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The carpus and tarsus
/content/chapter/10.22233/9781910443279.chap25
The carpus and tarsus
- Authors: Alessandro Piras and Tomás Guerrero
- From: BSAVA Manual of Canine and Feline Fracture Repair and Management
- Item: Chapter 25, pp 319 - 341
- DOI: 10.22233/9781910443279.25
- Copyright: © 2016 British Small Animal Veterinary Association
- Publication Date: January 2016
Abstract
Fractures of the carpus and tarsus are common in athletic dogs, but are encountered less frequently in pet dogs and cats. Operative techniques: Dorsal approach to the carpus; Palmaromedial approach to the radial carpal bone; Screw fixation of type I and II accessory carpal bone fractures; Pin and tension-band fixation of calcaneal fractures; Internal fixation of articular fractures of the talus; Internal fixation of central tarsal bone fractures.
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Figures
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25.1
(a) Dorsal slab fracture of the radial carpal bone (b) treated with lag screw stabilization. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.1
(a) Dorsal slab fracture of the radial carpal bone (b) treated with lag screw stabilization. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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25.2
(a) Parasagittal fracture of the radiocarpal bone. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. (b) Dorsal and (c) medial views of lag screw stabilization. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. (d) Alternatively, a headless compression screw can be used. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.2
(a) Parasagittal fracture of the radiocarpal bone. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. (b) Dorsal and (c) medial views of lag screw stabilization. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. (d) Alternatively, a headless compression screw can be used. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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25.3
(a) Avulsion fracture involving the origin of the palmar radiocarpal–metacarpal ligament. (b) Pin and tension-band repair. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.3
(a) Avulsion fracture involving the origin of the palmar radiocarpal–metacarpal ligament. (b) Pin and tension-band repair. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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25.4
(a) Dorsopalmar and (b) mediolateral views of a comminuted fracture of the palmar process of the radial carpal bone in a Greyhound. (c–d) The fracture has been stabilized with a 2 mm lag screw and an anti-rotational K-wire. Note how the screw has been inserted from the mediopalmar aspect of the bone in a laterodorsal direction. © 2016 British Small Animal Veterinary Association
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25.4
(a) Dorsopalmar and (b) mediolateral views of a comminuted fracture of the palmar process of the radial carpal bone in a Greyhound. (c–d) The fracture has been stabilized with a 2 mm lag screw and an anti-rotational K-wire. Note how the screw has been inserted from the mediopalmar aspect of the bone in a laterodorsal direction.
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25.5
(a) Dorsopalmar and (b) mediolateral views of a palmar luxation of the radiocarpal bone in a cat. (c) Dorsopalmar and (d) mediolateral postoperative radiographs. The luxation has been reduced and stabilized with a pin inserted through the radial carpal bone into the ulnar carpal bone and a prosthetic medial collateral ligament replacement, anchored to a bone screw and the pin. © 2016 British Small Animal Veterinary Association
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25.5
(a) Dorsopalmar and (b) mediolateral views of a palmar luxation of the radiocarpal bone in a cat. (c) Dorsopalmar and (d) mediolateral postoperative radiographs. The luxation has been reduced and stabilized with a pin inserted through the radial carpal bone into the ulnar carpal bone and a prosthetic medial collateral ligament replacement, anchored to a bone screw and the pin.
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25.6
A mid-body fracture of the ulnar carpal bone is stabilized with a headless compression screw. Alternatively, a standard 1.5 mm or 2 mm lag screw can be used. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.6
A mid-body fracture of the ulnar carpal bone is stabilized with a headless compression screw. Alternatively, a standard 1.5 mm or 2 mm lag screw can be used. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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25.7
Classification of accessory carpal bone fractures. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.7
Classification of accessory carpal bone fractures. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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25.8
(a) A type 1B accessory carpal bone fracture in a Greyhound (b–c) stabilized with a 1.5 mm lag screw. Note that the screw head has not been countersunk, to reduce the risk of iatrogenic splitting of the small fragment when the screw is tightened. (d) The fracture healed by 10 weeks postoperatively. © 2016 British Small Animal Veterinary Association
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25.8
(a) A type 1B accessory carpal bone fracture in a Greyhound (b–c) stabilized with a 1.5 mm lag screw. Note that the screw head has not been countersunk, to reduce the risk of iatrogenic splitting of the small fragment when the screw is tightened. (d) The fracture healed by 10 weeks postoperatively.
