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Unusual case: Sesamoid AVN

Discussion in 'Foot Surgery' started by drsarbes, Jun 6, 2013.

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  1. drsarbes

    drsarbes Well-Known Member


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    50 year old bicyclist with a Hx of chronic pain at the plantar aspect right foot. No acute trauma. Failed to respond to conservative treatment including custom insoles, cortisone injections, physical therapy, decreased activity and oral NSAIs.

    Dx: Fractured fibular sesamoid.

    At time of surgery a mass (suspected fibrolipoma) was excised along with an Avascular necrotic fibular sesamoid (see photos)

    Thought you might find this interesting.
     

    Attached Files:

  2. Lab Guy

    Lab Guy Well-Known Member

    Interesting case.

    Both ossicles of the tibial sesmoid are pretty smooth, maybe it was a bipartate sesmoid and the blood flow became interrupted to the smaller ossicle from constant pressure from a repetitive stress injury, ie, constant peddling. Rare indeed, if it was a fractured sesmoid without a history of trauma.

    Steven
     
  3. phil

    phil Active Member

    Thanks for sharing. That's very interesting.

    What pre op imaging was done (other than xray)? Bone scan/ MRI? Did it show up as pathological on imaging?
     
  4. drsarbes

    drsarbes Well-Known Member

    The xray does look like a tibial sesamoid....I may have taken a picture of the wrong xray. It was the lateral I operated on. Sorry for the confusion. I'll try and upload a DP view.

    No, pre op was just xrays. It looked fractured, nothing else. No need really to order any other imaging. I was just surprised when I excised it that it was an AVN....with a mass over it.

    After 3 decades I don't get surprised very often!

    Steve
     
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