Large Animals Fracture Repair

Equine Fracture Repairs

Figure 41:  Tension-band wires have been inserted to provide pakmar support following sesamoid disintegration.

Figure 42:  Subluxation of the pastern joint following rupture of the distal sesamoidean ligaments and subsequent fetlock arthrodesis.

Figure 43:  Closed comminuted third metatarsal fracture with a large butterfly fragment in a foal. The radiograph made after the limb was protected by a splint. B, Repair with two broad dynamic compression plates. The three screws in the center of the dorsal plate are placed as lag screw. Two screws in the center of the plate are 4.5mm screws; the remainder are 5.5mm screws for added strength. C. Fracture healing at 6 months. Moderate callus formation at the fracture site indicates that motion was present despite anatomic reconstruction and stabilization with two plates.

Figure 44:  A, Transverse open fracture of the third metacarpus in a foal. Although this fracture is easier to repair than the fracture shown in Figure 18-2, the presence of contamination increases the risk of infection. B, Dorsopalmar radiography of the repair 60 days following surgery. The limb recently developed swelling, and the incision is now open and draining. C. Lateral radiograph reveals a large sequestrum. The fracture did not heal because of the infection, and the foal was euthanized. This is a frequent result if osteomyelitis develops in metacarpal or metatarsal fractures repaired with plates and screw, even in foals.

Figure 45:  A, A midshaft transverse metacarpal fracture in a young foal. B, fracture repair with a transfixation pin cast. The fracture was aligned by closed reduction, and pins were placed through the metacarpus and later incorporated in a full-limb cast. C. Fracture callus has begun to form 3 weeks after surgery, and the fracture subsequently healed satisfactorily.

Figure 46:  Dorsopalmar radiograph of a displaced lateral condylar fracture of the third metacarpus in a 3-year-old Thoroughbred.

Figure 47:  Dorsopalmar radiograph of a displaced lateral condylar fracture following repair. The Lateral sesamoid has an axial sesamoid fracture (arrow), which is easily missed on an underexposed radiograph.

Figure 48:  Intraoperative radiograph to evaluate fracture reduction and the location of the 2.0mm marker drill bit. Two ASIF bone reduction forceps have been used to reduce the condylar fracture.

Figure 49:  Linear proximal metacarpal fracture in a horse with a history of recurrent episodes of severe lameness.

Figure 50:  A, Atypical propagating fracture of the proximal metacarpus in a 2-year-old Standardbred racehorse with severe lameness following a race. B, Surgical repair with interfragmentry lag screws. Screws were not inserted distally in the fracture because of the proximity of the nutrient foramen. The screws were removed after the fracture healed, and the horse subsequently competed in more than 100 race.

Figure 51:  Open comminuted fracture of the proximal third of the fourth metatarsal bone.

Figure 52:  Distal splint-bone fracture in a standard bred with concurrent suspensory desmitis.

Figure 53:  Fracture of the middle third of the second metacarpal bone treated conservatively and resulting in exuberant callus.

Figure 54:  Proximal fracture of the fourth metacarpal bone. B, displacement after amputation of the distal splint bone: C attempts to stabilize the proximal fragment.

Figure 55:  Chronic distal splint-bone fracture with displacement and callus formation.

Figure 56:  Open comminuted fracture of the proximal third of the fourth metatarsal bone.

Figure 57:  Distal splint-bone fracture in a Standardbred with concurrent suspensory desmitis

Figure 58:  Radiograph after lag-screw fixation of a frontal slab fracture involving both facets of the third carpal bone.

Figure 59:  Radiographic view (A) of carpal collapse affected with fracture of the third, fourth and intermediate bones. B Lar-screw fixation of each of the fractures bones.

Figure 60:  Radiograph of a fragment off the palmar aspect of the radial carpal bone (arrow), which was removed by arthroscopic techniques.