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25.9
(a) A type 1 accessory carpal bone fracture in a Greyhound that is composed of two small fragments. (b) These fragments were reduced and stabilized with two 1 mm lag screws. © 2016 British Small Animal Veterinary Association
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25.9
(a) A type 1 accessory carpal bone fracture in a Greyhound that is composed of two small fragments. (b) These fragments were reduced and stabilized with two 1 mm lag screws.
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25.10
Type I Salter–Harris fracture of the proximal calcaneal physis. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.10
Type I Salter–Harris fracture of the proximal calcaneal physis. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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25.11
Mid-body fracture of the calcaneus. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.11
Mid-body fracture of the calcaneus. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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25.12
(a) Plantarodorsal and (b) mediolateral views of a comminuted mid-body fracture of the calcaneus in a dog. A type V central tarsal bone fracture was also present. (c) Plantarodorsal and (d) mediolateral postoperative views. The calcaneal fracture was stabilized with a combination of lag screws, a laterally positioned 2/2.7 mm veterinary cuttable plate and a figure-of-eight tension-band wire applied to the plantar aspect of the bone. External coaptation was also applied for 6 weeks, to support the central tarsal bone fracture. (e) Plantarodorsal and (f) mediolateral views 12 weeks postoperatively. The fractures had healed uneventfully. © 2016 British Small Animal Veterinary Association
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25.12
(a) Plantarodorsal and (b) mediolateral views of a comminuted mid-body fracture of the calcaneus in a dog. A type V central tarsal bone fracture was also present. (c) Plantarodorsal and (d) mediolateral postoperative views. The calcaneal fracture was stabilized with a combination of lag screws, a laterally positioned 2/2.7 mm veterinary cuttable plate and a figure-of-eight tension-band wire applied to the plantar aspect of the bone. External coaptation was also applied for 6 weeks, to support the central tarsal bone fracture. (e) Plantarodorsal and (f) mediolateral views 12 weeks postoperatively. The fractures had healed uneventfully.
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25.13
(a) Dorsoplantar and (b) mediolateral views of a mid-body fracture of the calcaneus. (c–d) The fracture was stabilized with a combination of lag screws and biaxial plating, applied to the lateral (2/2.7 mm veterinary cuttable plate) and plantar aspects (1.5/2 mm veterinary cuttable plate). (e–f) The fracture had healed uneventfully 12 weeks postoperatively. © 2016 British Small Animal Veterinary Association
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25.13
(a) Dorsoplantar and (b) mediolateral views of a mid-body fracture of the calcaneus. (c–d) The fracture was stabilized with a combination of lag screws and biaxial plating, applied to the lateral (2/2.7 mm veterinary cuttable plate) and plantar aspects (1.5/2 mm veterinary cuttable plate). (e–f) The fracture had healed uneventfully 12 weeks postoperatively.
