Carpal arthrodesis using a minimally invasive approach and locking compression plates: Three cases

Three horses with carpal instability due to comminuted second carpal bone fractures (Cases 1 and 3), fracture of the head of the second metacarpal bone (Case 1) or comminuted fractures of the fourth carpal bone, ulnar and intermediate carpal bones (Case 2) were treated by minimally invasive approach for partial (Cases 1 and 3) or pancarpal (Case 2) joint arthrodesis, using locking compression plates. The joint cartilage was removed by either an arthroscopic approach (middle carpal joint and antebrachiocarpal joint) or a percutaneous drilling technique (carpometacarpal joint). Two or 3 locking compression plates were contoured to the dorsolateral, dorsomedial and dorsoaxial aspects of the carpal joints using a custom‐made tunnelling tool and a minimally invasive tunnelling technique, and the screws were positioned through stab incisions. All cases recovered well, were lame free at the walk, were able to trot and gallop and could be used for leisure and pasture activities (partial carpal arthrodesis) and breeding (pancarpal arthrodesis). Post‐operative x‐rays showed progressive joint fusion after 12 months (Case 1), 5 months (Case 2) and 10 months (Case 3). Case 2 with a pancarpal arthrodesis showed a mechanical lameness at the walk due to the inability to flex the carpus. Carpal flexion after carpometacarpal and middle carpal arthrodesis in Case 1 was calculated to be 42.6° and 44° in Case 3.     

Failure mode and bending moment of canine pancarpal arthrodesis constructs stabilized with two different implant systems

Objective— To compare failure mode and bending moment of a canine pancarpal arthrodesis construct using either a 2.7 mm/3.5 mm hybrid dynamic compression plate (HDCP) or a 3.5 mm dynamic compression plate (DCP).
Study Design— Paired in vitro biomechanical testing of canine pancarpal arthrodesis constructs stabilized with either a 2.7/3.5 HDCP or 3.5 DCP.
Sample Population— Paired cadaveric canine antebrachii (n=5).
Methods— Pancarpal arthrodesis constructs were loaded to failure (point of maximum load) in 4-point bending using a materials-testing machine. Using this point of failure, bending moments were calculated from system variables for each construct and the 2 plating systems compared using a paired t-test. To examine the relationship between metacarpal diameter and screw diameter failure loads, linear regression was used and Pearson' correlation coefficient was calculated. Significance was set at P <.05.
Results— HDCP failed at higher loads than DCP for 9 of 10 constructs. The absolute difference in failure rates between the 2 plates was 0.552±0.182 N m, P =.0144 (95% confidence interval: −0.58 to 1.68). This is an 8.1% mean difference in bending strength. There was a significant linear correlation r=0.74 ( P -slope=.014) and 0.8 ( P -slope=.006) between metacarpal diameter and failure loads for the HDCP and 3.5 DCP, respectively.
Conclusion— There was a small but significant difference between bending moment at failure between 2.7/3.5 HDCP and 3.5 DCP constructs; however, the difference may not be clinically evident in all patients.
Clinical Relevance— The 2.7/3.5 HDCP has physical and mechanical properties making it a more desirable plate for pancarpal arthrodesis.     

Clinical Evaluation of Pancarpal Arthrodesis Using a CastLess Plate in 11 Dogs

Objective— To describe the use of a 3.5/2.7 mm CastLess Plate (CLP) for pancarpal arthrodesis (PCA) in dogs.
Study Design— Case series.
Animals— Dogs with traumatic/degenerative carpal disease (n=11).
Methods— Records (September 2006–July 2007) of dogs that had PCA using a 3.5/2.7 mm CLP were reviewed to determine intra- and postoperative complications and use of external coaptation. Follow-up (≥12 months) was obtained by telephone interview of owners.
Results— Thirteen PCA procedures were performed; 5 intraoperative complications occurred in 4 procedures and included iatrogenic metacarpal fissure fracture (2), inability to remove an alignment pin (1), and poor distal plate position (2). External coaptation was used in 4 dogs: concomitant or iatrogenic injuries (3), bilateral PCA (1), for 3–6 weeks. Clinical evaluation 6–24 weeks postoperatively revealed iatrogenic metacarpal fractures to have healed and that 1 postoperative complication (infection) developed. Telephone follow up for 10 dogs (mean, 14 months; range, 12–20 months) revealed no further problems.
Conclusion— PCA using a 3.5/2.7 mm CLP reduces the need for external coaptation and seemingly reduces postoperative morbidity associated with other internal fixation techniques.
Clinical Relevance— PCA can be performed safely and successfully using a 3.5/2.7 mm CLP, with low postoperative morbidity compared with other PCA techniques. Particular attention should be taken when applying the distal component of the plate.     

