Fracture reduction is easier than in diaphyseal oblique fractures, because the length of the bone is maintained after injury. The fracture is reduced using large bone-holding forceps and 1-2 cortex screws placed in lag fashion from craniolateral to caudomedial.
Preparation and application of the DCS
The lateral Dynamic Condylar Screw plate is placed first. It is essential to cross the physis in this fracture to obtain adequate purchase in the distal fragment. An 8-9 hole plate is normally sufficient because of the distal location of the fracture. The plate is contoured to the surface of the bone using the bending templates. Special care is taken to not alter the most distal aspect of the plate contour, even if it is located a few millimeters from the bone. This would make the procedure very difficult.
The distal end of the plate with its 95°barrel and dynamic condylar screw is placed first. The remaining screws are inserted using axial compression techniques across the fracture plane.
Preparation of the DHS
Once the lateral plate is attached, the bending templates are used to contour the Dynamic Hip Screw plate with its 135° barrel to the cranial cortex of the femur. Care must be taken to avoid intersection of the barrel and screw of the DCS-plate with the barrel and screw of the DHS-plate to be inserted.
Application of the DHS
The barrel of the DHS is inserted proximal to the barrel of the DCS into the distal epiphysis. The barrel and screw are inserted first using the specialized instrumentation. The proximal screws are then inserted into the proximal segment. The most distal screw or screws is/are inserted as lag screws across the cranial cortex of the distal fragment, dependent upon the fracture configuration. Lastly the open screw holes in the lateral plate are filled if possible, avoiding the existing implants. If the plate screws interfere with the initially placed lag screws, the latter can be removed prior to insertion of the respective plate screws.
Example of completed fixation
4. Overview of rehabilitation
Stall rest is maintained for 6-8 weeks depending on the stability of the fracture.
Radiographs are then taken to determine the next step in exercise. Complete radiographs of the femur can only be taken under general anesthesia. In proximal fractures this may be necessary. The distal one-half of the femur can be radiographed in the standing horse. For most mid-shaft and distal fractures, standing radiographs are sufficient to assess fracture healing and stability. Implants are not removed from the femur, even in foals intended for high-level athletic use.