Transphyseal bridge

Intraoperative imaging is helpful, particularly if working through stab incisions to ensure proper implant positioning.

This procedure is performed with the patient placed in lateral recumbency or dorsal recumbency, through a stab incision.

A 3.2 mm hole is prepared in the medial epiphysis of the radius extending to approximately mid-point of the bone.
Screw length is determined by measuring the depth of the hole and choosing a screw 4-6 mm shorter than the measured length.
The hole is tapped and a 4.5 mm screw of appropriate length is inserted approximately ¾ of its length.

A second screw is inserted using the same technique in the distal radial metaphysis 30-40 mm proximal to the physis.

A 1.25 mm stainless steel cerclage wire is formed into a figure-of-8 pattern, introduced through the proximal skin incision and directed subcutaneously in distal direction and looped over the epiphyseal screw. The proximal ends are looped over the metaphyseal screw, twisted and tightened. The twisted ends of the wires are cut and the cut ends of the twist are bent over towards the bone to prevent irritation of the overlying soft tissues.

A second wire is placed in the same fashion to increase strength of fixation and provide for back up in case one of the wires fails.

The screws are fully tightened.

The soft tissues are closed routinely and a bandage is applied.

A full limb bandage is applied to the limb and the foal assisted during recovery.

The bandage is maintained for 30 days with bandage changes at 4 day intervals. After 2 weeks only the carpus is lightly bandaged

The foal is kept in stall rest for a minimum of 60 days. The first 30 days hand-grazing only is advised, followed by 30 days of hand-walking.

Follow up radiographs are taken 45-60 days postoperatively. If healing appears to be progressing without complications the foal is gradually transitioned to free paddock exercise.

The implants are removed once the fracture appears to be stable and any residual valgus deformity has resolved.