Foot Ankle Int. 2012 Sep;33(9):704-6. doi: 10.3113/FAI.2012.0704.
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.
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.
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.
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.
踇趾籽骨骨折的治疗具有挑战性。非手术治疗后出现症状性骨不连是常见问题。骨折的手术固定可导致成功愈合，但技术上具有挑战性，且与活动恢复时间（RTA）延长相关。籽骨切除术是一种替代的手术选择，可能提供可靠的结果并允许运动员更早地恢复活动。本病例系列研究的目的是评估一组接受籽骨切除术治疗的患有踇趾籽骨骨折的运动患者。
共有 24 名患者的 24 处籽骨骨折经非手术治疗失败，随后接受了籽骨切除术手术治疗。记录患者的年龄、活动水平、骨折骨、手术入路、RTA 所需时间和术后并发症。使用从 0（无疼痛）到 10（剧烈疼痛）的视觉模拟量表评估术前和术后疼痛。5 名患者被归类为从事大学间水平的精英运动员，19 名患者被归类为每周至少进行 3 次运动的活跃个体。患者的平均年龄为 32.2 ± 10.4 岁（范围 17 至 54 岁）。24 名患者的平均随访时间为 35 ± 21 个月（范围 8 至 70 个月）。
22/24 名患者（91.6%）在平均 11.6 ± 3.87 周（范围 8 至 24 周）时恢复活动。术前疼痛平均水平为 6.2 ± 1.4，治疗后疼痛水平改善至平均 0.7 ± 1。1 名患者在切除内侧籽骨后出现症状性踇外翻畸形。
本病例系列研究显示，对于运动个体的籽骨骨折，籽骨切除术后可获得良好的结果，疼痛缓解可靠，RTA 在 11.6 周内恢复。内侧籽骨切除术后仍存在渐进性踇外翻的担忧，本研究中发病率为 1/24 例。
