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

Long-term clinical and radiographic response to surgical and conservative m anagement of 22 dogs with fragmented sesamoids was evaluated. Mean follow-u p was 3.6 years (range = 3 months to 11.0 years). Initial (retrospective) and follow-up (prospective) radiographs of the affe cted palmar sesamoids and associated metacarpophalangeal joints were evalua ted using a graded scoring system. A lameness evaluation and physical exami nation were performed at followup in a blinded manner. In addition, owners were asked to complete a questionnaire regarding their pet's thoracic limb lameness. There was not any difference between groups (sesamoidectomy, conservative m anagement, incidental finding) in age at onset, duration of lameness prior to therapy, body weight at treatment, time to follow-up, number of affected joints, nor owner perceptions of whether they thought the lameness improve d, resolved, or recurred, and whether or not they were pleased with the out come. Sesamoid fragmentation treated by sesamoidectomy resulted in significantly greater progression of radiographic changes that were consistent with degen erative joint disease. Chronic lameness resolved or improved to the point of owner satisfaction wi th conservative therapy in most cases. Continued lameness, or recurrent. al though improved lameness associated with heavy activity, occurred following surgical extirpation of the affected sesamoids in many cases. Given these findings, a more conservative approach to the treatment of chronic lameness associated with sesamoid fragmentation may be warranted.