Surgical Management of Proximal Splint Bone Fractures in the Horse

Fractures of Metacarpal and Metatarsal II and IV (the splint bones) were treated in 283 horses over an 11 year period. In 21 cases the proximal portion of the fractured bone was stabilized with metallic implants. One or more cortical bone screws were used in 11 horses, and bone plates were applied in 11 horses. One horse received both treatments. Complications of screw fixation included bone failure, implant failure, radiographic lucency around the screws, and proliferative new bone at the ostectomy site. Only two of the horses treated with screw fixation returned to their intended use. Complications of plate fixation included partial fixation failure (backing out of screws), wound drainage, and proliferative bony response around the plate. Six of the 11 horses treated by plate fixation returned to their intended use. The authors recommend consideration of plate fixation techniques for repair of fractures in the proximal third of the splint bone.     

Repair of an open radial fracture in an adult horse

An open radial fracture in an adult horse (450 kg) was repaired by internal fixation, using two 18-hole 4.5-mm broad dynamic compression plates and 5.5- and 4.5-mm bone screws. The fracture healed completely, but when evaluated 9 months after surgery, the horse was lame on the fractured limb at a trot. Local infiltration of anesthesia along the distal half of the bone plates greatly ameliorated the lameness, suggesting that the plates were irritating the soft tissues and extensor tendons along the cranial and lateral aspects of the antebrachium. Both bone plates were removed simultaneously with no complications, and the horse became sound.     

The use of small (2.7 mm) screws for arthroscopically guided repair of carpal chip fractures

Reasons for performing the study: Removal of large chip fractures of the carpal bones and the osteochondral deficits that result, have been associated with a worse prognosis than removal of small fragments in similar locations. Hypothesis: Reducing the articular defects by repair of large osteochondral fragments may have advantages over removal. Methods: Horses with osteochondral chip fractures that were of sufficient size and infrastructure to be repaired with small (2.7 mm diameter) AO/ASIF cortex screws were identified and repair effected by arthroscopically guided internal fixation. Results: Thirty‐three horses underwent surgery to repair 35 fractures of the dorsodistal radial carpal bone (n = 25), the dorsal margin of the radial facet of the third carpal bone (n = 9) and the intermediate facet of the distal radius (n = 1). There were no surgical complications and fractures healed satisfactorily in 26 of 28 horses and 23 horses returned to racing performance. Conclusion: Arthroscopically guided repair of carpal chip fractures with small diameter cortex screws is technically feasible and experiences with 33 cases suggest that this may have advantages over fragment removal in managing such cases. Potential relevance: Surgeons treating horses with large chip fractures of the carpal bones should consider arthroscopically guided internal fixation as an alternative to removal.     

Outcome and racing performance after internal fixation of third and central tarsal bone slab fractures in horses. A review of 20 cases

Twenty horses with central and third tarsal bone slab fractures, were treated internal fixation. Eighteen of the 20 cases were Standardbred trotters, one was a Thoroughbred racehorse and one a Swedish Warmblood. The central tarsal bone (CT) was involved in 12 cases and the third tarsal bone (T3) in 8 cases. The fractures were treated by lag screw fixation with one (18 cases) or two (2 cases) 3.5 or 4.5 mm cortical screws. Horses were confined to stall rest for one month and then put on a gradually increasing exercise programme. Convalescence time was 3-8 months until the fracture had healed and training could be resumed. Fifteen of the horses regained athletic soundness. Thirteen of the horses (72%) raced after surgery (12 Standardbreds and 1 Thoroughbred). Nine (69%) of these 13 horses won races after surgery.     

