Medial condyle spiral fractures

Medial condylar fractures are injuries of race horses. In Thoroughbreds, there is a more even distribution between forelimbs and hind limbs. In Standardbreds, there may be a greater percentage of hind limb involvement.

Fractures typically cause fairly severe acute lameness. The degree of swelling is quite variable. Localizing lameness is not difficult because of pain on local manipulation and palpation.

A full set of radiographs (DP, LM, DMPLO, DLPMO) including the entire diaphysis is essential.

Although distal palmar/plantar comminution is not as common in medial condylar fractures as in lateral condylar fractures, the tangential projection to silhouette this region is advised.

On the DP projections the dorsal and palmar/plantar cortices of sagittal fractures typically (but not always) remain parallel at the level of the proximal sesamoid bones and distal third metacarpal/metatarsal bone (A).

True spiral fractures typically (but not always) have their dorsal and palmar/plantar cortices separate on this view at or below the apex of the proximal sesamoid bones (C).
The fracture in (B) did not spiral but an additional small fracture line can be seen further proximally (arrow). Note the oblique mid-diaphyseal lucency.

In all medial condylar fractures, the lateral and oblique views are essential to assess spiraling of the fracture.

If surgical fixation under anesthesia is elected, the ideal way to assess these fractures is with a CT scan. This is by far the most accurate method of understanding the fracture configuration and planning a surgery.