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.
Stab incision for ALD treatment
The surgery is performed at the concave (shorter) side of the bone.
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.
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.