Large Animals Fracture Repair

Equine Fracture Repairs

Figure 21:  Radiograph showing a palmar osteochondral fragment originating from the proximal palmar aspect of the middle phalanx.

Figure 22:  Soft-tissue avulsion and fracture of the eminences of the middle phalanx with resultant palmar instability of the proximal interphalangeal joint. Fracture of this size preclude primary reduction and stabilization; consequently, the palmar tension band connot be re-established.

Figure 23:  Palmar instability with proximal interphalangeal luxation and distal displacement of the proximal phalanx into the fracture line following comminuted middle phalangeal fracture. Note the close proximity of the fracture line to the articulation between the middle phalanx and the navicular bone.

Figure 24:  Uniaxial palmar eminence fracture of the middle phalanx. The fracture is chronic in nature, with evidence of periartecular new bone formation and degenerative joint disease of the proximal interphalangeal joint.

Figure 25:  Intraoperative radiography of parallel screw arthrodesis of the proximal interphalamgeal joint. Lateral to medial (A) and dorsal to palmar (B) projections.

Figure 26:  Improper screw length with impingement on the palmar soft-tissue structures in the navicular area.

Figure 27:  Exostosis on the dorsal aspect of the distal phalanx, distal to the extensor process (arrowhead), following proximal interphalangeal arthrodesis.

Figure 28:  T-plate applied dorsally for fixation of a biaxial eminence fracture of the middle phalanx and arthrodesis of the proximal interphalangeal joint.

Figure 29:  Radiographic follow-up 3 months following middle phalangeal fracture fixation and proximal interphalangeal arthrodesis utilizing a dorsal T-plate. Although increased purchase in the middle phalanx was possible with distal plate application, secondary impingement of the plate on the extensor process of the distal phalanx (arrowhead) has occurred.

Figure 30:  Fixation of an open pastern luxation with loss of medial and palmar periarticular support structures. Two 5.5 mm bone screws were placed in lag fashion across the proximal interphalangeal joint via stab incision to avoid further soft tissue compromise.

Figure 31:  A and B, Proximal interphalangeal arthrodesos using a combination of 5.5 mm bone screws placed in lag fashion across the medial and lateral aspects of the proximal interphalangeal joint, and a dynamic compression plate positioned dorsally. Note that in the lateral to medial projection there is a single 4.5 mm transarticular screw placed lag fashion through the second hole from the distal end of the plate. (B, arrowhead). Although the plate could be positioned more distally to allow increased purchase in the middle phalanx, such placement is inadvisable because of potential impingement on the joint capsule of the distal interphalangeal joint and the extensor process of the distal phalanx.

Figure 32:  A Lateral  to medial radiograph of a comminuted middle phalangeal fracture of the horse shown in figure 13-14. Note the evidence of fracture into the distal interphalangeal joint near the navicular bone (arrowhead). B. Intraoperative film showing complete fixation using two narrow dynamic compression plates with 5.5 mm bone screwa. Note the purchase in the pakmar eminences by distal screws, which are placed as lag screws through the plates.

Figure 33:  A and B, Foloow-up radiographs of the horse shown in fugure 13-14, demonstrating fracture healing and complete arthrodesis of the proximal interphalangeal joint. Note the minimal periosteal new bone formation, which indicates a stable fixation and the absence of degenerative changes in the distal interphalangeal joint.

Figure 34:  Radiograph of an osteochondral chip fragment (arrow) of the proximomedial eminence of the proximal phalanx.

Figure 35:  Radiograph of a typical articular apical sesamoid fracture before (A) after (B) removal through an arthrotomy.

Figure 36:  Radiograph of a horse with fetlock breakdown injury resulting from fracture distraction of the lateral and medial sesamoid bones. Breakdown injury caused by rapture of the distal sesamoidean ligaments. The sesamoids are displaced proximally.

Figure 37:  Dorsopalmar radiograph obtained prior to arthrodesis to treat intractable lameness associated with advanced degenerative joint disease. The joint has collapsed medially, resulting in varus angulation to the distal limb

Figure 38:  Arthrodesis of the fetlock in a horse with degenerative joint disease with an intact suspensory apparatus. The sesamoid bones have been attached to the metacarpus by lag screw.

Figure 39:  Arthrodesis of the fetlock in a horse with degenerative joint disease with an intact suspensory apparatus. The sesamoid bones have been attached to the metacarpus by lag screw.

Figure 40:  Tension-band wires have been inserted to provide pakmar support following sesamoid disintegration.