destructive surgical techniques, as it minimises collateral damage to crucial soft tissue structures around the sesamoid apparatus. For equine practitioners managing cases of performance-limiting metacarpophalangeal or metatarsophalangeal region lameness that prove unresponsive to conservative treatment, referral for surgical consultation should be considered earlier rather than deferred, particularly when diagnostic imaging confirms a nonarticular base fragment and the horse's value and intended use justify intervention.
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Practical Takeaways
- •Surgical removal of nonarticular base sesamoid fragments offers a viable treatment option for performance horses with corresponding lameness that has not responded to conservative management
- •The 'keyhole' surgical technique minimizes soft tissue damage and ligamentous disruption, potentially improving functional outcomes and return to work
- •Expect a 6-month rehabilitation period post-surgery; approximately 9 in 10 horses in this series returned to their previous level of use
Key Findings
- •11 horses with 16 nonarticular sesamoid fragments were successfully treated surgically with 90% (9/10) returning to intended use after 6 months convalescence
- •Right front forelimb (82%) and medial sesamoid (73%) were most commonly affected
- •A minimally invasive palmar/plantar approach through the digital flexor tendon sheath and straight distal sesamoidean ligament preserves distal sesamoidean ligament attachments