Healing of dorsal pancarpal arthrodesis in the dog

The purpose of this study was to assess radiographically the healing process in dogs which had undergone dorsal pancarpal arthrodesis with autologous cancellous bone grafting. The medical records of 17 dogs that had undergone dorsal pancarpal arthrodesis with complication-free dynamic compression plate fixation were reviewed. Postoperative healing was evaluated radiographically. It started five weeks after surgery and progressed for six to 12 weeks in all dogs. After this time period no further progression of healing was observed. Between weeks 6 and 8, bony fusion progressed significantly more rapidly in the intercarpal joint than in the radiocarpal joint. The following criteria had no influence on healing time: gender, age, bodyweight, and immediate versus delayed surgery after trauma. The major difficulties noted with respect to the interpretation of postoperative radiographs were irregular bony bridging, mainly caused by inadequate palmar curettage, and oblique projection of articular surfaces resulting in superimposition of joint spaces and solid bone.     

Partial carpal and pancarpal arthrodesis in the dog: a review of 50 cases

Fifty-six carpal arthrodeses were carried out in 50 dogs. Six of these had bilateral arthrodeses. A dynamic compression plate (DCP; Straumann Great Britain Ltd), placed on the dorsal aspect of the carpus, was used for fixation in all cases. The main indication for pancarpal arthrodesis was a hyperextension injury of the radiocarpal joint. Forty-three pancarpal arthrodeses were performed in 40 dogs (a bilateral procedure was performed in three). Hyperextension injuries of the intercarpal and carpometacarpal joints were treated by partial carpal arthrodesis in 10 dogs; three of these had bilateral procedures. Seventy-four per cent of dogs treated by pancarpal arthrodesis regained full limb function. Only 50 per cent of cases treated by partial carpal arthrodesis had a similar result.     

Third tarsal bone fractures in the greyhound

Objective : To describe the signalment, morphology, response to treatment and prognosis of third tarsal bone fractures in the racing greyhound. Methods : All third tarsal bone fractures seen by the author over a ten year period were included in the study. Diagnosis was by radiography. Treatments were reconstruction with a lag screw, fragment removal, centrodistal joint arthrodesis or conservative management. Results : Twenty-three cases were included in the study of which 16 cases were recent and seven cases chronic fractures. The chronic cases had been rested from between three and six months before an examination for recurrent lameness. There were five concomitant second tarsal bone fractures. Partial dorsal collapse was present in four cases. Thirteen dogs had lag screw fixation; three were lost to follow-up, seven returned to racing and three, all with partial tarsal collapse, failed to return to racing. Two dogs that had a centrodistal joint arthrodesis and one dog treated by rest alone raced again. Two dogs that had fragment removal failed to return to racing. Clinical significance : Veterinary examination of greyhounds with third tarsal bone fractures is often not sought at the time of the initial injury due to the benign presenting signs. Recurrence of lameness after rest is common. The prognosis for a successful return to racing would appear to be good following fragment fixation in both acute and chronic cases without dorsal tarsal collapse. Centrodistal joint arthrodesis may encourage bone union. The prognosis for conconservatively treated cases is guarded. Fragment removal is not recommended as a treatment.     