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25.14
(a) Plantarodorsal and (b) mediolateral views of a mid-body fracture of the calcaneus in a 1-year-old crossbred dog, stabilized with pins and cerclage wire 4 weeks previously. There has been a loss of fracture reduction and implant migration. (c–d) The fracture was revised with an intramedullary pin and two mini locking plates shortened to three holes and applied at the plantarolateral and plantaromedial aspects. (e–f) At 12 weeks post-revision, the fracture has healed and the plantaromedial implant and pin have been removed. (Courtesy of I Ljolje) © 2016 British Small Animal Veterinary Association
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25.14
(a) Plantarodorsal and (b) mediolateral views of a mid-body fracture of the calcaneus in a 1-year-old crossbred dog, stabilized with pins and cerclage wire 4 weeks previously. There has been a loss of fracture reduction and implant migration. (c–d) The fracture was revised with an intramedullary pin and two mini locking plates shortened to three holes and applied at the plantarolateral and plantaromedial aspects. (e–f) At 12 weeks post-revision, the fracture has healed and the plantaromedial implant and pin have been removed. (Courtesy of I Ljolje)
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25.15
(a) Plantarodorsal view of a slab fracture of the distolateral calcaneus. (b) Stabilization of fracture shown in (a) with two lag screws. (c–d) A slab fracture of the calcaneus associated with a comminuted (type V) fracture of the central tarsal bone. (e–f) The calcaneal fracture has been stabilized with three 2.7 mm lag screws inserted from lateral to medial, and the fracture of the central tarsal bone has been stabilized with three 2 mm lag screws. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.15
(a) Plantarodorsal view of a slab fracture of the distolateral calcaneus. (b) Stabilization of fracture shown in (a) with two lag screws. (c–d) A slab fracture of the calcaneus associated with a comminuted (type V) fracture of the central tarsal bone. (e–f) The calcaneal fracture has been stabilized with three 2.7 mm lag screws inserted from lateral to medial, and the fracture of the central tarsal bone has been stabilized with three 2 mm lag screws. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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25.16
(a) Plantarodorsal and (b) mediolateral views of a fracture of the base of the calcaneus in a 6-month-old Greyhound. (c–d) The fracture was stabilized with a combination of K-wires and a figure-of-eight tension-band wire. © 2016 British Small Animal Veterinary Association
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25.16
(a) Plantarodorsal and (b) mediolateral views of a fracture of the base of the calcaneus in a 6-month-old Greyhound. (c–d) The fracture was stabilized with a combination of K-wires and a figure-of-eight tension-band wire.
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25.17
Fracture of the lateral ridge of the talus producing a large osteochondral fragment. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.17
Fracture of the lateral ridge of the talus producing a large osteochondral fragment. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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25.18
Fracture of the neck of the talus. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.18
Fracture of the neck of the talus. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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25.19
(a–b) A tibiotarsal luxation, distal fibular fracture and a fracture of the medial trochlea of the talus in a cat. (c–d) The distal fibular fracture was stabilized with a pin and tension-band wire, and the fracture of the talus was stabilized with a combination of mini lag screws and a threaded K-wire. © 2016 British Small Animal Veterinary Association
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25.19
(a–b) A tibiotarsal luxation, distal fibular fracture and a fracture of the medial trochlea of the talus in a cat. (c–d) The distal fibular fracture was stabilized with a pin and tension-band wire, and the fracture of the talus was stabilized with a combination of mini lag screws and a threaded K-wire.
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25.20
Schematic view of the proximal articular surface of the central tarsal bone to illustrate the fracture types. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.20
Schematic view of the proximal articular surface of the central tarsal bone to illustrate the fracture types. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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25.21
A CT image of a type IV central tarsal bone fracture. The mediolateral fracture (white arrow) was visible on radiographs; however, the dorsoplantar fissure (black arrow) was only identified on the CT scan. The contralateral intact bone is visible on the right. © 2016 British Small Animal Veterinary Association
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25.21
A CT image of a type IV central tarsal bone fracture. The mediolateral fracture (white arrow) was visible on radiographs; however, the dorsoplantar fissure (black arrow) was only identified on the CT scan. The contralateral intact bone is visible on the right.
