Authors of section

Authors

Anton Fürst, Wayne McIlwraith, Dean Richardson

Executive Editor

Jörg Auer

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Fixation with plates and screws

1. Preparation and approach

This procedure is performed with the patient in dorsal recumbency or in lateral recumbency, through an open approach.

open approach

2. Reduction

The fracture is anatomically reduced using traction, tenting and rotating movements, followed by the application of one or two pointed reduction forceps.

fixation with plates and screws

3. Fixation (through an open approach)

Ideally two 3.5 mm interfragmentary cortex screws are inserted to fix the fracture.
If necessary the screw heads can be countersunk such that they are flush with bone surface, which allows the placement of a plate directly over them.
The reduction forceps are subsequently removed.

fixation with plates and screws

The first plate is contoured to cover the most distal aspect of the proximal fragment and attached to the bone either with the help of the push-pull device or through a position screw applied in neutral position though a plate hole near an end of the plate.
The screw is inserted perpendicular to the long axis of the bone.

fixation with plates and screws

Subsequnetly a second position screw is inserted through a plate near the distal end of the plate, also in neutral position. In adult horses it may be advantageous to apply some axial compression but usually it is not necessary if good anatomic reduction was achieved and interfragmentary are positioned well.

Note: Excessive axial compression through the plate(s) following interfragmentary fixation of the fracture may be detrimental because it may disrupt the perfect anatomic reduction achieved initially. Foals are especially prone to such complications.

fixation with plates and screws

Next one to two screws are placed in the center of the plate. If the screws cross the fracture plane they are inserted in lag fashion.

fixation with plates and screws

If two plates are implanted is best to apply now the second plate similar to the first one.

fixation with plates and screws

If locking compression plates are used at least two locking head screws are now inserted in the proximal and distal fragment of both plates.

fixation with plates and screws

The remaining screws are inserted taking care to avoid inadvertent contact with any previously inserted screw.

fixation with plates and screws

All screws are checked for tightness.

fixation with plates and screws

If only one plate is used, all remaining screws are inserted and solidly tightened.
Where ever possible and needed additional cortex screws are inserted across fracture lines in lag fashion.

fixation with plates and screws
fixation with plates and screws

4. Skin closure

The longitudinally split common/long digital extensor tendon is sutured with a simple continuous suture pattern of a 2-O
monofilament synthetic absorbable suture material.
The subcutaneous tissues are subsequently closed in identical fashion as the tendon and the skin is closed with skin staples or simple interrupted monofilament nylon sutures.

fixation with plates and screws

5. Aftercare

The patient is kept in a box stall for one month with some hand grazing after two weeks.
The bandage is maintained for 2-3 weeks and changes at 4-day intervals.
At the end of the first month the patient is allowed some exercise in a small paddock for one additional month.

fixation with plates and screws

Follow up radiographs are taken 2 months postoperatively. The remaining postoperative period is managed dependent upon the result of the follow up radiographs.

Implant removal

More information about implant removal can be found here.