A lateral approach for screw repair in lag fashion of spiral third metacarpal and metatarsal medial condylar fractures in horses.
Authors: Smith Lewis C R, Greet Timothy R C, Bathe Andrew P
Journal: Veterinary surgery : VS
Summary
Spiral fractures of the medial condyle of the third metacarpal or metatarsal bone present a significant challenge in equine orthopaedics, particularly in racehorses where high-performance demands necessitate anatomically sound repair. Smith, Greet and Bathe describe a lateral surgical approach for lag-screw fixation of these injuries, performed on nine Thoroughbreds (three forelimb, six hindlimb cases) with fracture lengths averaging 126 mm, using multiple 4.5 mm cortical screws inserted perpendicular to the fracture plane under radiographic or fluoroscopic guidance. Five horses returned to racing, one resumed training (though remained persistently lame and was retired to stud), and two went directly to stud without further athletic use, with all nine recovering uneventfully from anaesthesia and progressing through a standardised rehabilitation protocol of two months box rest followed by one month in-hand walking. The lateral approach offers distinct biomechanical and anatomical advantages—permitting screw insertion perpendicular to the fracture line whilst avoiding compromise to palmar or plantar soft tissues and circumventing the splint bones entirely. For practitioners, this technique represents a viable option for addressing otherwise challenging medial condylar fractures, with the authors noting that whilst performed under general anaesthesia in this series, the lateral approach is theoretically adaptable to standing surgery, potentially reducing anaesthetic risk in suitable candidates.
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Practical Takeaways
- •Lateral approach screw fixation is a viable option for spiral medial condylar fractures in performance horses, with 56% returning to racing in this series
- •The lateral approach avoids soft tissue complications associated with palmar/plantar approaches and may be adaptable to standing horse procedures
- •Expect 2 months box rest followed by gradual return to work; some horses may develop persistent lameness despite radiographic healing
Key Findings
- •Lateral approach screw fixation in lag fashion successfully repaired 9 spiral medial condylar MC3/MT3 fractures in Thoroughbreds with mean fracture length 126 mm
- •5 of 9 horses returned to racing, 1 returned to training but became persistently lame, and 2 were retired to stud
- •All horses recovered uneventfully from anesthesia and completed 3-month follow-up radiographic examination
- •Lateral approach allows perpendicular screw insertion to fracture plane without interference to palmar/plantar soft tissues or splint bones