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Percutaneous screw fixation for fractures of the sesamoid bones of the hallux

Department of Orthopaedics, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia.

Correspondence should be sent to Mr C. M. Blundell at 44 Christchurch Road, Norwich, Norfolk NR2 3NE, UK.

Over a period of one year we treated nine fractures of the sesamoid bones of the hallux, five of which were in the medial sesamoid. All patients had symptoms on exercise, but only one had a recent history of injury. The mean age of the patients was 27 years (17 to 45) and there were six men. The mean duration of symptoms was nine months (1.5 to 48). The diagnosis was based on clinical and radiological investigations. We describe a new surgical technique for percutaneous screw fixation for these fractures using a Barouk screw.

All the patients were assessed before and after surgery using the American Orthopaedic Foot and Ankle Society Hallux Score (AOFAS). There was a statistically significant improvement in the mean score from 46.9 to 80.7 (p = 0.0003) after fixation of the fracture with a rapid resolution of symptoms. All patients returned to their previous level of activity by three months.

We believe that this relatively simple technique is an excellent method of treatment in appropriately selected patients.