Fracture of the Medial Sesamoid Bone in a professional soccer player

The incidence of medial sesamoid bone fracture is rare. Clinically they are often misdiagnosed as soft tissue injuries and often missed. Thus generates an important morbidity for the patient. Objectives: We present a case of turf-toe injury: plantar-plate rupture with medial sesamoid bone fracture in a contact athlete. Methods: A 19-year-old professional soccer player injured his left toe when he planted his foot during a sprint. He had an hyperextension and axial overload traumatism in his toe. On physical examination he had pain, swollen, ecchymosis, instability and loss of plantar-flexion strength. Radiographs showed a transverse medial sesamoid bone fracture with retraction > 3 mm. Magnetic resonance imaging confirmed a subluxation of the proximal phalange and a plantar plate disruption. Because of the completely deficient flexion, the sesamoid retraction, and the articular subluxation, surgery was recommended to restore the MTPJ anatomy. Reduction of the fracture and Repair of the plantar plate was performed using non-absorbable 2-0 Fiber wire sutures through a medial approach. Postoperatively, the patient was placed in a cast, for a total of 2 weeks. After that he began a rehabilitation program. Results: The patient had a complete recovery. He returned to participation in his team at 3 months. At final follow-up, his dorsiflexion ROM was 60 in the involved toe. Conclusion: Turf-toe and disorders of the sesamoid complex is an important injury, often misdiagnosed and usually undertreated. They had an incidence of 25% to 50% of residual pain and limited dorsiflexion in those cases. Despite the incidence of surgical treatment of 2%, we have found hopeful results with the open reduction and internal fixation of the fracture. Accurate and timely diagnosis and treatment can allow for full return to activity for these athletes.