Fracture of the Medial Sesamoid of the First Metatarsal: A Clinical Case

The two sesamoid bones of the first metatarsal are embedded in a ligamentous complex within the context of the plantar ligament. They have a cartilaginous surface that articulates with the inferior aspect of the head of the first metatarsal, and at this level, each of them is surrounded by a ring-like fibrocartilaginous structure. Fracture of one of these two bones is quite rare, and treatment can be challenging due to the uncertain classification of this type of injury. Often, fractures remain unrecognized or are treated unsuccessfully. We present a unique case of a patient who was treated conservatively for 6 months, with only general indications, and was eventually treated surgically, not without difficulty, but with a successful final outcome. We looked for a method that could alleviate the patient's pain symptoms and promote functional recovery as much as possible. Due to the limited guidance in the scientific literature and the failure of conservative treatment attempts, we used a combination of reduction and osteosynthesis with an interfragmentary screw, with the addition of biological cement. The sesamoid bones of the big toe can cause serious disruptions to everyday life if they are fractured or damaged.