Authors of section

Author

Alan Ruggles

Executive Editor

Jörg Auer

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Resection

1. Resection

Patient positioning

The procedure is performed with the patient placed in dorsal recumbency.

Placing the arthroscope

The arthroscope is placed in the distal aspect of the dorsolateral pouch of the tarsocrural joint with the limb in extension. The limb is manipulated to allow proper placement of portals in the dorsolateral and if needed plantarolateral aspect of the joint.

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Identification of the fragment is usually obscured by the lateral collateral ligament attachments and fibrin which is regularly present in the joint.

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Creation of the instrument portal

An instrument portal is made lateral and proximal to the arthroscope portal. Fibrin within the joint is removed using Ferris-Smith rongeurs and lavage.
Once the fracture margin is identified, an arthroscopic scalpel is used to transect any remaining soft-tissue attachments to the fragment.

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Fragment removal

Once the fragment is freed of its soft-tissue attachments it can be removed with Ferris-Smith rongeurs.
Some fragments are quite large and may extend to the caudal tibia. In such cases a second instrument portal in the plantarolateral pouch is helpful for soft-tissue dissection and removal of the fragment.

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2. Closure

Creation of the instrument portal

If the instrument portal is large because of the size of the fragment, a two-layer closure of the portal is recommended.

3. Aftercare

For small fragments routine post arthroscopy bandaging and recovery is appropriate. Care should be taken during recovery if very large fragments have been removed or if there is significant additional damage to the lateral collateral ligament. In these circumstances the use of a splint (arrow) or cast-bandage is recommended to protect the tarsus during recovery.
These devices can be removed immediately postoperatively and a bandage can be applied.
The horse is confined in stall for 4-6 weeks with hand walking beginning after week 2 followed by pasture turn out for at least 8 weeks.
A firm swelling is typically present after removal because of the associated soft-tissue injuries. The swelling typically improves 4-6 months postoperatively.

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tension band
tension band