2-3 months following surgery the horse is returned for screw removal regardless of the radiographic appearance.
2. Localizing the screw
Often the head of the screw can not be distinctly palpated. If so, a grid of skin staples is placed over the site after aseptic preparation and a radiograph taken that is parallel with the direction of the screw. Typically this means a DLPMO view. This radiograph allows very accurate estimation for the location of an incision to remove the screw.
To access the plate usually the healed skin incision used for the original approach to the bone is circumcised followed by splitting the common digital extensor tendon again.
A 1 cm incision is made after local anesthetic is infused under the skin over the screw head. The surgeon must be certain to fully engage the hexagonal screw driver into the head of the screw because 3.5 mm screws are very easy to strip.
Following screw removal the incision is closed with skin sutures only.
6. Aftercare following screw removal
The horse is stall rested with hand-grazing only for 2 weeks, then increasingly hand-walked for another two weeks. At 4 weeks the horse can be turned out into a small paddock. At 8 weeks the horse is returned to training. The metacarpus is radiographed before the horse does its first breeze (work at maximal speed) to make sure that healing is complete. There may be a faint outline of the osteostixis holes still present but there should be no evidence of the original fracture and usually a significant endosteal callus.