Equis ISSN 2398-2977

Distal phalanx: fracture repair

Contributor(s): Stephen Adams, Graham Munroe, Jarred Williams

Introduction

  • Single lag screw fixation of Type III and some Type II distal phalanx fractures Distal phalanx: fractures can improve stability and compression of the fracture line improving the healing rate and decreasing the incidence of secondary degenerative joint disease Musculoskeletal: osteoarthritis (joint disease) (DJD) in the distal interphalangeal coffin joint.

Uses

Advantages

  • Increased compression and stability  →  improved healing rate/quality and decreased incidence of fibrous union.
  • Improved articular alignment  →  decreased likelihood of secondary coffin joint arthritis (DJD).
  • Decreases post-operative convalescent period.

Disadvantages

  • Increased expense.
  • Surgical complications are common particularly chronic drainage and infection around screw and associated lameness.
  • Demanding technique which requires particularly good alignment for successful outcome.
  • Expensive diagnostic tools such as CT or MRI oftentimes necessary for best outcome.
  • Not suitable for non-articular or wing fractures  →  potential exaggeration of step in articular surface.

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

  • Guarded - internal fixation improves the likelihood of fracture healing, especially at the articular margin, but does not guarantee it and DJD of the coffin joint can still occur.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Kay A T, Durgam S, Stewart M et al (2016) Effect of Cortical Screw Diameter on Reduction and Stabilization of Type III Distal Phalanx Fractures: An Equine Cadaveric Study. Vet Surg 45 (8),1025-1033 PubMed.
  • Gasiorowski J C & Richardson D W (2015) Clinical use of computed tomography and surface markers to assist internal fixation within the equine hoof. Vet Surg 44 (2), 214-22 PubMed.
  • Schade S M, Arnoczky S P & Bowker R M (2014) The microvasculature in the equine distal phalanx: implications for fracture healing. Vet Comp Orthop Traumatol 27 (2), 102-6 PubMed.
  • Rijkenhuizen A B, de Graaf K, Hak A et al (2012) Management and outcome of fractures of the distal phalanx: a retrospective study of 285 horses with a long term outcome in 223 cases. Vet J 192 (2), 176-82 PubMed.
  • Vandeweerd J M, Perrin R, Launois T et al (2009) Use of computed tomography in standing position to identify guidelines for screw insertion in the distal phalanx of horses: an ex vivo study. Vet Surg 38 (3), 373-9 PubMed.
  • Yovich J V (1989) Fractures of the distal phalanx in the horse. Vet Clin North Am Equine Pract (1), 145-160 PubMed.

Other sources of information

  • Bertone A B (1996) Fractures of the Distal Phalanx. Equine Fracture Repair. Ed: Nixon A J. W B Saunders, USA. ISBN 0-7216-6754-6.


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