Femur fractures associated with canine total hip replacement

OBJECTIVE: To report femur fracture as a complication of canine total hip replacement (THR) and to report the incidence, predisposing factors, treatment options, and outcome. STUDY DESIGN: Prospective clinical study. ANIMALS: Twenty-two client-owned dogs with 24 femoral fractures occurring during or after THR. METHODS: Cemented THR (BioMedtrix, Boonton, NJ) was performed. Medical records and radiographs were used to identify dogs that had femur fracture and to identify risk factors. Follow-up was obtained until dog death or study end. RESULTS: The overall incidence of femur fracture after THR was 2.9%. Femoral fractures occurred intraoperatively, immediately postoperatively, and up to 2196 days after THR. In 17 dogs, fractures resulted from a traumatic event. Osteopathy was present at THR in 5 dogs; all developed femoral fissures during reaming. Three dogs had fractures associated with cortical thinning secondary to aseptic loosening. Fracture treatment included euthanasia (1 dog), strict confinement (3 dogs), full cerclage wires on long oblique fractures (3 dogs), or plate and screw fixation (10 with, and 7 without, cerclage wires). All fractures extended near the distal tip of the femoral stem and all aggressively treated fractures healed. CONCLUSIONS: Predisposing risk factors for femur fracture after THR include osteopathy and iatrogenic fissures created during reaming. Trauma, excessive load concentration, and increased torque can lead to mid-diaphyseal fracture near the end of the femoral stem. Fracture did not disrupt THR implants. Cement fracture exposing the tip of the femoral stem did not affect fracture healing or rehabilitation. Immediate plate and screw fixation resulted in the most favorable outcome; healing occurred in 6-10 weeks. CLINICAL RELEVANCE: Femur fractures that occur after THR should be repaired using plate and screw fixation augmented with cerclage wire when needed. Forces on fissures should be neutralized to prevent propagation and fracture. Owners of high-risk patients (old dogs with osteopathies or previous hip surgery) should be counseled before THR. The prognosis is excellent when fractures are treated correctly.     

Radiographic and clinical features of carpal varus associated with chronic sprain of the lateral collateral ligament complex in 10 dogs.

Lameness associated with carpal varus deformity was recognised in 10 dogs, eight of which were Dobermann Pinschers. The dogs had a mean age of seven years and nine months. Carpal varus was usually bilateral with concurrent carpal hyperflexion and pronation. Carpal varus was present prior to the onset of lameness in four cases. With stress radiography the median angle of varus deviation in all carpi was 14.6 degrees , and an increase in the size of the ulnar /ulnar carpal bone joint space was seen in six of the seven dogs. Radiographic changes included: enthesophyte formation at the proximolateral aspect of metacarpal V, periarticular soft tissue swelling, especially lateral, bone proliferation at the carpometacarpal joint I and enthesophyte formation at metacarpophalangeal joint V. Four dogs were admitted for problems other than carpal varus and lameness was not treated. Five dogs were treated with nonsteroidal anti-inflammatory drugs, but lameness was not completely resolved and became exacerbated with exercise. One dog was successfully treated by pancarpal arthrodesis.     

Use of Bone Plate for Treatment of an Open Third Metacarpal Fracture in a Foal

A 7-month-old, 180-kg, female foal was presented with open diaphyseal fracture of the left third metacarpal bone. The fractured limb was stabilized preoperatively with external coaptation. Open reduction and internal fixation were done using 4.5-mm broad dynamic compression plate, which was applied in a neutralization manner. Postoperatively, external support with padded bandage reinforced with gutter splint made of fiber glass was provided. The incisional infection and the contaminated wound on medial aspect of the metacarpal were managed with regular dressing. Complete radiographic union and functional recovery were noticed by 4 months postoperatively. Open diaphyseal fractures can be managed by proper preoperative fracture stabilization, wound management, and fixation methods using bone plate and external coaptation.     

A Lateral Approach to the Repair of Propagating Fractures of the Medial Condyle of the Third Metacarpal and Metatarsal Bone in 18 Racehorses

Objectives— To report the technique, observations on fracture configurations and results of treatment by fixation lag screw following the fracture plane determined by an approach to the third metacarpal/metatarsal bone (MC3/MT3) that begins laterally over the metacarpo(metatarso)phalangeal joint and extends dorsally over the diaphysis of the bone.
Study Design— Case series.
Animals— Thoroughbred horses (n=18) with propagating fractures of the medial condyle of MC3/MT3.
Methods— Retrospective analysis of case records of horses with fractures of the medial condyle of MC3/MT3 that propagated sagittaly or in a spiral configuration into the diaphysis, repaired surgically under general anesthesia by screw fixation in lag fashion through a lateral approach with periosteal reflection.
Results— Fractures were readily identified at surgery, enabling screw fixation in lag fashion following the fracture plane. Fracture configurations varied and could be classified as sagittal and spiral fractures with fractures within each group generally following a similar course. All horses recovered relatively uneventfully from general anesthesia and surgery, and all fractures healed well. Thirteen horses returned to training; 5 subsequently raced.
Conclusions— Repair of propagating sagittal and spiral fractures of the medial condyle of MC3/MT3 with diaphyseal involvement, through a lateral approach with periosteal reflection permits stable fixation with minimal complications. In this series there were no catastrophic failures.
Clinical relevance— Fractures of the medial condyle of MC3/MT3 that propagate either sagittaly or in a spiral configuration into the diaphysis can be successfully repaired with screw fixation in lag fashion using a lateral approach with periosteal reflection.     

