Acute Comminuted Pathologic Fracture of a Hallucal Sesamoid with Tophaceous Gout: A Case Report.

Abstract

Fractures in the sesamoid bones may occur by direct trauma or repetitive overuse (stress fractures). Acute fracture of the hallucal sesamoids is seen most often with dislocation of the metatarsophalangeal joint after a high-energy injury1. A chronic stress fracture of the sesamoid bone is generally found in athletes and can be difficult to differentiate from other conditions that affect the hallucal sesamoids2. The optimal choice of treatment remains unclear3. In chronic tophaceous gout, urate deposition may occur in articular cartilage, subchondral membranes, joint capsules, and periarticular tissues. An isolated intraosseous tophaceous lesion in the hallucal sesamoids is rare4-7. We found only one previously published report describing a chronic stress fracture and nonunion of a hallucal sesamoid that was associated with tophaceous gout8. To our knowledge, there have been no previously published reports of an acute comminuted pathologic fracture of a hallucal sesamoid with a tophaceous deposit. We describe a rare case of an acute comminuted pathologic fracture with tophus of the fibular sesamoid in a young soldier with no history of gout or underlying systemic disorder. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A twenty-year-old soldier with no history of gout noted a painful disability of the right forefoot during a military march. The pain persisted for several days, and he was not able to bear weight in the standing position. He noted that he had experienced similar forefoot pain three years prior; he had also experienced similar symptoms several times before, but with less intensity. The pain increased during forced dorsiflexion of the …