Authors of section

Authors

Anton Fürst, Wayne McIlwraith, Dean Richardson

Executive Editor

Jörg Auer

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Resection

1. Positioning and approach

Positioning of the horse

Usually, the resection of the splint bone is performed under general anesthesia with the horse in lateral recumbency with the fractured splint bone up.

For segmental ostectomies, surgery with the horse standing may be considered to reduce risks during the recovery phase.

Approach

For this procedure an approach to the split bones is used. A straight incision is placed along the entire length of the splint bone.

Proximal splint bone fracture - resection

All the attachments to the splint bone are transected including the intermetacarpal/-tarsal ligament, the metacarpal/-tarsal fascia and the collateral ligaments of the carpus/tarsus.

Proximal splint bone fracture - approaches

2. Complete removal of the splint bone

Resection

The complete splint bone including all fragments are removed.
With the removal of the head of the splint bone a part of the articular surface of the carpometacarpal/tarsometatarsal joint is removed. The removal of the attachment of the collateral ligament as well as the removal of a part of the carpometacarpal/tarsometatarsal joint raises the risk of joint instability.

Proximal splint bone fracture - resection

Complication

Radiograph of a luxation of the tarsometatarsal joint that developed during recovery from anesthesia after complete splint bone removal.

Proximal splint bone fracture - resection

3. Alternative: Segmental ostectomy

Segmental ostectomy

In some cases, a segmental ostectomy can be performed in horses with complicated fractures composed of multiple small fragments.
If the distal fragment is not firmly attached to the third metacarpal/metatarsal bone, it should rather be removed, as it can irritate the suspensory ligament.

Proximal splint bone fracture - resection

Clinical example before (left) and after (right) the segmental ostectomy.

Proximal splint bone fracture - resection

Pitfall

The remaining proximal stump may dislocate, which can result in significant lameness and, eventually, degenerative joint disease.

Proximal splint bone fracture - resection

To avoid dislocation of the proximal stump, the fixation of the proximal remaining splint bone to the third metacarpal/-tarsal bone with a plate is necessary.

Proximal splint bone fracture - resection

4. Aftertreatment

A bandage is applied and changed every 3 days for wound evaluation and wound care for two weeks.
Antibiotics are administered dependent upon the degree of infection.
The sutures are removed after 10 days.

The horse is kept in a stall for 4 weeks followed by hand-walking exercises for another 4 weeks before the horse can go back to its intended work.

Follow-up x-rays are taken 8 weeks after surgery to evaluate fracture healing resp. the remodeling process.

Possible complications
Splint bone fractures can be further complicated by the development of osteitis, osteomyelitis and/or bone sequestra.

wound debridement