Fragmented palmar metacarpophalangeal sesamoids in dogs: a long-term evaluation

Summary

Long-term clinical and radiographicresponse to surgical and conservativemanagement of 22 dogs with fragmentedsesamoids was evaluated. Mean follow-up was 3.6 years (range = 3 monthsto 11.0 years).

Initial (retrospective) and follow-up(prospective) radiographs of the affectedpalmar sesamoids and associatedmetacarpophalangeal joints were evaluatedusing a graded scoring system. A lameness evaluation and physicalexamination were performed at followupin a blinded manner. In addition,owners were asked to complete a questionnaireregarding their pet’s thoraciclimb lameness.

There was not any difference betweengroups (sesamoidectomy, conservativemanagement, incidental finding)in age at onset, duration of lamenessprior to therapy, body weight at treatment, time to follow-up, number ofaffected joints, nor owner perceptionsof whether they thought the lamenessimproved, resolved, or recurred, andwhether or not they were pleased withthe outcome.

Sesamoid fragmentation treated bysesamoidectomy resulted in significantlygreater progression of radiographicchanges that were consistentwith degenerative joint disease.

Chronic lameness resolved or improvedto the point of owner satisfactionwith conservative therapy in most cases. Continued lameness, or recurrent,although improved lameness associatedwith heavy activity, occurred followingsurgical extirpation of the affectedsesamoids in many cases. Given thesefindings, a more conservative approachto the treatment of chronic lamenessassociated with sesamoid fragmentationmay be warranted.

Long-term clinical and radiographic response to surgical and conservative management of 22 dogs with fragmented sesamoids was evaluated. Mean follow-up was 3.6 years. Sesamoid fragmentation treated by sesamoidectomy resulted in significantly greater progression of radiographic changes that were consistent with degenerative joint disease. Chronic lameness resolved or improved to the point of owner satisfaction with conservative therapy in most cases. Continued or recurrent lameness was common following sesamoidectomy. Conservative therapy should be attempted prior to sesamoidectomy for dogs with chronic lameness associated with palmar metacarpophalangeal sesamoid fragmentation.

Keywords

Metacarpophalangeal - sesamoid - sesamoidectomy - conservative management

• REFERENCES

• 1 Bateman JK. Fractured sesamoids in the greyhound. Vet Rec 1959; 71: 101.
• 2 Davis PE, Bellenger CR, Turner DM. Fractures of the sesamoid bones in the Greyhound. Aust Vet J 1969; 45: 15-9.
• 3 Hickman J. Veterinary Orthopaedics. Philadelphia: JB Lippincott; 1964: 230-1.
• 4 Robins GM, Read RA. Diseases of the sesamoid bones. In: Bojrab MJ. (ed). Disease Mechanisms in Small Animal Surgery. Philadelphia: Lea & Febiger; 1993: 1094-101.
• 5 Bennett D, Kelly DF. Sesamoid disease as a cause of lameness in young dogs. J Small Anim Pract 1985; 26: 567-79.
• 6 Berg JA. Fractures of palmar and plantar sesamoid bones as a cause of lameness in the dog. J Am Vet Med Assoc 1973; 163: 968-70.
• 7 Read RA, Black AP, Armstrong SJ, MacPherson GC, Peek J. Incidence and clinical significance of sesamoid disease in Rottweilers. Vet Rec 1992; 130: 533-5.
• 8 Vaughan LC, France C. Abnormalities of the volar and plantar sesamoid bones in Rottweilers. J Small Anim Pract 1986; 27: 551-8.
• 9 Krooshof Y, Hazewinkel HAW. Examination and treatment of fractures of sesamoid bones in the feet of dogs. Tijdschr Diergeneeskd 1986; 111: 1167-72.
• 10 Brinker WO, Piermattei DL, Flo GL. Handbook of Small Animal Orthopedics and Fracture Management. Philadelphia: WB Saunders; 1990: 228-9.
• 11 Morgan JP. Radiology in Veterinary Orthopedics. Philadelphia: Lea & Febiger; 1972: 391-2.
• 12 Piermattei DL. An Atlas of Surgical Approaches to the Bones and Joints of the Dog and Cat. Third Edition.. Philadelphia: WB Saunders; 1993. 216 217.