A mature Thoroughbred gelding that was used as a high level jumper presented for evaluation of a nonweightbearing forelimb lameness following a fall. Radiographs revealed a complete, noncomminuted, minimally displaced sagittal fracture of the greater tubercle. Supporting limb laminitis was a major concern in the short term based on the severe lameness at presentation. Open reduction with internal fixation was chosen over stall rest in an attempt to more rapidly return the weightbearing function to the limb. The procedure was performed standing and 3 bone screws were placed standing in an attempt to avoid implant or catastrophic bone failure that can accompany recovery from general anaesthesia. The day following surgery the lameness was significantly improved as the horse was able to bear some weight on the heel. The gelding was discharged 5 days following surgery and was fully weightbearing at the walk. Six months following surgery the horse was free of lameness and resumed training. This report describes our experience and rationale in placing bone screws in a standing horse for treatment of a greater tubercle fracture.