Surgical Approach for Removal of Nonarticular Base Sesamoid Fragments of the Proximal Sesamoid Bones in Horses
Article first published online: 25 SEP 2008
© Copyright 2008 by The American College of Veterinary Surgeons
Volume 37, Issue 7, pages 619–624, October 2008
How to Cite
BROKKEN, M. T., SCHNEIDER, R. K. and TUCKER, R. L. (2008), Surgical Approach for Removal of Nonarticular Base Sesamoid Fragments of the Proximal Sesamoid Bones in Horses. Veterinary Surgery, 37: 619–624. doi: 10.1111/j.1532-950X.2008.00427.x
- Issue published online: 25 SEP 2008
- Article first published online: 25 SEP 2008
- Submitted August2007; Accepted May 2008
Objectives— To describe a surgical approach for the removal of nonarticular base sesamoid fragments in performance horses and to report the outcome.
Study Design— Retrospective study.
Animals— Horses (n=11), 7 months to 10 years of age, with lameness because of nonarticular base sesamoid fragments.
Methods— Lameness was localized to the metacarpophalangeal/metatarsophalangeal region by clinical examination or response to diagnostic local anesthesia. Radiographs confirmed the diagnosis of a nonarticular base sesamoid fragment. Surgical removal was performed with an incision over the base of the affected sesamoid through the digital flexor tendon sheath. After identifying the fragment with the aid of needles, a small vertical incision was made in the straight distal sesamoidean ligament (SDSL) and the fragment was freed from its attachments and removed. Six months convalescence and rehabilitation was prescribed for all horses.
Results— Eleven horses had 16 nonarticular fragments of the base of the proximal sesamoid bones. Eleven (69%) fragments occurred in the forelimbs with the right front (82%) and medial sesamoid (73%) more commonly affected. Horses were treated by surgical fragment removal. In horses with follow-up, 9 of 10 returned to their intended use.
Conclusions— Surgical removal of nonarticular base sesamoid fragments can be accomplished through a palmar/plantar approach through the digital flexor tendon sheath and SDSL. This “keyhole” approach minimizes damage to the distal sesamoidean ligament attachments to the sesamoid base and allows some horses to return to their intended use.
Clinical Relevance— Surgical removal of nonarticular base sesamoid fragments should be considered in horses with performance-limiting lameness as a result of the fragment.