Fig. 8. Plain radiographs and CT images of a comminuted carpal fracture. Triple plating using a minimally invasive technique allowed management without a cast. The carpus is cosmetic and solidly fused within a few months.
Catastrophic dehiscence of these fractures is espe- cially probable when the affected cannon bone is in a hindlimb. There are many options for treating these injuries including lag screw fixation of the visible portion of the fracture only, open application of a combination of lag screws and plate. Special anesthetic recov- ery systems such as a pool system or sling are in- valuable but fractures can occur up to a few weeks after lag screw fixation. Plate fixation has there- fore become a more standard treatment. Because these fractures are not displaced, a minimally inva- sive approach can be used to place the plate. The horse is placed with the affected limb uppermost. First, two cortical screws are placed in lag fashion
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across the condyle using routine technique. The screws are placed from lateral to medial even though the smaller portion of the fracture is medial. This is not a mechanical problem because the bone of the distal cannon bone is extremely dense and the me- dial fragment is large enough to provide adequate strength. The “normal” direction of screws is re- versed because the plate is placed lateral. Lateral placement is strongly recommended because the plates are removed with the horse standing. A 2-cm skin incision is made between the extensor tendons on the proximal cannon bone. A plate- passing device was made by attaching a handle to a piece of stainless steel with similar dimensions of a broad plate. The end of the device is sharpened to