Surgical management of complete diaphyseal third metacarpal and metatarsal bone fractures: Clinical outcome in 10 mature horses and 11 foals

Reasons for performing study: Osteosynthesis of third metacarpal (McIII) and third metatarsal (MtIII) bone fractures in horses is a surgical challenge and complications surrounding the repair are common. Retrospective studies evaluating surgical repair, complications and outcome are necessary to increase knowledge and improve success of long bone fracture repair in the horse. Objectives: To evaluate clinical findings, surgical repair, post operative complications and outcome of 10 mature horses and 11 foals with McIII or MtIII fractures that were treated with open reduction and internal fixation (ORIF). Methods: Medical records were reviewed and follow‐up information obtained by means of radiographs and/or telephone questionnaire. Results: Survival was achieved in 62% of the horses (3 mature/10 foals). On long‐term evaluation (>6 months) 11 horses (2 mature/9 foals) were fit for their intended activity, one mature horse had a chronic low grade lameness, and one foal was lost to follow‐up because it was sold. The main fracture types were simple transverse (33.3%) or simple oblique (28.6%) and 71.4% of the fractures were open, 3 Type I (one mature/2 foals) and 12 type II (7 mature/5 foals). The preoperative assessment revealed inadequate emergency treatment in 10 horses (5 mature/5 foals; 47.6%). Survival rate of horses with open fractures was 12.5% (1/8) in mature and 85.7% (6/7) in foals. Post operative incisional infection (4 mature, 3 foals) was only managed successfully in 2 foals. Fracture instability related to inadequate fracture fixation technique occurred in 4 horses (all mature) and was always associated with unsuccessful outcome. Conclusions: Age, bodyweight and infection are strongly associated with outcome in treatment of complete McIII/MtIII fractures. Clinical relevance: Rigid fixation using plates and screws can be successful in treatment of closed or open, complete diaphyseal McIII/MtIII fractures in mature horses and foals. Instable fixation, infection and a bodyweight >320 kg are major risk factors for unsuccessful outcome.     

Compression plating of radial and ulnar fractures in the goat.

Internal fixation of radial and ulnar fractures in three goats was accomplished using bone plates. Intervals between the time of fracture and internal fixation varied from one to 13 days. The goats were ambulatory the day after surgery, and recoveries were uneventful.     

Fractures of the palmar aspect of the carpal bones in horses: 10 cases (1984-2000)

OBJECTIVE: To determine clinical and radiographic findings, treatment, and outcome of horses with fractures of the palmar aspect of the radial carpal bone, with or without concurrent fractures of the palmar surfaces of the other carpal bones. DESIGN: Retrospective study. ANIMALS: 10 horses. PROCEDURE: Medical records were reviewed to obtain information on history, signalment, clinical and radiographic findings, treatment, and outcome. Follow-up information was gathered from owners and referring veterinarians. RESULTS: 7 horses became lame after recovery from general anesthesia for treatment of an unrelated problem. The remaining 3 horses developed a fore-limb lameness after falling (1 horse) or being turned out in a pasture (2 horses). Fractures involved the palmar surface of the radial carpal bone in all 10 horses; in addition, the ulnar carpal bone was affected in 2 horses, the intermediate carpal bone in 2 horses, and the distal aspect of the radius in 4 horses. None of the 4 horses treated nonsurgically returned to work, and 3 were euthanatized because of recalcitrant lameness. In the other 6 horses, fragments were removed surgically. Two were euthanatized because of continued lameness, 1 was euthanatized for other reasons, 2 were sound enough for light work, and 1 returned to athletic work. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that fractures of the palmar aspect of the carpal bones are uncommon in horses. The prognosis appears to be poor for affected horses but may be better for horses that undergo arthroscopic removal of intra-articular fragments.     

Dorsal Frontal Fractures of the First Phalanx in the Horse

Dorsal frontal fractures of the first phalanx in nine horses are described. All fractures were in hindlimbs, and two horses were affected bilaterally. Of the eleven fractures, seven were incomplete and nondisplaced, one was complete and nondisplaced, and three were complete and displaced. Two horses with complete displaced fractures had their fractures repaired with lag screw fixation combined with open reduction, and the other seven horses were treated nonsurgically.
All horses were sound on the injured limb within 3 to 6 months of the injury. Lag screw fixation was recommended for horses with complete, displaced dorsal frontal fractures in order to reduce the articular defect and help prevent secondary joint changes. Nonsurgical therapy in the form of stall rest with a heavy support wrap resulted in bony healing of the fracture in 4 to 6 months.
Follow-up was obtained on all nine horses: two were retired for breeding; five performed equal to or better than their previous level of racing performance; one was performing successfully as a combined training horse; and one returned to a lower level of performance due to an unrelated forelimb lameness.     

