Standing fracture repair: Is it better than general anaesthesia?

Standing fracture repair was introduced into equine surgery using the rationale that the course of propagating fractures of the metacarpal and metatarsal condyles was not accurately predicted by preoperative radiographs and that the risks associated with recovery from general anaesthesia outweighed potential benefits [1,2]. These premises were endorsed by Payne and Compston [3] who also reported the use of the technique in treating nonpropagating fractures of the metacarpal and metatarsal condyles and of the proximal phalanx. Questions were raised by Martens and Declercq [4], however, critical appraisal including comparisons of efficacy, morbidity and mortality has been lacking. Additionally, techniques for in-theatre imaging, principally computed tomography (CT) and arthroscopy, together with the development of arthroscopically guided minimally invasive repair together with improved safety of general anaesthesia have progressed. A risks vs. benefits debate is therefore timely