Feline Ilial Fractures: A Prospective Study of Dorsal Plating and Comparison with Lateral Plating

Objective— To (1) report a technique for repair of feline ilial fractures using a dorsally applied bone plate and (2) compare outcome with cats treated by a lateral plate.
Study Design— Prospective study.
Animals— Cats (n=10) with iliac fractures.
Methods— Cats with ilial fractures (January 2005–December 2006) were treated by application of a dorsally applied bone plate. Immediate postoperative radiographs were compared with those taken 4–6 weeks later to assess screw loosening, screw purchase, and pelvic canal narrowing. Owners were contacted for medium-term (>3 month) follow-up. Data were compared with a report of outcome after lateral plating (LP) in 21 cats.
Results— Mean (± SD) screw purchase (89 ± 11 mm) was significantly greater ( P <.01) with a dorsal plate compared with a lateral plate (33 ± 8 mm). Significantly more screws ( P <.01) were used with a dorsal plate (median, 7) compared with a lateral plate (median, 6). Significantly less postoperative pelvic canal narrowing developed in the dorsal plating group between postoperative and 4–6-week follow-up radiography compared with the LP group (2% versus 15%, P <.01).
Conclusion— Dorsal plating of feline ilial fractures results in significantly less screw loosening and pelvic canal narrowing at 4–6 weeks after surgery compared with LP.
Clinical Relevance— Dorsal plating of feline iliac fractures may reduce complications associated with pelvic canal narrowing such as constipation and megacolon.     

A Biomechanical Comparison of Headless Tapered Variable Pitch and AO Cortical Bone Screws for Fixation of a Simulated Lateral Condylar Fracture in Equine Third Metacarpal Bones

OBJECTIVE: To compare drilling, tapping, and screw-insertion torque, force, and time for the 4.5-mm AO and 6.5-mm Acutrak Plus (AP) bone screws, and to compare the mechanical shear strength and stiffness of a simulated complete lateral condylar fracture of the equine third metacarpal bone (MC3) stabilized with either an AO or AP screw. STUDY DESIGN: In vitro biomechanical assessment of screw-insertion variables, and shear failure tests of a bone-screw-stabilized simulated lateral condylar fracture. SAMPLE POPULATION: Eight pairs of cadaveric equine MC3s METHODS: Metacarpi were placed in a fixture and centered on a biaxial load cell in a materials-testing system to measure torque, compressive force, and time for drilling, tapping, and screw insertion. Standardized simulated lateral condylar fractures were stabilized by either an AO or AP screw and tested in shear until failure. A paired t test was used to assess differences between screws, with significance set at P < .05. RESULTS: Insertion and mechanical shear testing variables were comparable for AO and AP insertion equipment and screws. CONCLUSION: The 6.5-mm tapered AP screw can be inserted in equine third metacarpal condyles and is mechanically comparable with the 4.5-mm AO screw for fixation of a simulated lateral condylar fracture. CLINICAL RELEVANCE: Considering the comparable mechanical behavior, the potential for less-persistent soft-tissue irritation with the headless design, and the ability to achieve interfragmentary compression by inserting the screw in one hole drilled perpendicular to the fracture plane, the 6.5-mm tapered AP screw may be an attractive alternative for repair of incomplete lateral condylar fractures in horses.     

Reduction and temporary stabilization of acetabular fractures using ASIF mandibular reduction forceps: technique and results using plate fixation in 25 dogs