A Lateral Approach to the Repair of Propagating Fractures of the Medial Condyle of the Third Metacarpal and Metatarsal Bone in 18 Racehorses

Objectives— To report the technique, observations on fracture configurations and results of treatment by fixation lag screw following the fracture plane determined by an approach to the third metacarpal/metatarsal bone (MC3/MT3) that begins laterally over the metacarpo(metatarso)phalangeal joint and extends dorsally over the diaphysis of the bone.
Study Design— Case series.
Animals— Thoroughbred horses (n=18) with propagating fractures of the medial condyle of MC3/MT3.
Methods— Retrospective analysis of case records of horses with fractures of the medial condyle of MC3/MT3 that propagated sagittaly or in a spiral configuration into the diaphysis, repaired surgically under general anesthesia by screw fixation in lag fashion through a lateral approach with periosteal reflection.
Results— Fractures were readily identified at surgery, enabling screw fixation in lag fashion following the fracture plane. Fracture configurations varied and could be classified as sagittal and spiral fractures with fractures within each group generally following a similar course. All horses recovered relatively uneventfully from general anesthesia and surgery, and all fractures healed well. Thirteen horses returned to training; 5 subsequently raced.
Conclusions— Repair of propagating sagittal and spiral fractures of the medial condyle of MC3/MT3 with diaphyseal involvement, through a lateral approach with periosteal reflection permits stable fixation with minimal complications. In this series there were no catastrophic failures.
Clinical relevance— Fractures of the medial condyle of MC3/MT3 that propagate either sagittaly or in a spiral configuration into the diaphysis can be successfully repaired with screw fixation in lag fashion using a lateral approach with periosteal reflection.     

Conservative management of minimally displaced radial fractures in three horses

Minimally displaced, spiral, radial fractures were diagnosed in three adult horses. Two horses had open fractures and in one horse the fracture was closed. A diagnosis was made on radiographs taken 24 h, 5, and 9 days after the fracture. There was minimal displacement of the fracture fragments despite the considerable time which had elapsed between fracture and diagnosis and an unfavourable prognosis with internal fixation, so conservative therapy was the preferred method of treatment. One horse developed a sequestrum and draining sinus, which was treated surgically under general anaesthesia 3 months after diagnosis of the fracture. Other complications were minimal and transient. Two horses were being used for pleasure riding 12 months after fracture and one horse was pasture sound at 8 months.     

Conservative management of minimally displaced radial fractures in three horses

Minimally displaced, spiral, radial fractures were diagnosed in three adult horses. Two horses had open fractures and in one horse the fracture was closed. A diagnosis was made on radiographs taken 24 h, 5, and 9 days after the fracture. There was minimal displacement of the fracture fragments despite the considerable time which had elapsed between fracture and diagnosis and an unfavourable prognosis with internal fixation, so conservative therapy was the preferred method of treatment. One horse developed a sequestrum and draining sinus, which was treated surgically under general anaesthesia 3 months after diagnosis of the fracture. Other complications were minimal and transient. Two horses were being used for pleasure riding 12 months after fracture and one horse was pasture sound at 8 months.     

Evaluation of transfixation casting for treatment of third metacarpal, third metatarsal, and phalangeal fractures in horses: 37 cases (1994-2004)

OBJECTIVE: To evaluate clinical findings, complications, and outcome of horses and foals with third metacarpal, third metatarsal, or phalangeal fractures that were treated with transfixation casting. DESIGN: Retrospective case series. Animals-29 adult horses and 8 foals with fractures of the third metacarpal or metatarsal bone or the proximal or middle phalanx. PROCEDURES: Medical records were reviewed, and follow-up information was obtained. Data were analyzed by use of logistic regression models for survival, fracture healing, return to intended use, pin loosening, pin hole lysis, and complications associated with pins. RESULTS: In 27 of 35 (77%) horses, the fracture healed and the horse survived, including 10 of 15 third metacarpal or metatarsal bone fractures, 11 of 12 proximal phalanx fractures, and 6 of 8 middle phalanx fractures. Four adult horses sustained a fracture through a pin hole. One horse sustained a pathologic unicortical fracture secondary to a pin hole infec-tion. Increasing body weight, fracture involving 2 joints, nondiaphyseal fracture location, and increasing duration until radiographic union were associated with horses not returning to their intended use. After adjusting for body weight, pin loosening was associated with di-aphyseal pin location, pin hole lysis was associated with number of days with a transfixation cast, and pin complications were associated with hand insertion of pins. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that transfixation casting can be successful in managing fractures distal to the carpus or tarsus in horses. This technique is most suitable for comminuted fractures of the proximal phalanx but can be used for third metacarpal, third metatarsal, or middle phalanx fractures, with or without internal fixation.     

