Alternative approach for fracture fixation following implant infection in a Salter-Harris type-II fracture of the proximal phalanx in a Warmblood foal

Abstract

A 2-day-old female Warmblood foal (70 kg) presented with a closed, displaced Salter-Harris type-II fracture of the proximal physis of the left hind first phalanx. The fracture was repaired with four 4.5 mm cortical screws and a wire in a figure-of-8 pattern applied on the lateral and medial aspect of the phalanx, respectively. A 4.5 mm cortical screw was additionally inserted in lag-fashion to engage the lateral metaphyseal spike. Three days postoperatively, medial and proximal displacement of the distal fracture fragment and implant infection were apparent and revision surgery was performed. Previous implants were removed and two 4.5 mm transphyseal cortical lag-screws were placed in proximolateral–distomedial and dorsoproximal–plantarodistal direction across the physis and the fracture line. Postoperatively, the fracture healed rapidly and the implants were removed 6 weeks later. Nineteen months after implant removal, the horse did not show any sign of lameness, despite a shortening of the proximal phalanx compared to the contralateral limb. In cases of postoperative implant instability and infection, implant removal often becomes necessary. However, new implants cannot be placed safely in the previous location. To avoid this problem, this report describes an alternative approach for screw positioning in case of previous implant infection in a Salter-Harris type-II fracture of the proximal physis of the first phalanx.