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Avoiding Technical Failures in Fracture Repair in the Horse
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Lecture objectives
- Identify technical errors in internal fixation in the horse
- Critique internal fixation repairs for technical errors
- Analyse internal fixation errors for biomechanical reasons for failure
Technical errors using screws and plates occur to all surgeons and under all circumstances. Obviously, with experience, the failure rate is reduced (we hope!). Technical failures occur in the following categories: poor preoperative planning; improper intraoperative radiographic control; improper use of the equipment; improper application of the implant; and any combination of the above. This lecture will demonstrate many of the technical errors that can happen in plate fixation of fracture repairs in the horse.
Careful preoperative radiographic evaluation and technique will reduce the rate of technical errors. Imaging control during surgery, whether by radiographs, fluoroscopy or computed tomography, will prevent errors, ensure proper placement and use of implants, improve results and allow the surgeon to gain confidence in the surgical techniques.
In my personal encounters with technical failures, failure to understand the biomechanical forces of the fracture, improper use of the equipment and failure to have adequate radiographic control has led to the most frequent cause of failure.
Some examples of mistakes in equine facture repair include:
Poor preoperative planning
- Inadequate understanding of the fracture biomechanics
- Inadequate familiarity with surgical anatomy
- Failure to identify all fracture lines – post-operative fracture or poor reduction
- Inadequate or improper implant inventory to complete task
- Inadequate understanding of techniques and pitfalls of specific fractures
Inadequate radiographic control (Figures 1 and 2)
- Screwhead incompletely seated – reduce compression, soft tissue pain
- Screw has bottomed out – failure to compress fracture
- Screw in fracture line – additional fractures
- Screw too long – soft tissue problems
- Screw does not enter into medullary cavity where appropriate
- Plate placed incorrectly – not central to bone, insufficient length
Improper use of equipment
- Instrument breakage – little morbidity
- Improper compression of fracture
- Poor staggering of plates inhibits screw placement – especially with locking compression plates
Improper application of implants (Figures 3 and 4)
- Poor understanding of biomechanics of fracture or specific issues with individual fracture
- Improper technique of inserting implants
[...]
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About
How to reference this publication (Harvard system)?
Affiliation of the authors at the time of publication
Rood and Riddle Equine Hospital, PO Box 12070, Lexington, Kentucky, USA
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