Postoperative outcome of screw fixation with autogenous bone grafting for the management of hallux sesamoid fracture nonunion

Although sesamoid-preserving procedures have been attempted to complement sesamoidectomy for hallux sesamoid fracture nonunion, few reports document the results. Accordingly, the objective of this study was to review the outcomes of patients with hallux sesamoid fracture nonunion who underwent screw fixation with autogenous bone grafting.

Medical records of patients who underwent surgery between January 2013 and September 2022 were reviewed. Outcomes were assessed using the foot function index (FFI) and the visual analog scale (VAS) for pain. Fracture union was assessed using plain radiographs and computed tomography scans.

Ten patients (4 males and 6 females) were enrolled. The mean age was 39.4 years (standard deviation [SD], 14.0), and the mean follow-up duration was 23.4 months (SD, 14.5). The FFI score improved from 72.3 (SD, 8.7) preoperatively to 8.2 (SD, 10.7) 12 months postoperatively and to 6.6 (SD, 8.3) at the final follow-up (p < 0.01, respectively). The VAS score improved from 67.8 (SD, 13.5) preoperatively to 2.2 (SD, 3.8) 12 months postoperatively, finally improving to 3.6 (SD, 4.8) at the final follow-up (p < 0.01, respectively). Union was achieved in all patients 3 months postoperatively. Although no complications were observed, hardware removal was performed in two patients owing to discomfort and psychological anxiety.

Given that the symptoms improved in all patients without complications, as observed in this study, screw fixation with autogenous bone grafting appears to be a viable option for treating hallux sesamoid fracture nonunion.