Authors of section

Authors

Anton Fürst, Christoph Lischer

Executive Editor

Jörg Auer

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Plate fixation

1. Principles

When the comminution is that severe, that stable internal fixation cannot be achieved, euthanasia has to be considered.

Calcaneus - comminuted fracture of the shaft - plate fixation

2. Preparation and approach

This procedure is performed with the patient placed in lateral recumbency and through the approach to the calcaneal shaft.

plate fixation

3. Reduction and Fixation

Reduction

Reduction of the fracture is achieved with pointed reduction forceps. The reduction clamps should be applied to allow plate application without removing the clamps.

Calcaneus - simple fracture of the shaft - plate fixation

Plate application

If adequate reduction has been achieved, the plate is immediately applied.

A broad 4.5 mm locking compression plate is anatomically contoured and applied to the plantarolateral surface of the calcaneus. At least two 5 mm locking head screws should be inserted into each main fragment.

Dependent upon the fracture configuration, additional screws are inserted in lag fashion across the fracture planes.

Calcaneus - simple fracture of the shaft - plate fixation

If the fracture is highly instable, cortex screws in lag fashion should first be placed across the fracture planes before the plate is applied.

Since there is frequently not enough room to place two 4.5 mm screws, the use of 3.5 mm cortex screws is encouraged. These screws can be countersunk beneath the bone surface allowing the plate to be applied directly over the screw heads.

Calcaneus - simple fracture of the shaft - plate fixation

It may be possible to apply a second narrow plate parallel to the first one. Despite the fact that ideally the two plates should be applied at right angles relative to each other the proposed configuration still adds to the stability of the fixation.

Each plate should contain an interfragmentary screw.

Calcaneus - simple fracture of the shaft - plate fixation

4. Aftertreatment

Broad spectrum antibiotics are administered for 3 weeks.

The limb is placed in a full limb cast for three weeks. If necessary it is encouraged to change the cast after 7 to 10 days when the initial swelling has subsided. This is followed by a cast that can be snugly applied to the limb.

The horse is kept in a stall for 4-8 weeks. Hand-walking exercises are indicated for another 4-8 weeks before the horse can be put back into training.

Follow-up radiographs are taken 8 weeks after surgery to evaluate fracture healing and prescribe further postoperative management.

resection

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

screw fixation