OBJECTIVE: To report the results of acetabular fracture fixation in 25 dogs in which a specialized forceps (ASIF mandibular reduction forceps, Synthes USA, Paoli, PA) was used to obtain fracture reduction and stabilization. STUDY DESIGN: A retrospective clinical study. ANIMAL POPULATION: Twenty-five client-owned dogs with traumatic acetabular fractures. METHODS: The mandibular reduction forceps (MRF) use a screw on each side of the fracture to attach the clamp directly to the bone and permit direct manipulation of the fragments. Medical records from 25 dogs with acetabular fractures were reviewed to determine the effectiveness of this technique in obtaining, and then maintaining, fracture reduction while a plate was being applied. RESULTS: Clinical results were considered successful in 24 of 25 dogs; the small size of 1 dog prevented application of the MRF. The final reduction and fixation of the fractures was evaluated as anatomic in 17 dogs, near-anatomic in 6 dogs, and nonanatomic in 1 dog. CONCLUSIONS AND CLINICAL RELEVANCE: Application of the MRF is an effective technique for aiding the reduction of acetabular fractures in dogs. It maintains reduction while simultaneously permitting unimpeded access to the dorsal acetabular rim, thus facilitating accurate contouring of a plate. Accurate reduction and rigid fixation of articular fractures is essential to prevent secondary osteoarthritis.     

Evaluation of transfixation casting for treatment of third metacarpal, third metatarsal, and phalangeal fractures in horses: 37 cases (1994-2004)

OBJECTIVE: To evaluate clinical findings, complications, and outcome of horses and foals with third metacarpal, third metatarsal, or phalangeal fractures that were treated with transfixation casting. DESIGN: Retrospective case series. Animals-29 adult horses and 8 foals with fractures of the third metacarpal or metatarsal bone or the proximal or middle phalanx. PROCEDURES: Medical records were reviewed, and follow-up information was obtained. Data were analyzed by use of logistic regression models for survival, fracture healing, return to intended use, pin loosening, pin hole lysis, and complications associated with pins. RESULTS: In 27 of 35 (77%) horses, the fracture healed and the horse survived, including 10 of 15 third metacarpal or metatarsal bone fractures, 11 of 12 proximal phalanx fractures, and 6 of 8 middle phalanx fractures. Four adult horses sustained a fracture through a pin hole. One horse sustained a pathologic unicortical fracture secondary to a pin hole infec-tion. Increasing body weight, fracture involving 2 joints, nondiaphyseal fracture location, and increasing duration until radiographic union were associated with horses not returning to their intended use. After adjusting for body weight, pin loosening was associated with di-aphyseal pin location, pin hole lysis was associated with number of days with a transfixation cast, and pin complications were associated with hand insertion of pins. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that transfixation casting can be successful in managing fractures distal to the carpus or tarsus in horses. This technique is most suitable for comminuted fractures of the proximal phalanx but can be used for third metacarpal, third metatarsal, or middle phalanx fractures, with or without internal fixation.     

Metacarpal and metatarsal fractures in dogs

Metacarpal fractures were more common than metatarsal fractures in this retrospective study of 37 dogs. Fractures of one metacarpal or metatarsal bone occurred In 24 per cent of the dogs, two metacarpal bones in 16 per cent, three metacarpal or metatarsal bones in 19 per cent, and four metacarpal or metatarsal bones in 41 per cent. Eighty-seven per cent of the dogs with fractures of four bones had fracture displacement or malalignment of at least one digit. Progressive fracture healing usually occurred Irrespective of stabilisation method. For malaligned fractures, however, external coaptation did not consistently improve alignment. Fracture alignment was consistently Improved by open reduction and internal fixation of acute fractures with bone plates. Fractures of four bones occurred most often In the distal metacarpus as opposed to the proximal metatarsus. Therefore, open reduction and internal fixation may be more commonly indicated for severe metacarpal fractures, because fracture displacement or axial1 malalignment was significantly associated with fractures of the mid or distal regions of the metacarpus or metatarsus (P=0.052).     

Minimally invasive plate fixation of lower limb injury in horses: 32 cases (1999-2003)

REASONS FOR PERFORMING STUDY: Complications of osteosynthesis including superficial and deep infections continue to affect adversely outcome in equine surgery of the lower limb. OBJECTIVE: To describe a technique for minimally invasive plate fixation in horses and evaluate clinical results of the technique. HYPOTHESIS: Lower complication rates would occur in horses treated with a minimally invasive approach compared with conventional techniques. METHODS: Cases of minimally invasive plate fixation from January 1999 to December 2003 were evaluated. Case records, radiographs and race records for horses that sustained distal third metacarpal/metatarsal (Mc/tIII) condylar fractures were assessed. Follow-up information was obtained and results analysed. In addition, results for horses that received arthrodesis by a conventional, open approach during the same period were evaluated and statistical analysis was performed. RESULTS: Thirty-two cases of minimally invasive plate fixation were identified (22 incomplete distal Mc/tIII condylar fractures with a spiralling or diaphyseal component, 10 metacarpophalangeal arthrodeses and 4 pastern arthrodeses). For both types of arthrodesis, surgery times and infection rates were lower and survival rates higher in the minimally invasive group, but no statistical difference was found. Spiralling condylar fractures were successfully managed, without catastrophic fracture. CONCLUSIONS AND POTENTIAL RELEVANCE: Minimally invasive percutaneous plate osteosynthesis (MIPPO) can be successfully used for select applications in horses, and may reduce morbidity and mortality in equine fracture repair.     

