Authors of section

Authors

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

Executive Editor

Jörg Auer

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Fragment removal

1. Preparation

Details on appropriate preparation and draping for this procedure can be found here.

fragment removal

2. Surgical technique

Arthroscopic examination

In lateral recumbency the arthroscope is inserted through the proximal most aspect of the palmar pouch, whereas the instruments are inserted through a separate incision at the level of the fracture plane.

Abaxial fracture of the proximal sesamoid bone - removal

The arthroscope is inserted and the fracture configuration inspected.

Abaxial fracture of the proximal sesamoid bone - removal

Fragment removal

The fragment is freed from its attachments with the help of sharp instruments such a scalpels, special, curved small osteotomes or sharp periosteal elevators. Once freed up the fragment is removed as a whole. Dependent upon the size of the fragment the instrument incision may have to be enlarged for fragment removal.

Abaxial fracture of the proximal sesamoid bone - removal

Another option is the use of an arthrobur to grind down the fragment and remove the debris via suction.

A combination of these techniques is also possible and larger fragments scan be split with an osteotome and removed fragment by fragment.

Abaxial fracture of the proximal sesamoid bone - removal

Debridement and inspection of the fracture bed

Once the fragment is removed the joint is thoroughly inspected and any remaining debris or any small fragments are removed. Special attention is given to the ligamentous attachment remains, which are checked for osseous remains attached to them.

It is advisable to take intraoperative radiographs to assure that the entire fragment is removed. Intraoperative fluoroscopy represent another option.

Abaxial fracture of the proximal sesamoid bone - removal

Lavage and closure

The joint is thoroughly lavaged, the excess fluid removed from the joint, the arthroscope removed and the incisions closed using routine technique. A sterile pressure bandage is applied to the limb with the horse still on the table.

3. Aftertreatment

A splint-pressure bandage is applied prior to recovery from anesthesia. In most cases the splint can be left off after a couple of days.

For abaxial fractures, only a pressure bandage is applied.

fragment removal

Extended stall rest and a gradual return to exercise will typically result in a functional fibrous union, however soundness is dependent upon the degree of osteoarthritis that develops.
Generally stall rest for 90 days followed by hand walking for 30-60 days is sufficient prior to free exercise.

Healing can be monitored radiographically and ultrasonographically. In some cases new bone formation at the fracture site may be noticed after some weeks, which usually do not cause any problems. The potential for return to the previous activities has to be judged cautiously.

wound debridement