Less Invasive Techniques for Equine Fracture Repair and Arthrodesis

Internal fixation of equine fractures has advanced over the last few decades primarily because of improving expertise by practicing surgeons and correct application of implants according to proven mechanical principles. The unfortunate reality of fracture repair in horses, however, is that failures still occur commonly because of infection and delayed union. Delayed union in other species is a lesser issue because the consequences of severe lameness and overload of the contralateral limb are less and the expectations for return to function are usually lower.

A large proportion of fractures in horses occur in the distal extremities where soft tissue coverage is poor. Aggressive open exposures and application of plates/screws/IM nails etc. all adversely affect local vascularity. Aggressive surgical reduction usually disrupts the fracture hematoma, medullary elements and periosteal integrity. The natural evolution of surgical technique is to make procedures less invasive. Less invasive approaches diminish the risk of infection, ameliorate postoperative pain, cause less scarring and cosmetic blemish and generally interfere less with the healing processes. The disadvantages of less invasive techniques include the necessity for accessory imaging modalities such as endoscopy and fluoroscopy. Added expense is also a potential disadvantage of minimally invasive fracture repair because optimal fixation of less than perfectly reduced fractures involves the use of newer (and more expensive) locked plating technology. Finally, there is little doubt that it is easier to make errors when using less invasive techniques.

Case selection for minimally invasive fracture repair is still being defined and will continue to depend on a surgeon’s experience and available equipment. Many surgeons now will repair displaced carpal slab fractures and lateral condylar fractures with a minimally invasive arthroscopic approach (Arthroscopically assisted repair of articular fractures. Clinical Techniques in Equine Practice, 2002. Reduction and internal fixation of displaced phalangeal and mid-body sesamoid fractures also can be done with a combination of arthroscopic and fluoroscopic guidance.  [...]