Discussion

The majority of equine fractures are articular and prognosis usually is determined by the severity of articular insult and of the deficit that remains. In general, reconstruction without incongruity of the articular surface is critical to resumption of an athletic career.
The advent of internal fixation under arthroscopic control or guidance occurred in 1986 when Richardson described a technique for repair of slab fractures of the third carpal bone. The minimally invasive technique and accurate anatomical reduction dovetailed perfectly with the goals of AO/ASIF and led to rapid universal adoption. The principle of using arthroscopically determined percutaneous markers for delineation of fracture margins and implant trajectory allowed adaptation to repair of other and more complex slab fractures (McIlwraith et al. 2005) and of carpal chip fractures (Wright and Smith 2011).
Articular incongruity is the most common surgical complication of fractures of the metacarpal and metatarsal condyles. Arthroscopically guided repair of fractures of the lateral condyle optimises accuracy of reduction (Richardson 2002; McIlwraith et al. 2005; Wright and Nixon 2012). It has permitted also identification and treatment of concurrent lesions within the metacarpophalangeal/metatarsophalangeal joint such as capsular tears, radiologically silent comminution and impingement lesions on the proximal sesamoid bone which are prognostically significant and otherwise would have been unrecognised. In parasagittal fractures of the proximal phalanx, subtle displacement and thus articular incongruity can be impossible to detect radiologically or by open surgical techniques. Arthroscopic inspection of the dorsoproximal articular surface can be performed expeditiously and is recommended before fixation of all displaced fractures.
Arthroscopically guided reduction and repair of mid body fractures of the proximal sesamoid bones was reported by Busschers et al. (2008). This has all of the advantages enjoyed at other locations and has improved markedly the quality of reduction, accuracy of implant placement and subsequent results compared to open surgical procedures.
Unsurprisingly, the accuracy of assessment and precision permitted by arthroscopy stimulated thoughts toward its use in other fractures. Similar techniques have been employed and advantages obtained in other sites including fractures of the talus, lateral malleolus of the tibia, middle phalanx and distal phalanx.
The presentation will summarise the author's experiences, current clinical applications and views.