Page 172 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Musculoskeletal system: 1.4 The forelimb 147

VetBooks.ir Differential diagnosis through internal fixation. With lateral condylar
Condylar fractures are usually managed
P1 fracture; fetlock subluxation; severe soft-tissue
fractures, two cortical screws placed in lag fash-
injury; synovial sepsis.
ion are usually sufficient to deal with most frac-
Diagnosis tures (Fig. 1.269). Non-displaced fractures can
Physical examination usually provides a high index be treated through stab incisions and this is com-
of suspicion of a fracture, particularly with com- monly performed by some clinics in the standing
plete, unstable fractures. Diagnosis is usually pro- sedated horse. Displaced lateral condylar fractures
vided by radiography and it is important to gain require reduction before fixation and arthroscopic
additional views to completely assess and type the visualisation is often performed. Medial condy-
fracture, particularly those involving articulations. lar fractures are treated through internal fixa-
Occasionally, scintigraphy or MRI may be required tion either using screws and a plate or screws
to diagnose incomplete fractures and responses to alone (Fig. 1.270), although plating techniques
local analgesia may be confusing in some cases. are deemed superior. Diaphyseal fractures can
be managed through a double-plating technique
Management (Fig. 1.271). Incomplete diaphyseal fractures
Initial management should involve stabilisation of can be managed conservatively with radiographic
the fracture and assessment with regards to suitabil- monitoring of healing (Fig. 1.272). Transverse
ity to travel. Open or severely comminuted fractures and proximal articular fractures are also usu-
may require immediate euthanasia. Radiographic ally managed conservatively, although displace-
assessment is used to determine the initial manage- ment can occur during the rehabilitation period
ment and prognosis of the case. and may require internal fixation or euthanasia.

1.269 1.270

Fig. 1.269 The complete, minimally
displaced lateral condylar fracture in
1.264 post lag screw internal fixation.

Fig. 1.270 The medial condylar
fracture in 1.265 post lag screw internal
fixation.