Long incomplete longitudinal fractures of the third metacarpal and metatarsal bone in horses

Five horses with long incomplete longitudinal fractures of the third metacarpal bone and three horses with similar fractures of the third metatarsal bone were examined. In three of the metacarpal fractures a long incomplete fissure extended proximomedially, in association with the more common lateral condylar fracture of the third metacarpal bone, and in the other two cases the fracture originated from the medial aspect of the distal articular surface. In the three horses with fractures of the third metatarsal bone the fractures had a consistent spiral configuration.     

Comminuted First Phalanx Fractures in 30 Horses: Surgical vs. Nonsurgical Treatments

Comminuted first phalanx fractures were diagnosed in 30 horses. One leg was involved in each horse. Five horses were presented with open fractures. Nine horses had a portion of intact cortex (strut) extending from the proximal to distal joint. Ten horses were euthanized, including one with an open fracture, without treatment. The remaining 20 horses were treated by open reduction with a neutralization plate (8 horses, including one with an open fracture), open reduction with lag screw fixation (3 horses), lag screw fixation through stab incisions (2 horses), external coaptation with a cast (3 horses), and external skeletal fixation using a weight supporting shoe (4 horses, including 3 with open fractures).
Thirteen horses were euthanized following treatment because of persistent infection (9), chronic lameness (2), and third metacarpal bone fractures (2). Seven horses survived longer than 1 year after treatment. Six were lame and used as breeding animals, and one horse went on to race successfully. All four horses with open fractures that were treated were subsequently euthanized.
Significantly more horses with an intact strut of bone survived after treatment (4 of 7 [57%]) when compared to horses without an intact strut of bone that were treated (3 of 13 [23%]) (p < 0.05).
Invasive surgical approaches used for the repair of comminuted first phalanx fractures in this study were associated with an unacceptable infection rate (55%). Techniques involving less trauma to the compromised soft tissue around the fracture should afford a better chance for a successful outcome.     

Factors associated with racing performance of Thoroughbreds undergoing lag screw repair of condylar fractures of the third metacarpal or metatarsal bone

OBJECTIVE: To evaluate effects of sex, fracture configuration, affected limb, and screw placement on outcome of Thoroughbreds with condylar fractures involving the third metacarpal or metatarsal bone. DESIGN: Cohort study. Animals-56 horses. PROCEDURE: Age, sex, affected limb, fracture configuration, fracture length, fracture fragment width, and distance of the most distal screw from the articular surface were analyzed in logistic regression models. RESULTS: Females were more likely to have displaced fractures and race in fewer races after surgery than males. Sex and fracture configuration were associated with number of postoperative races. Among horses that returned to racing, those with thicker fracture fragments were 11 times as likely as horses with thinner fracture fragments to win a race after surgery. Horses with longer fractures and older horses had fewer postoperative races. Horses in which the most distal screw had been placed further from the joint surface had more races. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that female horses with displaced condylar fractures and male horses with nondisplaced condylar fractures are more likely to be referred for treatment. The effect of sex on outcome for these horses cannot be clearly separated from the effect of fracture configuration. When adjusted for fracture configuration, males were 6 times as likely as females to race after surgery. When adjusted for sex, horses with nondisplaced fractures were 17 times as likely as horses with displaced fractures to race after surgery. Results suggest that the most distal screw should be placed above the epicondylar fossa.     

Standing repair of an articular dorsal medial oblique fracture of the proximal third metacarpal bone in a racing Standardbred

The third metacarpal bone (McIII) is a common site of long bone fractures in racehorses. However, articular fractures of the dorsomedial aspect of McIII are a rare location of such injuries. This report describes the successful standing surgical repair of an articular fracture of the dorso-medial proximal McIII in a 4-year-old Standardbred racing mare using lag screw fixation.