Screw fixation or resection

This procedure is performed with the patient placed in lateral recumbency and through stab incisions.

The fracture is reduced with pointed reduction forceps.
Anatomic reduction is confirmed by intraoperative radiographs.
Reduction is maintained with the pointed reduction forceps.

Before insertion of the screw, the optimal screw location is chosen with the help of needles.
Intraoperative radiography is used to confirm the proposed screw position.
Dependent upon the size of the fragment a 3.5 or 4.5 mm cortex screw is introduced in lag fashion.

Note: It may be advantageous to use two 3.5 mm screws instead of one 4.5 mm screw, as with two screws rotational stability assured.

In case the fragment is too small to reattach by means of a screw, the fragment is removed. The attachment of the collateral ligament is transected, before the fragment can be taken out.

Because only part of the collateral attachment is transected it usually not necessary to apply full limb cast. However it may prudent to apply such a cast for the recovery period only, despite the fact recovery with a full limb cast is more difficult for the horse.
A bandage is applied for two weeks and it should be changed every 5 days.

Sutures are removed after 10 days.

The horse is kept in a stall for 4 weeks. Hand-walking exercises are indicated for another 4 weeks before the horse can be put back into training.

Follow-up x-rays are taken 8 weeks after surgery to evaluate fracture healing.

Radiographic control after two years. The fracture has healed completely and no signs of degenerative joint disease can be seen.