Authors of section

Authors

Anton Fürst, Wayne McIlwraith, Dean Richardson

Executive Editor

Jörg Auer

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Minimally invasive fixation

1. Introduction

Minimal invasive fracture fixation is becoming more and more popular among equine surgeons. A prerequisite is profound knowledge of the anatomic situation and the internal fixation techniques. Intraoperative availability of an image intensifier is strongly encouraged.
Minimal invasive fracture fixation is almost exclusively performed with locking compression plates and locking head screws.

minimally invasive fixation

2. Preparation and approach

This procedure is performed with the patient in dorsal recumbency or in lateral recumbency, through a minimally invasive approach.

stab incision for minimally invasive fixation

3. Minimal invasive fixation

The subcutaneous tissues are separated from the periosteum with the help of a long periosteal elevator or a similar instrument in distal and proximal direction along the entire bone where the plate will be applied.

minimally invasive fixation

At the distal end of the bone another small incision is prepared to allow insertion of the pre-contoured plate in proximal direction.

minimally invasive fixation

Plate insertion is supervised with the help of the image intensifier.

minimally invasive fixation

The first screw is inserted through a distal hole.

minimally invasive fixation

An additional small skin incision is performed at the proximal end of the plate followed by insertion in neutral position of another screw near the end of the plate.

minimally invasive fixation

If possible additional screws are inserted through the plate at the fracture site.

minimally invasive fixation

Next the second plate is applied at the planned location using identical technique.

minimally invasive fixation

The stab incision for insertion of the remaining screws are best performed through an identical plate placed directly over the implanted plate on the surface of the bone.

minimally invasive fixation

The remaining screws are inserted one by one taking care not to contact any of the previously inserted screws.
Final tightening of all screws is performed by hand.

minimally invasive fixation

4. Closure

All incisions are closed with simple interrupted skin sutures.

minimally invasive fixation

5. Regional intravenous perfusion

At the end of the procedure it is advisable to perform regional intravenous perfusion with broad spectrum antibiotic of the surgeon’s choice.
A tourniquet is applied at the distal third of the radius/tibia followed by insertion of an indwelling catheter into the corresponding vein distal to the tourniquet (Cephalic vein in the forelimb, saphenous vein in the hind limb).

plate fixation

About 40 ml of blood is withdrawn from the vein followed by by slow injection of the same amount if antibiotic.
The antibiotic is maintained in the fracture region for 20 to 30 minutes.

6. Recovery from anesthesia

If the fracture was repaired with two plates the limb is covered by a tight full-limb bandage and recovered from anesthesia.

additional material

In selected cases a full-limb splint is added to the bandage for recovery.

plate fixation

7. 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.