title: [Anatomical reconstruction of fresh, malunion and nonunion of fractures of the sesamoid bones of the hallux].
abstract: BACKGROUND
  Multifragmentary sesamoid bones of the hallux have established the concept of sesamoidea multipartita which is explained as a congenital characteristic of these bones. Sesamoid bones although fragmented are often asymptomatic as are, for example fragmented patellae. Evidence shows, however, that fragmentation of sesamoid bones is significantly more frequent in young people active in sports (soccer). The diagnosis of traumatic fractures and subsequent pain and disability is a challenge. Patients often present to physicians relatively late and are, therefore, treated in the acute phase long after onset of pain.
  
  
  METHODS
  Inquisitive interview of the patient and precise examination together with a detailed radiological investigation (computed tomography) are essential to be able to determine a causal relation to the fragmentation of sesamoid bones. Treatment consists of an anatomical reconstruction of vital bone fragments possibly augmented with an autologous cancellous bone graft after debridement. Surgical approaches are longitudinal medial for the medial sesamoid bone and longitudinal plantar for the lateral sesamoid bone. The means of fixation mostly involves two 1.5 mm screws for optimal mechanical stability.
authors.affiliation: Reparto di Chirurgia Ortopedica, Clinica Luganese, sede Moncucco, Via Moncucco 10, CH-6900, Lugano, Schweiz, k.klaue@bluewin.ch.
authors.forename: K
authors.initials: K
authors.lastname: Klaue
mesh_terms: D000328:Adult; D005260:Female; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000601:surgery*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006214:Hallux / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation / Q000379:methods; D012716:Sesamoid Bones / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D016896:Treatment Outcome