Clinical use of computed tomography and surface markers to assist internal fixation within the equine hoof.
Authors: Gasiorowski Janik C, Richardson Dean W
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: CT-Guided Internal Fixation in Equine Hoof Fractures Fracture fixation within the hoof presents unique surgical challenges due to the confined space and complexity of three-dimensional anatomy, which this 2015 retrospective case series addressed by evaluating CT imaging combined with barium paste surface markers to guide screw placement in distal phalanx and distal sesamoid bone fractures across 16 horses. The surgical team pre-planned implant trajectories using CT image series with grids of radiopaque markers placed at proposed entry and exit points, then verified screw position, length and fracture reduction with post-operative imaging; planning required 10–20 minutes, with surgery times averaging 61 minutes and total anaesthesia time averaging 171 minutes. All horses achieved near-optimal screw positioning with no malpositioned implants or consequential complications, and fracture reduction was confirmed in every case. For practitioners managing distal limb fractures, this technique offers a practical method to improve precision and reduce the risk of catastrophic implant malposition—a particular concern when working within the hoof capsule where there is minimal margin for error and re-drilling is often not feasible. Adoption of this approach, particularly when paired with an aiming device, represents a significant refinement in equine orthopaedic surgery, though the extended operative and anaesthesia times warrant consideration in clinical decision-making.
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Practical Takeaways
- •CT-guided fixation with barium paste surface markers reliably improves accuracy of screw placement in distal phalanx and distal sesamoid fractures, eliminating guesswork during surgical approach
- •The technique adds 10–20 minutes of preoperative planning time but ensures correct implant positioning and reduces risk of revision surgery or complications from malposition
- •Use of an aiming device with this method simplifies execution and makes the technique practical for routine equine orthopedic surgery
Key Findings
- •CT-guided internal fixation with surface marker grids achieved near-optimal screw position and length in all 16 horses with no consequential malposition
- •Fracture reduction was achieved in all cases using this technique
- •Mean surgical time was 61 minutes (range 45–90) and mean general anesthesia time was 171 minutes (range 115–220)
- •Preoperative planning with CT imaging and grid creation required 10–20 minutes per case