A clinical evaluation of a headless, titanium, variable-pitched, tapered, compression screw for repair of nondisplaced lateral condylar fractures in thoroughbred racehorses

OBJECTIVE: To report clinical evaluation of headless compression screws for repair of metacarpal/metatarsal (MC/MT3) condylar fractures in horses. STUDY DESIGN: Retrospective case study. SAMPLE POPULATION: Racing Thoroughbreds (n=16) with nondisplaced lateral condylar fractures of MC/MT 3. METHODS: Medical records (1999-2004) of horses with nondisplaced longitudinal fractures of the lateral condyle of MC/MT3 were reviewed. Pre-operative variables retrieved were: patient age, gender, limb involvement, injury occurrence, fracture length, and width, evidence of palmar comminution and degenerative joint disease, number of pre-injury starts, and pre-injury earnings. Post-operative variables retrieved were: surgical complications, surgical time, number of race starts, and post-operative earnings. RESULTS: MC3 (n=11) and MT3 (5) nondisplaced longitudinal fractures of the lateral condyle were repaired with Acutrak Equine (AE) screws. Left front limb fractures were most common (8) followed by left hind (5) and right front (3). Nine fractures occurred during training and 7 during racing; 4 fractures had palmar comminution. No surgical complications occurred. Of 15 horses that returned to training, 11 (73%) raced 306+/-67 days after injury and had greater mean (+/-SD) post-injury earnings/start ($5290.00+/-$8124.00) than pre-injury ($4971.00+/-$2842.00). Screw removal was not required in any horse. CONCLUSION: The AE screw is a viable option for repair of nondisplaced lateral condylar MC/MT3 fractures in Thoroughbred racehorses. CLINICAL RELEVANCE: Adequate stability of nondisplaced lateral condylar fractures can be achieved with a headless tapered compression screw while avoiding impingement on the collateral ligaments and joint capsule of the fetlock joint.     

Technique for arthroscopic repair of third carpal bone slab fractures in horses

A technique involving internal fixation guided by arthroscopy was used to repair third carpal slab fractures in 23 horses. The technique allowed good reduction and compression of the fractures, with minimal surgical trauma. Ten of 17 horses with a 6-month or longer follow-up have returned to race successfully.     

Surgical repair of radial carpal bone fractures in two racehorses

A 3-year-old Standardbred gelding (Case 1) and a 2-year-old Thoroughbred gelding (Case 2) were referred for surgical evaluation of a left radial carpal bone (RCB) fracture, sustained during training. Clinical findings at the time of initial examination included a palpable effusion within the left middle carpal joint in both horses and marked signs of pain and reduced range of motion on flexion of the affected carpus. In both horses, the RCB fracture was evident on the following radiographic views of the carpus: dorsolateral–palmaromedial oblique (30° off lateromedial) and flexed lateromedial. An additional loose wedge-shaped osteochondral fragment at the proximal articular surface of the RCB could be seen in Case 2. Both horses underwent surgical reduction and repair of the fracture between 1 and 2 days following the initial injury, which consisted of arthroscopic removal of any intra-articular osteochondral fragments, and arthroscopic assisted-interfragmentary compression via a standard dorsomedial and dorsolateral approach to the antebrachiocarpal joint (ACJ) and middle carpal joints (MCJ). The two horses returned to function as racehorses, 6 months (Case 1) and 16 months (Case 2) after surgery. The RCB is a relatively uncommon site for large carpal fractures in horses. The clinical presentation and findings from this report were similar to that of third carpal bone (C3) slab fractures, confirming that surgical repair is indicated in selected cases of RCB fractures.     

A biomechanical comparison of headless tapered variable pitch and AO cortical bone screws for fixation of a simulated slab fracture in equine third carpal bones

OBJECTIVE: To compare the mechanical shear strengths and stiffnesses obtained from in vitro testing of a simulated complete third carpal bone (C3) frontal plane radial facet slab fracture (osteotomy) stabilized with either a 4/5 Acutrak (AT) compression screw or a 4.5-mm AO cortical bone (AO) screw inserted in lag fashion. Drilling, tapping, and screw insertion torques, forces, and times also were compared between AT and AO implants. STUDY DESIGN: In vitro biomechanical assessment of site preparation, screw insertion, and shear failure test variables of bone screw stabilized simulated C3 slab fracture in paired cadaveric equine carpi. SAMPLE POPULATION: Eight pairs of cadaveric equine C3 without orthopedic abnormalities. METHODS: Standardized simulated C3 slab fractures were repaired with either AO or AT screws (AO/C3 and AT/C3 groups, respectively). Drilling, tapping, and screw insertion torques, forces, and times were measured with a materials testing machine for each screw type. Repaired specimens were tested in axially oriented shear until failure. Paired Students t-tests were used to assess differences between site preparation, screw insertion, and shear testing variables. Significance was set at P <.05. RESULTS: There were no significant differences in bone fragment measurements of the standardized simulated C3 slab fractures created for AO or AT screws. There were no significant differences for mean and maximum drilling torques; however, the tapered AT drill had greater maximum drilling force compared with the 3.2-mm and 4.5-mm AO drill bits. Mean insertion torque and force measured from the self-tapping AT screw were not significantly different compared with the 4.5-mm AO tap. There were no significant differences in maximum screw torque among constructs. Total procedure time was significantly longer for the AT group (5.8 +/- 1.6 minutes) compared with the AO group (2.9 +/- 1.1 minutes; P =.001). AT stabilized specimens had significantly greater mean +/- SD initial shear stiffness (3.64 +/- 1.08 kN/mm) than AO specimens (1.64 +/- 0.73 kN/mm; P =.005). All other shear mechanical testing variables were not statistically different among screw types. CONCLUSION: The 4/5 Acutrak insertion technique was accurate and safe, and the AT screw effectively stabilized simulated equine C3 frontal plane slab fractures. When tested in shear, this screw type was mechanically comparable to the 4.5-mm AO screw; however, AT constructs had greater initial shear stiffness. Initial shear stiffness was likely an indirect measure of interfragmentary compression, and thus may indicate that the AT screw provides a more rigid fixation for frontal plane C3 slab fractures in horses. CLINICAL RELEVANCE: Considering the comparable mechanical behavior, greater initial shear stiffness for AT screw stabilized C3 slab fracture fragments, the ability to accurately insert the screw with the aid of a guide pin, and the potential for less persistent soft tissue irritation with the headless screw design, the 4/5 tapered AT screw is an attractive alternative for repair of C3 slab fractures in horses.     

