The few radiologists I’ve heard from have mostly favored fracture as the contours are not rounded at the cleft (it looks more like 1 cracked pebble than 2 adjacent pebbles…I’m told….which is the same thing).To be clear, even though the baseline XRs I have are from 1 month ago, I have no idea how long she has been symptomatic.
I have heard from Caio Nery, who is an orthopedic foot surgeon from Sao Paolo who has previously lectured in our Clinical Series forum and case sessions.
He confirmed that it is truly an academic distinction and shared 2 articles.
Even though these titles refer to fractures, they make it clear that the treatment would be the same for a painful bipartite sesamoid.
I suppose, unless someone is suing someone over personal injury, it is not important for us to be certain of the DDx….and even then, probably not either.
On Tue, Aug 8, 2023 at 10:08 AM hilary umans <hilary.umans> wrote:
She has no recollection of acute injury, but she is a dancer.XR from 1 month ago reported as non displaced fracture vs bipartite medial sesamoid.
I know that we describe smoothly rounded margins of developmentally bipartite sesamoids that I don’t see here, but I’m not sure if this is fracture or developmental.
The US was actually done 1-2 weeks ago, not that I would consider it the next line assessment of sesamoiditis vs fracture.
You can see the cleft, without periostitis, callus or demonstrable hyperemia.
It seems so trivial, but I have been consulted on a previous lawsuit in a case of personal injury where a more obvious bipartite sesamoid was misread as fracture and the plaintiff was laying blame. In that case, there were old radiographs that proved the point. In this case, there is no prior imaging.
If it’s a fracture, it would be a chronic non-union.
I’m not sure if it was actually affect management….as she has symptomatic sesamoid pain (I know there are some podiatrists and orthopedic foot surgeons on this forum…that is a question for you).
Does anyone have anymore insight how to distinguish between these possibities?
To be clear, we did not recommend the CT…but now I have to report it.
I’m inclined to say "bipartite vs chronic fracture non-union" again.
Thoughts?
