Use of a modified transfixation pin cast for treatment of comminuted phalangeal fractures in horses.
Authors: Rossignol Fabrice, Vitte Amélie, Boening Josef
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Modified Transfixation Pin Casting for Comminuted Phalangeal Fractures Comminuted phalangeal fractures present substantial orthopaedic challenges in horses, and this case series of 11 adult horses examines a refined transfixation pin casting technique that incorporates dorsal recumbency positioning, distally placed pins anchored in the epiphysis and metaphysis, and a hybrid plaster-fiberglass cast construct. Using 6.3 mm positive profile pins positioned at the centre of the condylar fossa with a second pin 3–4 cm proximal, the authors achieved zero pin loosening over 6–8 weeks of external fixation, with nine of 11 horses (82%) surviving despite one case of distal metacarpal fracture at the proximal pin site. Critically, the distal pin placement adjacent to the fetlock joint did not precipitate septic arthritis in any case, suggesting that careful pin positioning and hybrid cast application may mitigate infection risk even with articular proximity. The technique's principal advantages lie in enhanced pin stability, reduced risk of secondary pin-hole fractures, and promising long-term fixation integrity—findings that support consideration of this approach for practitioners managing comminuted distal limb fractures where traditional external fixation has shown limitations. Further comparative studies would strengthen recommendations, but the 82% survival rate and absence of pin-related complications warrants evaluation within your clinical decision-making for these challenging cases.
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Practical Takeaways
- •This modified transfixation technique shows promise for comminuted phalangeal fractures with good pin longevity and low complication rates in adult horses
- •Distal pin positioning near the fetlock joint did not result in septic arthritis in this case series, suggesting this approach may be safe despite anatomical proximity to the joint
- •Consider hybrid casting (plaster + fiberglass) combined with lag screw fixation as a surgical option for comminuted phalangeal fractures when other stabilization methods are inadequate
Key Findings
- •Modified transfixation pin cast technique using dorsal recumbency and distal pin positioning achieved no pin loosening in 10 of 11 horses over 6-8 weeks
- •82% survival rate (9 of 11 horses) with no septic arthritis despite distal pin placement near the fetlock joint
- •Hybrid plaster and fiberglass cast combined with lag screw fixation of fracture fragments when possible provided adequate stabilization