In 2017, a study describing the technique and outcome of minimally invasive repair of third tarsal bone (T3) slab fractures was reported in 17 thoroughbred racehorses using radiographically guided screw placement (Barker et al 2017). The series utilised the consistent orientation of T3 slab fractures, involving the dorsal lateral margin of the T3 and with the use of radiographically guided needle markers, screw placement could be achieved under radiographic guidance.
Since this data set was published preoperative computed tomographic (CT) evaluation was carried out on all T3 slab fractures undergoing repair at Newmarket Equine Hospital between 2014 and 2024 (n=52) and their configurations documented.
In late 2023, postoperative CT was introduced which allowed for more accurate three-dimensional evaluation of screw placement. Post operative CT identified short comings in the accuracy of screw placement in a lateromedial plane which cannot be assessed adequately using radiography. This led to the introduction CT guided screw placement to ensure central screw placement in the fracture fragment. Accurate screw placement was achieved using a drilling Jig (two types were used in the series, a commercial available jig or a disposable jig made intra-operatively) and intra-operative CT to ensure central and perpendicular drill placement on the fracture fragment.
The purpose of this series is to raise awareness of the challenges of accurate screw placement using needle markers and conventional 2D imaging during T3 slab fracture repair, provide details of an alternative technique and report on the outcome.
