Approach for comminuted and transverse body fractures of the equine proximal phalanx
1. Skin incision
This approach can be used for open reduction and internal fixation of comminuted fractures with a medial intact strut of bone or for transverse body fractures repaired with double-plating.
A curved incision through the skin and subcutaneous tissues is performed at the lateral side, extending distally from the distal end of the fourth metatarsal/metacarpal bone to approximately one half of the length of the proximal phalanx.
For double-plating in transverse body fractures, the incision over the dorsal aspect of the proximal phalanx may have to be carried more axially to apply a plate on the dorsal medial aspect of the bone.
The skin flap is dissected laterally to expose the palmar/plantar joint capsule of the fetlock joint. The joint capsule is opened through a stab incision. The incision is carried along the joint margin through the lateral collateral ligament of the fetlock joint and extended along the dorsal margin of the fetlock joint.
The proximal articular surface is identified, the soft tissues elevated as needed, and the fracture planes are debrided.
4. Wound closure
The joint capsule and the collateral ligament are closed with interrupted absorbable sutures. The remainder of the closure is routine.