Use of computed tomography in standing position to identify guidelines for screw insertion in the distal phalanx of horses: an ex vivo study.
Authors: Vandeweerd Jean-Michel E, Perrin Roland, Launois Thomas, Brogniez Laurent, Clegg Peter D, Desbrosse Francis G
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Sagittal fractures of the equine distal phalanx require precise internal fixation, yet preoperative planning traditionally relies on radiography, which provides limited three-dimensional anatomical detail in a structure with complex contours and critical neurovascular structures. Researchers compared standing computed tomography (CT) against conventional radiography for preoperative planning of lag screw insertion in ten cadaveric thoracic limbs, measuring both the accuracy of implant placement and operative efficiency. CT imaging proved significantly more accurate for identifying insertion guidelines, whilst dramatically reducing surgical time to 7.7 minutes compared with 12.7 minutes using radiographic planning—both approaches successfully avoided penetration of the articular surface, solar surface, or semilunar canal. For practitioners managing these challenging fractures, standing CT represents a meaningful advancement in preoperative assessment, offering the dual benefit of enhanced precision and substantial time savings that could translate to reduced operative trauma and improved patient outcomes. The non-invasive nature of standing CT imaging makes this technique particularly practical for equine practice, as it eliminates positioning constraints and stress associated with recumbency during imaging.
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Practical Takeaways
- •Consider standing CT for pre-operative planning of distal phalanx fracture repair—it reduces operative time by approximately 5 minutes and improves screw placement accuracy
- •Standing position CT imaging provides practical anatomic guidance that translates directly to faster, more precise surgical execution without safety compromise
- •CT-guided screw insertion eliminates risk of iatrogenic damage to critical structures (articular surface, solar margin, semilunar canal) in distal phalanx fracture repair
Key Findings
- •CT was significantly more accurate than radiography for identifying screw insertion guidelines in the distal phalanx (P=0.049)
- •Standing CT reduced surgical time to 7.7 minutes compared with 12.7 minutes for radiographic planning (P=0.000)
- •No screw penetration of articular surface, solar surface, or semilunar canal occurred in either CT or radiographic groups
- •Standing CT can reliably determine anatomic landmarks for lag screw fixation of sagittal distal phalanx fractures