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Updated: Apr 25, 2026
Assessment of Bone Fracture Healing Using Micro-Computed Tomography
Published on: December 9, 2022
Clinical use of computed tomography and surface markers to assist internal fixation within the equine hoof
Janik C Gasiorowski1, Dean W Richardson
1Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania.
Insights
Computed tomography (CT) and hoof surface markers enable precise screw placement for internal fixation of distal phalanx (DP) and distal sesamoid bone (DSB) fractures in horses. This technique proved simple, rapid, and accurate for clinical application.
Area of Science:
- Veterinary surgery
- Orthopedic surgery
- Diagnostic imaging
Background:
- Internal fixation of distal phalanx (DP) and distal sesamoid bone (DSB) fractures in horses presents surgical challenges due to the hoof's confined anatomy.
- Accurate screw placement is critical for successful fracture repair and optimal outcomes in equine limb injuries.
Purpose of the Study:
- To describe the clinical application of computed tomography (CT) combined with hoof surface markers for guiding internal fixation of equine distal phalanx (DP) and distal sesamoid bone (DSB) fractures.
- To evaluate the accuracy, efficiency, and outcomes of this CT-guided technique.
Main Methods:
- A retrospective case series involving 16 horses with DP or DSB fractures treated with CT-guided internal fixation.
- Preoperative CT imaging with barium paste grids on the hoof surface was used to plan drill bit entry and trajectory.
- Postoperative CT confirmed screw position, length, and fracture reduction; surgical and anesthesia times were recorded.
Main Results:
- Screw placement and length were near-optimal in all cases, with no significant malpositioning.
- Successful fracture reduction was achieved in all treated horses.
- Preoperative planning averaged 10-20 minutes, with surgical times averaging 61 minutes and general anesthesia averaging 171 minutes.
Conclusions:
- The combination of CT and surface marker grids provides an accurate, simple, and rapid method for screw placement in clinical DP and DSB fractures.
- The technique facilitates precise internal fixation within the hoof wall, improving surgical outcomes.
- The use of an aiming device is recommended to further enhance this CT-guided surgical approach.
Objective:
To describe clinical use of computed tomography (CT) and hoof surface markers to facilitate internal fixation within the confines of the hoof wall.
Study Design:
Retrospective case series.
Animals:
Horses (n = 16) that had CT-guided internal fixation of the distal phalanx (DP) or distal sesamoid bone (DSB).
Methods:
Drill bit entry point and direction were planned from CT image series performed on hooves with grids of barium paste dots at proposed entry and projected exit sites. Post-implantation CT images were obtained to check screw position and length as well as fracture reduction. Imaging, reduction, and surgical and general anesthesia times were evaluated. Outcome was recorded.
Results:
Screw position and length were considered near optimal in all horses, with no consequential malposition of bits or screws. Fracture reduction was evident in all cases. Preoperative planning times (at least 2 CT image acquisitions and grid creation) ranged from 10 to 20 minutes. Surgery time ranged from 45 to 90 minutes (mean, 61 minutes) and general anesthesia time ranged from 115 to 220 minutes (mean, 171 minutes).
Conclusions:
The combination of CT and surface marker grids allowed accurate positioning of screws in clinical DP and DSB fractures. The technique was simple and rapid. An aiming device is useful for the technique.
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