Study compares screw and X-plate repair for equine carpal fractures

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A new ex vivo study in Veterinary Surgery compared two fixation strategies for vertical plane accessory carpal bone fractures in horses: traditional repair with two 4.5 mm cortical screws placed in lag fashion, and a construct using one 4.5 mm lag screw plus a lateral angular-stable X-plate with four 2.7 mm locking screws. In 20 equine cadaver forelimbs, both techniques were technically feasible, and neither restored the strength of the intact accessory carpal bone. Mean maximum strength was 6.82 kN for the screw-only group and 7.91 kN for the X-plate group, versus 11.26 kN for native bone, with no significant difference between the two repair methods. The paper also reported less implant bending and a smaller fracture gap with the X-plate construct, even though overall load-to-failure performance was similar. (ecvs.org)

Why it matters: Accessory carpal bone fractures are uncommon, but they can be difficult to manage because the bone’s shape makes stable fixation challenging, and conservative treatment has long been associated with fibrous union or non-union rather than bony healing. For equine surgeons, this study suggests the X-plate approach may be a workable alternative when standard lag screw placement is limited by anatomy, but it doesn’t yet show a clear biomechanical advantage in ultimate construct strength. (ecvs.org)

What to watch: The next step is whether clinical case series or prospective in vivo data show that the X-plate’s lower bending and smaller fracture gap translate into better healing, fewer complications, or faster return to work. (pmc.ncbi.nlm.nih.gov)