Plate fixation

Fractures of the body of the scapula are repaired by means of one plate applied to the cranial aspect of the scapular spine and a second plate to the caudal aspect thereof. Care must be taken to stagger the plate such that a screw in the cranial plate is placed between the two adjacent screws in the caudal plate.

Read more about patient prognosis and possible complications.

This procedure is performed with the patient placed in lateral recumbency through the lateral approach.

The fracture is anatomically reduced and the cranial plate is contoured to the bone.

A cortex screw is placed through the second combi hole cranial to the fracture site and tightened.

The next cortex screw is inserted through the second combi hole caudal to the fracture site in load condition and solidly tightened.

Two additional cortex screws are placed in neutral position in the second last combi hole at both ends of the plate and tightened. This assures the entire plate has good contact with underlying bone.

The second plate is contoured to the caudal aspect of the scapular spine and applied to the bone in identical fashion as the cranial plate.

Note: The two plates have to be staggered such that a screw inserted at a right angle relative to the long axis of one plate fits between the two adjacent screws in the second plate. The fact that the distances between two screws differ when cortex- or locking head screws are inserted has to be taken in account.

The remaining screws (either cortex or locking head screws) are inserted and tightened. At least 2 locking head screws must be inserted cranial and caudal to the fracture site in both plates.

Two immediate postoperative radiographic views of a repaired fracture.

The soft tissues are closed in several layers. A simple continuous suture is placed in subcutaneous tissues, followed simple interrupted sutures in the skin covered by a stent bandage.

Horses are restricted to stall rest for 60 days to allow time for the dead space to fill with fibrous tissue and the biceps tendon to reattach. A carefully controlled rehabilitation program is important for these horses to regain strength and coordination in their shoulder joints.

Percutaneous stimulation of the shoulder muscles during rehabilitation to minimize muscle atrophy should be considered.

Typically, physical therapy begins with range-of-motion exercises and hand-walking for 5 minutes per day, followed by walking over ground poles and gradual increases in duration of exercise each day. Horses are not usually ready to return to training or to be turned out into a paddock for 6 to 12 months after surgery.