Short incomplete sagittal fractures of the proximal phalanx in ten horses not used for racing

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=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=4) included box confinement for 2 months followed by 1 month of hand walking. Surgical therapy (n=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.     

Treatment of long bone fractures in South American camelids: 5 cases

An adult llama and four alpacas were referred with long bone fractures. The llama presented with a closed, comminuted fracture of the right metatarsal bones. Two of the alpacas presented with comminuted fractures of the proximal radius. One fracture was closed and one was open. One alpaca had a closed, comminuted fracture of the distal radius, and the final alpaca had a closed, oblique fracture of the metatarsus. A diagnosis was made in each animal on the basis of clinical examination and radiographs. All fractures were managed by open reduction and internal fixation using selective placement of lag screws and dynamic compression plates. Four animals made uneventful recoveries and no long-term complications were encountered. One alpaca was re-admitted for plate failure and non-union of the fracture 5 weeks after surgery. The plate and screws were removed and a transfixation cast was applied. The fracture healed, however the alpaca showed signs of radial nerve paralysis after the cast was removed. With confinement in a small yard, full function gradually returned to the leg over the ensuing 4 months. Using techniques recommended in other species, South American camelids are suitable candidates for long bone fracture repair using open reduction and internal fixation.     

Use of transfixation pin casts to treat adult horses with comminuted phalangeal fractures: 20 cases (1993-2003)

OBJECTIVE: To determine the clinical applications, short and long-term survival, and complications of using transfixation pin casts for treatment of comminuted phalangeal fractures in adult horses. DESIGN: Retrospective case series. ANIMALS: 20 horses. PROCEDURES: Medical records were reviewed to obtain information regarding signalment, fracture location, treatment methods, complications, and short-term survival (discharge from hospital). Long-term follow-up information was obtained via contact with owners or trainers. RESULTS: 12 fractures were in a hind limb, and 8 were in a forelimb. Fourteen fractures occurred in a middle phalanx, and 6 occurred in a proximal phalanx. Eleven fractures were treated with internal fixation combined with transfixation pin casts, and 9 fractures were treated with transfixation pin casts alone. Transfixation pin casts were maintained for a mean of 52 days (median, 49 days; range, 1 to 131 days). Fourteen (70%) horses were discharged from the hospital, whereas 6 (30%) were euthanized during the treatment period. Reasons for euthanasia included secondary fracture of the third metacarpal or metatarsal bone, avascularity of the distal aspect of the limb associated with an open fracture, and displacement of the fracture after transfixation pin cast removal. A significantly greater number of horses was discharged from the hospital when the transfixation pin cast was maintained for > 40 days, compared with those in which the transfixation pin cast was maintained for < 40 days. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that horses should be maintained in a transfixation pin cast for a minimum of 40 days, as this was associated with an increase in short-term survival without an increased risk of catastrophic failure.     

Fractures of the humerus.

A single or double bar, type I, unilateral external fixator can be used as primary or ancillary treatment for repair of many humeral fractures. Treatment of contaminated and comminuted fractures with external skeletal fixation provides rotational stability and axial alignment, access for wound management and bone grafting, and avoidance of vascular compromise by surgical invasion. In addition, the combination of external and internal (IM pins, cerclage wires, plates) fixation can provide greater initial fracture stability and subsequent dynamization or loading of bone (as the fixator is removed) than either of the systems used individually.     

