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Radiology News


Sesamoid Fracture-Plain Film

An adult with history of  injury with pain and swelling near the great  toe. X rays AP/oblique  show three sesamoids instead of usual two, with jarred, and sharp margins of horizontally cleavaged medial sesamoid with soft tissue shadow in the vicinity . In view of local tenderness possibly represents fracture.

Teaching points by Dr MGK Murthy & Dr Sumer Sethi
·         Sesamoid bones occur in the tendon of flexor hallucis brevis(FHB)  in the plantar surface of great toe and are 2 in numbers called tibial and fibular sesamoids
·         Play an important role in giving mechanical advantage to FHB in assisting weight bearing  behind  great toe , in addition to keeping the  head of MT off the ground , with medial sesamoid playing more role  in this
·         Can  be bipartite in about 10% of people (amongst them 25% are bilateral), in which case it  looks 3 in numbers(medial is more bipartite than lateral), with occasional  one multipartite
·         Fracture shows  sharp edges, corners/jarred margins/invariably transverse or horizontal/more involving medial/Soft tissue swelling/pain/local tenderness /other side absent (bipartite is well defined and medial more along with corticated margins)
·         Bone scintigraphy positive only in fractures or MR shows marrow edema
·         Other diseases include sesamoiditis/avascular necrosis/displacement/stress fracture 
Sesamoid Fracture-Plain Film Reviewed by Sumer Sethi on Wednesday, November 16, 2011 Rating: 5

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