Davos Courses

Executive Editor: Jörg Auer

Authors: Lawrence Bramlage, Alan Ruggles, Jörg Auer, Jeffrey Watkins, Patricia Hogan


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Lateral approach (prox. phalanx)

The standard lateral approach can be used for sagittal fractures of the proximal phalanx. The incision starts at the level of the fetlock joint and extends as far distally as necessary for insertion of the appropriate number of screws.

Access: palmar/plantar eminence

Palmar/plantar eminence fractures of the proximal phalanx are usually reduced closed. Either small incisions or arthroscopic control are useful in assisting anatomic reduction.

Insertion of the screws is accomplished by means of stab incisions through the associated collateral ligament.

Curved approach (prox. phalanx)

This approach can be used for open reduction and internal fixation of comminuted fractures with a medial intact strut of bone or for transverse body fractures repaired with double-plating.

Stab incision: Arthroscopy

A small skin stab incision is performed directly over the location where each screw is inserted. If a staple is inserted the skin incision is centered over the physis and adjusted in length according to the length of the staple.
All incisions are carried down to the underlying bone.

Stab incision for ALD treatment

The surgery is performed at the concave (shorter) side of the bone.
The incisions for the two techniques that will be described in the surgical technique are carried out at the same level of the bone, about 2 cm proximal to the physis involved.

Access: Corrective osteotomies

The skin incision is made dorsolaterally over the common/long digital extensor tendon. The incision extends from the carpo-metacarpal/-tarsal joint to the distal McIII/MtIII physis.

Dorsal approach (prox. phalange)

The dorsal approach is used for fractures of the distal proximal phalanx and the proximal middle phalanx, infections and pastern arthrodesis.
It exposes the proximal interphalangeal joint surfaces and the dorsal proximal aspect of the middle phalanx and the distal dorsal surface of the proximal phalanx.

Approach to the distal phalanx

Access to fractures of the distal phalanx and the distal sesamoid bone is mostly through the hoof wall and described in detail within "Reduction & Fixation".

Stab incisions: Arthroscopy

Fractures of the proximal sesamoid bones are mostly treated under arthroscopic control, and instruments and implants are placed through stab incisions. Details are described within "Reduction & Fixation".

Approach to the fetlock joint

Since the fetlock joint will not fully open in any position, the collateral ligament is detached using an iatrogenic condylar fracture, which is created with a bone saw.

Note: An alternate technique involves the transection of the lateral collateral - and the metacarposesamoidean ligament, instead of the iatrogenic condylar fracture.

v1.3 2013-11-20