Principles of Equine Osteosynthesis: Book & CD-ROM. L. R. Bramlage

radiographs show good fracture healing without periosteal proliferative change or degenerative joint disease.

      Fig. X7B: The medial condylar fracture involves a great deal more of the shaft of the bone, and often “disappears” from radiographic views as it courses proximally.

      Fig. X7C: A bone scan of the distal metacarpus in a horse showing typical premonitory signs may show intense uptake of isotope before any radiographic evidence of fracture has appeared.

7.2 Preoperative considerations

      Check for additional lesions.

      The most important factor specific to these fractures to be considered preoperatively is the presence of associated lesions. Bilateral fractures, fragmentation along the fracture line, especially of the flexor surface of the condyle [3, 8], and, axial fractures of the proximal sesamoid [9] warrant particular mention. Appropriate radiographic projections should be performed to rule out these additional injuries, as they will affect the details of the operative procedure and the prognosis for its outcome. If the instability has persisted for some time, a synovitis may be present, with the possible onset of degenerative joint changes. Such changes in an animal actively engaged in competition should prompt the surgeon to ask in particular whether the horse has received intra-articular therapy of any sort. Using the AO Documentation System, this information would have been gathered as one of the preoperative “checkpoints” [10].

      Fractures of the medial condyle deserve further scutiny.

      If the fracture affects the medial condyle a more thorough radiographic, and perhaps scintigraphic, examination is indicated to elucidate the true extent of pathology. These fractures, especially when located in a hind limb, may spiral all the way to the proximal articular surface. This entire plane must be brought under interfragmentary compression, and the screws employed possibly protected by the application of a neutralization plate (chapter 1, Basic principles of fracture treatment).

7.3 Surgical anatomy

      In nondisplaced lateral condylar fractures most, if not all, of the surgeon‘s orientation is based on soft tissue landmarks, the incision(s) being simple stab(s). These same landmarks will serve in displaced fractures, but assume less importance, since the articular surface will be directly visualized.