Partial Excision of a Tibial Sesamoid Fracture Nonunion in a Patient with Congenital Absence of Fibular Sesamoid: A Case Study.

BACKGROUND

Hallucal sesamoid injuries occur in approximately 5% to 10% of foot and ankle injuries. Most cases can be treated conservatively. However, when nonoperative management fails, surgical intervention is warranted.

METHODS

The present case involved a 17-year-old female high school senior who presented to the clinic with right hallux pain. Radiographs were obtained and revealed congenital absence of the fibular sesamoid and evidence of a minimally displaced avulsion fracture involving the proximal medial tibial sesamoid. Treatment was complicated by the congenital absence of the fibular sesamoid and by a high activity level.

RESULTS

After conservative treatment failure, the patient underwent partial excision of her tibial sesamoid. She was followed for 1.5 years after initial presentation to our clinic. The patient was able to return to daily activities; however, she was not able to return to softball competitively due to pain.

CONCLUSIONS

We hypothesize she was unable to return to softball because the absence of a sesamoid can decrease push-off strength. We recommend that providers treating athletes educate their patients on the possible loss of strength and take this into account when creating a treatment plan.