Soft Tissue Approach to Pastern Arthrodesis Using a Curvilinear “S”-Shaped Incision, 25 Cases

Introduction: Pastern arthrodesis is performed for a variety of reasons including degenerative arthropathy, luxation/subluxation, fracture or rarely sepsis. Traditional open approaches have been described using an inverted T. The aim of this study is to propose a new soft tissue approach with an S shape based on previous clinical experience.

Materials and Methods: Since 2013, 25 patients (in 4 hospitals) were operated using an S-shaped incision. Initial cadaver work had delineated how to centre the approach allowing tension-free placement of the three-hole LCP pastern plate at the distal vicinity of the skin incision. Lateral boundaries carried the incision abaxially allowing tunnelling access to the collateral ligament for unilateral or bilateral desmotomy, depending on access restriction and case chronicity. Tendon incision using a W-pattern resembled previous descriptions.

Results: None of the horses developed surgical site complications. None of the cases developed surgical site complications. Of the 25 cases, one fracture developed overload laminitis in the contralateral limb and one elective case developed colitis due to accidental NSAID overdose. Both were lost within the first week post-operatively. The remaining 23 horses survived and were back to intended use. Cosmetic result and healing were perceived superior to previous cases using the inverted T-approach.

Discussion/Conclusion: No control group was available in this retrospective series. Based on our experience, the S-shaped approach heals faster and without thickening at the junction of vertical incision and suture lines. This follows the trend in human cosmetic surgeries where curvilinear incisions heal with superior cosmetic result compared with abrupt angle changes approach and suture pattern apposition.

Acknowledgements: None.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
26 October 2022