- Lateral approach
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.
An alternate approach is through stab incisions for individual screw insertion.
Anatomy and landmarks
The dorsal artery crosses the mid-portion of the proximal phalanx. It can be ligated, if necessary, but it is often possible and preferred to insert the fixation without disrupting the artery.
The extensor branch of the suspensory ligament progresses from the proximal palmar/plantar aspect of the bone in a dorsodistal direction across the lateral aspect of the proximal phalanx. The branch needs to be retracted if it interferes with the desired screw location.
The fetlock joint capsule in the proximal aspect of the incision is a useful landmark for the location of the sagittal groove of the proximal phalanx. The most proximal screw should be placed just distal to the joint capsule attachment to the bone and proximodorsal to the extensor branch of the suspensory ligament.