Comminuted First Phalanx Fractures in 30 Horses: Surgical vs. Nonsurgical Treatments

Comminuted first phalanx fractures were diagnosed in 30 horses. One leg was involved in each horse. Five horses were presented with open fractures. Nine horses had a portion of intact cortex (strut) extending from the proximal to distal joint. Ten horses were euthanized, including one with an open fracture, without treatment. The remaining 20 horses were treated by open reduction with a neutralization plate (8 horses, including one with an open fracture), open reduction with lag screw fixation (3 horses), lag screw fixation through stab incisions (2 horses), external coaptation with a cast (3 horses), and external skeletal fixation using a weight supporting shoe (4 horses, including 3 with open fractures).
Thirteen horses were euthanized following treatment because of persistent infection (9), chronic lameness (2), and third metacarpal bone fractures (2). Seven horses survived longer than 1 year after treatment. Six were lame and used as breeding animals, and one horse went on to race successfully. All four horses with open fractures that were treated were subsequently euthanized.
Significantly more horses with an intact strut of bone survived after treatment (4 of 7 [57%]) when compared to horses without an intact strut of bone that were treated (3 of 13 [23%]) (p < 0.05).
Invasive surgical approaches used for the repair of comminuted first phalanx fractures in this study were associated with an unacceptable infection rate (55%). Techniques involving less trauma to the compromised soft tissue around the fracture should afford a better chance for a successful outcome.     

Complete Excision of a Fractured Fourth Metatarsal Bone in Eight Horses

Proximal open comminuted fractures of the fourth metatarsal bone (Mt IV) in eight horses were treated by complete removal of the affected bone and antimicrobial therapy. Two horses had concurrent septic arthritis of the tarsocrural or distal tarsal articulations, and five horses had radiographic evidence of osteomyelitis and sequestration of the affected bone. Five horses became athletically sound for their intended use, two horses with septic arthritis had residual lameness but were pasture sound, and one horse was lost to follow-up. Excision of the entire bone appears to be an acceptable treatment of open comminuted fractures of the proximal one-third of Mt IV that do not respond to more conservative modes of therapy.     

Use of a pool-raft system for recovery of horses from general anesthesia: 393 horses (1984-2000)

OBJECTIVE: To describe the pool-raft recovery system protocol and to evaluate the clinical outcome in horses that underwent recovery from general anesthesia using this system. DESIGN: Retrospective study. ANIMALS: 393 horses that underwent recovery from general anesthesia in the pool-raft system. PROCEDURE: Anesthetic records were examined from horses recovered from anesthesia in the pool-raft system between January 1984 and December 2000. Complete medical records of horses were examined when available. Information regarding the anesthetic and recovery period was recorded. Horses first recovered from general anesthesia in the pool-raft and, once awake, were transported to a recovery stall and lowered to the floor in a standing position. RESULTS: 351 horses underwent 1 pool-raft recovery, and 42 horses underwent multiple pool-raft recoveries. Most horses were recovered from general anesthesia within the pool-raft system to safeguard repair of a major orthopedic injury. During 471 pool-raft recoveries, 34 (7%) horses had complications within the recovery pool and 62 (13%) had complications within the recovery stall. Deaths resulted from complete failure of internal fixation, pulmonary dysfunction, or a combination of pulmonary dysfunction and fixation failure in 2% (10/471) of horses that underwent pool-raft recoveries. CONCLUSIONS AND CLINICAL RELEVANCE: The pool-raft system is a good option for recovery from general anesthesia. Although not a fail-safe system, it appears to decrease the complications of recovering horses in a high-risk category. Potential disadvantages of this system are added expense and manpower necessary in building, maintenance, and usage, as well as size limitations of the raft itself.     

Treatment of fractured antebrachial bones in both thoracic extremities in toy breed dogs by application of reconstruction plates

Stabilization of fractures at distal third of antebrachial bones in toy breed dogs is often connected with bone healing complications, including delayed union or non-union. In the present study 9 toy breed dogs with fractures at distal third of the epiphysis of two antebrachial bones were treated. Each dog had fractured both thoracic limbs. In all the dogs, internal stabilization was applied using the 1 mm, 4 or 5 -hole reconstructive mini plates. In three dogs mini plates were applied in treatment of non-union of antebrachial bones. In each case radius bone was stabilized only. X-ray examination performed in all the dogs 10 weeks postoperatively showed complete adhesion of treated bones. It was found that application of reconstructive mini plates in treatment of simultaneous fractures of distal shaft of both antebrachial bones is effective therapeutic method.