title: Surgical approach for removal of nonarticular base sesamoid fragments of the proximal sesamoid bones in horses.
abstract: OBJECTIVE
  To describe a surgical approach for the removal of nonarticular base sesamoid fragments in performance horses and to report the outcome.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Surgical removal of nonarticular base sesamoid fragments should be considered in horses with performance-limiting lameness as a result of the fragment.
authors.affiliation: Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, USA. brokkenm@vetmed.ufl.edu
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Brokken
authors.forename: Robert K
authors.initials: RK
authors.lastname: Schneider
authors.forename: Russell L
authors.initials: RL
authors.lastname: Tucker
mesh_terms: D000818:Animals; D005260:Female; D050723:Fractures, Bone / Q000601:surgery / Q000662:veterinary*; D006736:Horses / Q000293:injuries* / Q000601:surgery*; D007794:Lameness, Animal; D008297:Male; D012716:Sesamoid Bones / Q000293:injuries* / Q000601:surgery*; D016896:Treatment Outcome