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25.22
Dorsal exposure of the carpus. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.22
Dorsal exposure of the carpus. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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25.23
Palmaromedial exposure of the radial carpal bone. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.23
Palmaromedial exposure of the radial carpal bone. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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25.24
Palmarolateral exposure of the accessory carpal bone. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.24
Palmarolateral exposure of the accessory carpal bone. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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25.25
Screw fixation of (a) type I and (b) type II articular fractures of the accessory carpal bone. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.25
Screw fixation of (a) type I and (b) type II articular fractures of the accessory carpal bone. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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25.26
Plantarolateral exposure of the calcaneus. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.26
Plantarolateral exposure of the calcaneus. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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25.27
Pin and tension-band repair of a Salter–Harris type I fracture of the proximal calcaneal physis. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.27
Pin and tension-band repair of a Salter–Harris type I fracture of the proximal calcaneal physis. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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25.28
Pin and tension-band repair of a mid-body fracture of the calcaneus. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.28
Pin and tension-band repair of a mid-body fracture of the calcaneus. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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25.29
Medial exposure of the talocrural joint via osteotomy of the medial malleolus. (a) Exposure of the medial aspect of the tarsus. (b) Retraction of caudal tendons prior to osteotomy. (c) Position of osteotomy. (d) Distal reflection of medial malleolus to expose the medial trochlear ridge. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.29
Medial exposure of the talocrural joint via osteotomy of the medial malleolus. (a) Exposure of the medial aspect of the tarsus. (b) Retraction of caudal tendons prior to osteotomy. (c) Position of osteotomy. (d) Distal reflection of medial malleolus to expose the medial trochlear ridge. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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25.30
(a) Repair of a fracture of the lateral talar ridge using countersunk K-wires. The fracture is exposed via osteotomy of the distal fibula and lateral reflection of the malleolus. If possible small lag screws should be used rather than K-wires, since these provide better stability, although when used in small bone fragments there is a risk that the lag screws can cause further fragmentation. (b) The fibular osteotomy is repaired using two positional screws into the distal tibia. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.30
(a) Repair of a fracture of the lateral talar ridge using countersunk K-wires. The fracture is exposed via osteotomy of the distal fibula and lateral reflection of the malleolus. If possible small lag screws should be used rather than K-wires, since these provide better stability, although when used in small bone fragments there is a risk that the lag screws can cause further fragmentation. (b) The fibular osteotomy is repaired using two positional screws into the distal tibia. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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25.31
Dorsomedial exposure of the central tarsal bone. (a) Incision through skin and subdermal fascia. (b) Retraction of the tibialis cranialis tendon exposes the fracture. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.31
Dorsomedial exposure of the central tarsal bone. (a) Incision through skin and subdermal fascia. (b) Retraction of the tibialis cranialis tendon exposes the fracture. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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25.32
Repair of a type I/II central tarsal bone fracture using a dorsoplantar lag screw. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.32
Repair of a type I/II central tarsal bone fracture using a dorsoplantar lag screw. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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25.33
(a) Schematic to show screw position in the repair of a type IV central tarsal bone fracture. A mediolateral partially threaded cancellous screw is used to stabilize the medial slab; this allows more space for insertion of a dorsoplantar lag screw to stabilize the dorsal slab. (b) Plantarodorsal and (c) mediolateral views of a type IV central tarsal bone fracture in a Greyhound. (d) Plantarodorsal and (e) mediolateral postoperative views. The fracture has been stabilized with a mediolateral 4 mm partially threaded screw and dorsoplantar 2.7 mm lag screw. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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25.33
(a) Schematic to show screw position in the repair of a type IV central tarsal bone fracture. A mediolateral partially threaded cancellous screw is used to stabilize the medial slab; this allows more space for insertion of a dorsoplantar lag screw to stabilize the dorsal slab. (b) Plantarodorsal and (c) mediolateral views of a type IV central tarsal bone fracture in a Greyhound. (d) Plantarodorsal and (e) mediolateral postoperative views. The fracture has been stabilized with a mediolateral 4 mm partially threaded screw and dorsoplantar 2.7 mm lag screw. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.