Sesamoid arthrodesis. A, Palmar plate is mobilized by dividing accessory collateral ligament at its insertion into palmar plate. Articular surface of sesamoid is denuded of cartilage. Cortical defect is created at head-neck junction of metacarpal. B, Two straight needles (with Kirschner wire driver) are used to pass polypropylene (Prolene) suture through sesamoid-palmar plate complex and metacarpal neck to secure sesamoid into cortical defect created. C, Intraosseous suture is tied over metacarpal under extensor tendons as permanent suture. Kirschner wire is placed across metacarpophalangeal joint to maintain joint in approximately 30 degrees of flexion. Seam in collateral ligament is repaired, and proximal radial edge of palmar plate is sutured to metacarpal periosteum and aponeurotic fibers of abductor pollicis brevis. SEE TECHNIQUE 72.10.