Internal Fixation of Fractures of the Third Phalanx in Three Horses (original) (raw)
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Veterinary Journal
A multicentre study of 285 cases was performed to enhance the management of distal phalangeal fractures on the basis of clinical evidence. The outcome after treatment was available for 223 of the cases. Horses with a non-articular type I fracture had a better prognosis (91.7%) for return to original or expected level of use than horses with an articular type II or III fracture (69.6% and 74.1%, respectively). The prognosis for types IV and V fractures was fair (57.7% and 57.1%, respectively) and for type VI good (80%). Horses with a hindlimb fracture had a significantly greater chance of a successful outcome. No significant association between age or time to start treatment and success rate was noted. The best treatment option for types I–III fractures was a conservative approach (box rest). Type IV fractures were best treated by arthroscopic removal of the fragment. Immobilisation of the hoof did not seem to influence outcome. Radiological findings and clinical healing were not accurately correlated and the re-commencement of training should be based on clinical rather than radiological findings. Complete osseous union of the fracture was not essential for a successful return to athletic activity.
Veterinary Surgery, 2005
Objectives-To compare the precision obtained with computer-assisted screw insertion for treatment of mid-sagittal articular fractures of the distal phalanx (P3) with results achieved with a conventional technique. Study Design-In vitro experimental study. Sample Population-Thirty-two cadaveric equine limbs. Methods-Four groups of 8 limbs were studied. Either 1 or 2 screws were inserted perpendicular to an imaginary axial fracture of P3 using computer-assisted surgery (CAS) or conventional technique. Screw insertion time, predetermined screw length, inserted screw length, fit of the screw, and errors in placement were recorded. Results-CAS technique took 15-20 minutes longer but resulted in greater precision of screw length and placement compared with the conventional technique. Conclusion-Improved precision in screw insertion with CAS makes insertion of 2 screws possible for repair of mid-sagittal P3 fractures. Clinical Relevance-CAS although expensive improves precision in screw insertion into P3 and consequently should yield improved clinical outcome.
Short Incomplete Sagittal Fractures of the Proximal Phalanx in Ten Horses Not Used for Racing
Veterinary Surgery, 2008
Objective-To describe short incomplete sagittal fractures of the proximal phalanx (type Ia P1 fractures) in horses not used for racing and report outcome. Study Design-Retrospective study. Animals-Horses (n ¼ 10) with type Ia P1 fractures. Methods-Retrieved data of horses with type Ia P1 fractures were signalment, history and results of orthopedic examination. Radiographs were re-evaluated for position and length of the fracture line, presence of osteoarthritis or subchondral cystic lesions (SCL), periosteal new bone formation and subchondral sclerosis. Conservative treatment (n ¼ 4) included box confinement for 2 months followed by 1 month of hand walking. Surgical therapy (n ¼ 6) consisted of internal fixation by screws inserted in lag fashion in 5 horses. Concurrent SCL were debrided by curettage via a transcortical drilling approach. In 1 horse, only SCL curettage but not internal fixation was performed. Outcome was assessed on a clinical and radiographic follow-up examination in all horses. Results-Mean follow-up time was 27 months (median, 13.5 months; range, 9 months to 9 years). All horses treated with internal fixation were sound at follow-up and had radiographic fracture healing. Of the 4 horses managed conservatively, 3 remained lame and only 1 horse had radiographic evidence of fracture healing. Catastrophic fracture propagation occurred in 2 horses not treated by internal fixation, 20 and 30 months after diagnosis, respectively. Conclusions-Horses with a type Ia P1 fracture treated surgically had a better outcome than those managed conservatively and lack of fracture healing seemingly increases the risk of later catastrophic fracture. Clinical Relevance-Surgical repair of type Ia P1 fractures should be considered to optimize healing and return to athletic use.
Veterinary Surgery, 2000
Objectives-To compare the biomechanical properties, in full limb preparations, of intact second phalanx and a simulated comminuted second phalangeal fracture stabilized with either two bone plates or a custom Y-plate. Study Design-In vitro biomechanical assessment of intact limbs and of paired limbs with a simulated second phalangeal fracture stabilized by one of two fixation methods. Animal Population-Thirteen pairs of equine cadaveric forelimbs. Methods-A comminuted second phalangeal fracture was created in six paired cadaveric limbs. For each limb pair, the fracture was stabilized with two plates in one limb, and with a Y-plate in the contralateral limb. These limbs and seven pairs of intact limbs were subjected to axial compression in a single cycle until failure. Mechanical properties were compared with a mixed-model ANOVA and post hoc contrasts. Joint contact pressure, screw insertion torque, and final screw torque remaining after mechanical testing were also evaluated for constructs. Results-No significant differences in mechanical testing variables were detected between construct types. However, the Y-Plate construct had significantly greater yield load, yield displacement and yield energy, and failure load and stiffness values than those for intact specimens, whereas the double-plate construct only had greater stiffness than intact specimens. There were no significant differences in joint contact pressures for both constructs. The final screw torque for proximal phalangeal screws was significantly greater for the Y-plate constructs than for double-plate constructs. Conclusions-The Y-plate was as effective as the double-plate technique for stabilization of simulated comminuted second phalangeal fractures in monotonically tested equine cadaveric forelimbs. Clinical Relevance-This investigation supports evaluation of the Y-plate for repair of comminuted second phalangeal fractures in equine patients. Its specific design may facilitate repair of second phalangeal fractures, and may provide increased stability by allowing the proximal fragments of the second phalanx to be fixed with three screws placed through the plate.
