Preparation proximal sesamoids

In preparation for surgery, the hair is removed from the distal limb starting from the coronary band and extending proximally to the mid-metatarsal/metacarpal region. The entire hoof is thoroughly cleaned.

The entire distal limb is prepared for aseptic surgery and placed in a sterile bandage to be removed at the time of surgery.

Left: the limb was prepared as described above in the standing horse the day before the surgery.

The horse is anesthetized and placed in lateral recumbency with the affected proximal sesamoid bone uppermost.

For the removal of an apex fragment, the animal can be positioned either in dorsal recumbency or in lateral recumbency.

Dorsal recumbency allows the insertion of the arthroscope from the contralateral palmar pouch to facilitate better visualization and an unfretted region for the instrument insertion and manipulation during fragment removal.

Application of a tourniquet after application of a temporary Esmarch bandage is optional; the author favors its use.

In dorsal recumbency a tourniquet is rarely needed.

The distal limb and the entire foot are scrubbed again for aseptic surgery and draped. The fetlock region is best draped with a sterile adhesive drape such as an Ioban® drape to facilitate good visual control of the surgical site.