Authors of section

Authors

Jörg Auer, Larry Bramlage, Patricia Hogan, Alan Ruggles, Jeffrey Watkins

Executive Editor

Jörg Auer

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Screw fixation and resection

1. Principles

Special attention is given to compression of the articular fracture line. Extraarticular fractures can heal by second intention and are usually not fixed unless the fragments are big and there is enhanced intraoperative diagnostic imaging available.
If possible two screws are inserted.

Multifragement fracture of the distal phalanx

2. Preparation and approach

With the appropriate preparation and draping of the surgical site, this procedure is performed with the patient placed in lateral recumbency.

fragment removal

3. Treatment

Screw fixation

The main articular fracture configuration is repaired by means of two 4,5 mm cortex screws inserted in lag fashion as described for the sagittal fractures.

Multifragement fracture of the distal phalanx

Fragment removal

If needed, the extensor process fragment can be removed under arthroscopic supervision.

Multifragement fracture of the distal phalanx

Filling the holes in the hoof wall

A small portion of a gentamycin-impregnated collagen sponge is inserted in each hole to fill the space between the surface of the distal phalanx and the hoof wall.

Multifragement fracture of the distal phalanx

The rest of the hole is filled with antibiotic-impregnated polymethylmethacrylate (PMMA). The edges are sealed with cyanoacrylate glue. If desired a Kevlar® strip can be glued over the top followed by non-adhesive tape covered.

Abaxial articular fracture of the distal phalanx - screw fixation

4. Aftertreatment

Because the non-articular fragments are not repaired, additional external coaptation is needed to facilitate their healing. For that purpose the horse is recovered either in a hoof cast or with a bar shoe and side clips.

screw fixation and resection

The cast is changed at 2 weeks and left in place for another 4 weeks. At that time the hoof is wrapped only with non-elastic tape for 2 weeks.

screw fixation and resection

Radiographic follow up

Follow-up radiographs are taken at 2 months after initiation of the treatment. Dependent on the result and the findings of a brief lameness exam treatment is either continued or stopped.
Bar shoes with side clips are changed at 4-6 weeks intervals. At the third application the side clips can usually be removed. It is advisable to take radiographs at the 2nd changing of the shoes to assess healing.

screw fixation and resection

Left a multifragment fracture, treated at the time of admission (Dec 13, 2001 / 2 views): the faint fracture lines can be appreciated.

screw fixation and resection

A 7.5 week follow up after insertion of one cortex screw in lag fashion: The fracture lines are becoming wider and somewhat fuzzy.

screw fixation and resection

The 10.5 week follow up radiograph shows progression of bone healing. A horse shoe with side clips is applied to provide additional external support to the fracture. However the fractures are not completely healed.

screw fixation and resection

Complication

The hoof cast and horse shoes with side clips effectively prevent hoof expansion during weight-bearing, which leads to a contracted foot. Once the cast is removed a special shoe whose heels are taped to the outside is applied to facilitate expansion of the heels. This procedure takes some time.

The same problem occurs with the bar shoe and side clips. The management is identical to the one above.

screw fixation and resection
screw fixation and resection