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Many of the fractures are almost exactly midsaggital, dividing the bone into medial and lateral halves. These are readily approached by internal fixation, since external landmarks (i.e. the hoof) can be used to deduce the location and course of the fracture. Orientation of the screw is 90º
to the long axis of the limb (parallel to the sole surface in a well-balanced foot). The insertion of the screw confers the stability necessary to bring about healing (see below.)
 A complication of midsagittal fractures of the distal phalanx may be comminution at the level of the extensor process. These will usually stabilize during the healing process of the main fracture, and only rarely require removal.
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