Authors of section

Authors

Anton Fürst, Christoph Lischer

Executive Editor

Jörg Auer

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Screw fixation

1. Preparation and approach

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

screw fixation

2. Surgical technique

Planning the screw position

The optimal screw position is chosen based on the fracture configuration seen on CT images.
The screw position is determined with the help of needles. One needle is placed into the proximal intertarsal joint, one into the distal intertarsal joint and one at the intended screw position.

Simple fractures of the central tarsal bone - screw fixation

Stab incision

A stab incision is placed over the planned screw position on the medial side of the tarsus over the central tarsal bone.

Simple fractures of the central tarsal bone - screw fixation

Drilling the glide hole

A 4.5 mm glide hole is drilled perpendicular to the fracture plane in to the medial aspect of the central tarsal bone.

Simple fractures of the central tarsal bone - screw fixation

Intraoperative radiography or fluorosocpy aids in recognizing when the glide hole reaches or just passes the fracture plane.

Simple fractures of the central tarsal bone - screw fixation

Preparing the thread hole

The 3.2 mm insert drill sleeve is inserted into the glide hole and the thread hole drilled across the rest of the bone.

Simple fractures of the central tarsal bone - screw fixation

Countersinking

A countersink depression is prepared to accept the screw head.

Simple fractures of the central tarsal bone - screw fixation

Measuring screw length

The depth gauge is introduced to determine the required screw length.

Simple fractures of the central tarsal bone - screw fixation

Inserting the screw

The hole is tapped and a 4.5 mm cortex screw of predetermined length is inserted and tightened.

Simple fractures of the central tarsal bone - screw fixation
Simple fractures of the central tarsal bone - screw fixation

Correct screw placement is confirmed using the C-arm before the stab incision is closed in two layers with interrupted skin sutures.

Simple fractures of the central tarsal bone - screw fixation

3. Aftertreatment

Recovery

A support bandage that includes the entire tarsal region is applied and the horse is recovered from anaesthesia with manual assistance.

Aftercare

The limb is bandaged for 15 days. The horse is confined to a box stall for 2 months, after which time it is put on a small paddock or another 2 months. The sutures are removed 10 days postoperatively.

Implant removal

If the lameness persists after surgery, it may be necessary to remove the screw via a medial stab incision. It is believed that postsurgical pain is caused by the rigid implant in a less rigid bone. This is supported by the observation that after implant removal horses have a higher rate of return to athletic activity.

screw fixation