Equis ISSN 2398-2977

Bone: slab fracture repair - lag screw

Contributor(s): Patrick Colahan, Bud G E Fackelman, Chris Whitton, Graham Munroe

Introduction

Uses

Advantages

  • Similar to all internal fixation repair of equine fractures and including:
    • Good anatomic realignment of the fracture.
    • Internal compression of the fracture decreasing fracture healing time and improving quality of bone repair (primary bone union).
    • Decreased chances of post-repair secondary osteoarthritis of the affected joints.
  • The carpal slab fixation techniques using arthroscopic guidance increase visualization of the fracture site, allow it to be debrided, guide anatomic alignment, and ensure lavage of the joint post-repair to minimize disruption of joint homeostasis.
  • Minimal soft tissue disruption with arthroscopic and radiographic-guided repair techniques.

Disadvantages

  • More expensive than conservative treatment.
  • Guided repair techniques require slightly higher surgical skill levels than open arthrotomy repair.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

Carpal fractures

  • Good - for smaller or non-displaced fractures - 70-75% return to racing.
  • Fair - for large or displaced fractures.
  • Standardbreds seem to have a slightly better prognosis than Thoroughbred horses from returning to racing.
  • Many horses return to racing at a lower level.

Tarsal fractures

  • Success rates of up to 75% have been reported for both central and third tarsal bone slab fractures for return to racing.
  • However, a number of them develop some degree of osteoarthritis Musculoskeletal: osteoarthritis (joint disease) of the small tarsal joints and require intra-articular medication.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Barker W H & Wright I M (2017) Slab fractures of the third tarsal bone: Minimally invasive repair using a single 3.5 mm cortex screw placed in lag fashion in 17 Thoroughbred racehorses. Equine Vet J 49 (2), 216-220 PubMed.
  • Hirsch J E et al (2007) Clinical evaluation of a titanium, headless variable-pitched tapered cannulated compression screw for repair of frontal plane slab fractures of the third carpal bone in thoroughbred racehorses. Vet Surg 36 (2), 178-84 PubMed.
  • Murray R C et al (1998) Biomechanical comparison of the Herbert and AO cortical bone screws for compression of an equine third carpal bone dorsal plane slab osteotomy. Vet Surg 27 (1), 49-55 PubMed.
  • Martin G S, Haynes P F & McClure J R (1988) Effect of third carpal slab fracture and repair on racing performance in Thoroughbred horses - 31 cases (1977-1984). JAVMA 193 (1), 107-110 PubMed.
  • Richardson D W (1986) A technique for arthroscopic repair of third carpal bone slab fractures in horses. JAVMA 188 (3), 288-291 PubMed.


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