Authors of section

Authors

Anton Fürst, Christoph Lischer

Executive Editor

Jörg Auer

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Screw fixation

1. Principles

Choice of treatment

For the treatment of comminuted fractures, often a combination of several techniques is required, such as arthroscopy and intraoperative radiographic control. Those techniques are described in the complete sagittal fractures and large trochlear ridge fractures.

Comminuted fractures of the talus

If the comminution is that severe, that sufficient stabilization cannot be achieved, euthanasia has to be discussed.

Comminuted fractures of the talus

2. Preparation and approach

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

screw fixation

3. Case example

Case example of a 16 year old Thoroughbred with a complete sagittal fracture in conjunction with a medial trochlear ridge fracture of the talus. The fracture is repaired by means of several screws inserted in lag fashion to fix both fracture planes.

Comminuted fractures of the talus

The first screw is inserted to provide interfragmentary compression across the medial trochlear ridge fracture.

Comminuted fractures of the talus

The second screw is inserted to fix the sagittal talus fracture.

Comminuted fractures of the talus

The third screw is inserted again across the sagittal fracture. Intraoperative x-ray reveals that the screw enters the fracture of the medial trochlear ridge fracture and had to be removed.

Comminuted fractures of the talus

Insertion of the fourth screw provides further compression across the medial trochlear ridge fracture.

Comminuted fractures of the talus

Additional intraoperative imaging revealed that the third screw was partially placed into the fracture line of the trochlear ridge fracture. The screw was therefore replaced.

Comminuted fractures of the talus

Final radiographic assessment reveals perfect reconstruction of both fracture planes.

Comminuted fractures of the talus
Comminuted fractures of the talus

4. Aftertreatment

A bandage is applied, the horse recovered, and maintained for two weeks. The bandage should be changed every 5 days.

The 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.

screw fixation