Plate fixation for management of plantar instability of the distal tarsus/proximal metatarsus in 5 horses.
Authors: McCormick Justin D, Watkins Jeff
Journal: Veterinary surgery : VS
Summary
# Plate Fixation for Tarsal and Proximal Metatarsal Instability Traumatic injuries causing plantar instability in the distal tarsal and proximal metatarsal region present a significant surgical challenge, yet surgical management options remain poorly defined in the equine literature. McCormick and Watkins reviewed 19 years of medical records to evaluate outcomes in five horses treated with broad dynamic or locking compression plates applied to the plantar-lateral aspect of the tarsus, spanning from the proximal calcaneus to the proximal metatarsus; lesions included three cases of proximal intertarsal joint subluxation and two cases of distal tarsal or proximal metatarsal fractures. Four of the five horses were successfully discharged, and long-term follow-up (minimum one year post-operative) revealed all four to be sound at pasture with three suitable for limited ridden work, though complications including peroneus tertius rupture (two cases) and postoperative infection (one case) occurred during the perioperative period. These results suggest that plate fixation provides sufficient biomechanical stability for managing plantar instability at this anatomical level, though the small case number and complication rate warrant cautious optimism. For practitioners managing severe tarsometatarsal trauma with instability, plate fixation represents a viable surgical option where conservative management has failed, though clients should be counselled regarding potential complications and realistic expectations for athletic use.
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Practical Takeaways
- •Plate fixation is a viable surgical option for horses with tarsal/proximal metatarsal instability, with most returning to pasture soundness within 1 year
- •Be aware that peroneus tertius rupture is a potential complication—monitor for this in recovery and early rehabilitation
- •Expect that some horses may be limited to pasture work rather than ridden work, so set realistic client expectations preoperatively
Key Findings
- •5 horses treated with plate fixation (4 DCP, 1 LCP) for tarsal/proximal metatarsal instability achieved long-term outcomes
- •4 of 5 horses were sound at pasture >1 year post-surgery; 3 were sound enough for limited riding
- •Perioperative complications occurred in 3 horses (2 peroneus tertius ruptures, 1 postoperative infection)
- •Plate fixation provided adequate strength and stability for managing plantar instability injuries