Veterinary Surgery, 2019
Objective: To determine long term outcomes of nonracing equines athletes treated for short incomplete proximal sagittal fractures of the proximal phalanx (SIPSFP1) by lag screw fixation. Study design: Retrospective study. Sample population: Thirty-one horses. Methods: Medical records from horses with an SIPSFP1 (2008-2014) were reviewed. Long-term (≥12 months) outcomes were assessed with telephone interviews and clinical and radiographic examinations. Results: Warmblood was the predominant breed in cases included in the study. Among horses with long-term interview information, 27 of 31 returned to previous athletic activity level. In total, 15 horses with 19 fractures had clinical and radiographic assessment after a minimum of 12 months. Among those, nine of 15 horses were sound at the trot, and six of 15 were mildly lame. Complete radiographic healing was confirmed in six limbs, and the facture line was evident in 13. The position of the proximal screw was not associated with radiographic fracture healing or return to soundness. Conclusion: Most horses treated for SIPSFP1 with lag screw fixation returned to previous activity levels, although radiographic fracture healing remained incomplete 12 months or more after surgery. Clinical significance: Lag screw fixation is a valid treatment for horses not used for racing that are experiencing an SIPSFP1 and results in a high rate of return to intended use, although complete radiographic fracture healing cannot be expected.
Treatment of incisive bone fracture in a horse using an acrylic splint
Equine Veterinary Education, 2009
External manipulation revealed pain and crepitus in the gingival region of the rostral maxilla. An intraoral examination revealed upper gingival haematomas, misalignment and malocclusion of the incisors (prognathism). A radiograph of the rostral maxilla confirmed ventrally displaced bilateral fractures of the incisive portion of the maxilla rostral to the canine teeth (Triadan 104/204).
Veterinary Surgery, 2010
Objective: To determine the rate of postoperative infection (POI) for internal fixation repaired equine long bone fractures and arthrodeses and identify associated risk factors. Study Design: Case series. Animals: Horses (n = 192) with fracture repair of the third metacarpal and metatarsal bones, radius, ulna, humerus, tibia, and femur, or arthrodesis with internal fixation. Methods: Medical records (1990-2006) were reviewed for signalment, anatomic location, fracture classification and method of repair, technique and surgical duration, bacterial species isolated, postoperative care, onset of POI, and outcome. Results: Of 192 horses (171 [89%] closed, 21 [11%] open fractures), 157 (82%) were discharged from the hospital. Infection occurred in 53 (28% horses), of which 31 (59%) were discharged. Repairs without POI were 7.25 times more likely to be discharged from the hospital. Closed fractures were 4.23 times more likely to remain uninfected and 4.59 times more likely to be discharged from the hospital compared with open fractures. Closed reduction and internal fixation was associated with a 2.5-fold reduction in rate of POI and a 5.9 times greater chance for discharge from the hospital compared with open reduction and internal fixation. Females had a strong trend for increased POI when compared with colts and stallion but not geldings. Conclusions: Overall rate of POI was 28%. Fracture classification, method of repair, gender, and surgical duration were significant risk factors.
Veterinary Surgery, 2009
Objectives-To compare the precision of radiography and computed tomography (CT) preoperatively in the standing position for identification of guidelines for screw insertion in the distal phalanx, and to identify whether standing CT might improve operative time compared with preoperative radiographic planning. Study Design-Experimental ex vivo study. Animals-Cadaveric equine thoracic limb pairs (n ¼ 10). Methods-Insertion of a 4.5 mm cortex screw in lag fashion into an intact distal phalanx was evaluated in 2 groups (n ¼ 10) of cadaveric equine thoracic limbs. In 1 group, the site, direction, and length of the implant were determined by radiography, and in the other group, by CT. Accuracy of screw placement was verified by specimen dissection. Outcomes were (1) absence of penetration of the articular surface, the solar surface, or the semilunar canal (2) appropriate length and direction of the screw. Surgical time was also measured. Results-No screw penetrated the articular surface, the solar surface, or the semilunar canal in either group. CT was more accurate to identify guidelines for screw insertion (U ¼ 23.50, P ¼ .049). With CT, surgical time (mean, 7.7 minutes) was significantly shorter (U ¼ 0.000, P ¼ .000) than with radiography (mean, 12.7 minutes). Conclusion-Standing CT can be used to accurately determine anatomic landmarks for screw insertion in lag fashion in sagittal fractures of the distal phalanx. Clinical Relevance-This study has a clear clinical relevance for improved internal fixation of sagittal fractures of the distal phalanx.