Clinical evaluation of the locking compression plate for fetlock arthrodesis in six thoroughbred racehorses

Objective— To report use of a locking compression plate (LCP) for fetlock arthrodesis in Thoroughbred racehorses after catastrophic disruption of the suspensory apparatus.
Study Design— Retrospective case study.
Animals— Racing Thoroughbreds (n=6) with a catastrophic breakdown injury of the suspensory apparatus.
Methods— Medical records (2004–2006) of horses that had fetlock arthrodesis using an LCP were reviewed. Preoperative recorded variables were: age, gender, affected limb, injury type and occurrence, limb support used and time to surgery. Recorded surgical variables were: implants used and cost, surgery time, and anesthetic recovery method. Postoperative recorded variables included: treatment, physical status, complications, and outcome.
Results— Of 6 Thoroughbred racehorses that had LCP arthrodesis, 4 were sound for breeding purposes the next year and 2 horses were euthanatized (1 at 16 days, 1 at 68 days) because of proximal interphalangeal joint (PIJ) luxation. No surgical complications were associated with implant application. Postoperative complications were similar to those reported for other arthrodesis techniques.
Conclusions— LCP is a viable option for fetlock arthrodesis in Thoroughbred racehorses after catastrophic suspensory apparatus disruption.
Clinical Relevance— Adequate fetlock stability can be achieved with an LCP, and although the repair is likely more stable it is ∼3 times more expensive than using a limited contact dynamic compression plate (LC-DCP) with cortical screws.     

Survey of arthroscopic surgery for carpal chip fractures in thoroughbred racehorses in Japan

Medical and racing records of 155 Thoroughbred racehorses that underwent arthroscopic surgery for carpal chip fractures were investigated. Articular damage for 98.4% of the fractures was classified as G1 or G2 using McIlwraith's criteria. The rate of return to racing after surgery was 82.6%. Evaluation of racing performance after surgery was attempted using a placing index (PI) based on race finish position. There was no significant difference in the PI distribution between horses that underwent surgery and other healthy horses.     

Surgical and nonsurgical management of sagittal slab fractures of the third carpal bone in racehorses: 32 cases (1991-2001)

OBJECTIVE: To compare results (ie, return to racing and earnings per race start) of surgical versus nonsurgical management of sagittal slab fractures of the third carpal bone in racehorses. DESIGN: Retrospective study. ANIMALS: 32 racehorses (19 Thoroughbreds, 11 Standardbreds, and 2 Arabians). PROCEDURE: Medical records and radiographs were reviewed to obtain information regarding signalment and treatment. Follow-up information was obtained from race records. Robust regression analysis was performed to evaluate earnings per start in horses that raced at least once before and after injury. RESULTS: 22 (69%) horses raced at least once after treatment of the fracture. All 7 horses treated by means of interfragmentary compression raced after treatment, and horses that underwent interfragmentary compression had significantly higher earnings per start after the injury than did horses treated without surgery. Eight of 9 horses treated by means of arthroscopic debridement of the damaged cartilage and bone raced after treatment, but only 7 of 16 horses treated without surgery (ie, stall rest) were able to return to racing after treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that racehorses with sagittal slab fractures of the third carpal bone have a favorable prognosis for return to racing after treatment. Horses treated surgically were more likely to race after treatment than were horses treated without surgery.     

A biomechanical comparison of equine third metacarpal condylar bone fragment compression and screw pushout strength between headless tapered variable pitch and AO cortical bone screws

OBJECTIVES: To compare bone fragment compression and the mechanical pushout strength and stiffness of 6.5-mm Acutrak Plus (AP) and 4.5-mm AO cortical (AO) bone screws after stabilization of a simulated equine third metacarpal (MC3) bone complete lateral condylar fracture. STUDY DESIGN: In vitro biomechanical paired study of screw insertion variables, bone fragment compression, and screw pushout tests using a bone screw stabilized simulated lateral condylar fracture model. SAMPLE POPULATION: Six pairs of cadaveric equine MC3s. METHODS: Metacarpi were placed in a fixture and centered on a biaxial load cell in a materials testing system to measure torque, compressive force, and time for drilling, tapping, and screw insertion. Fragment compression was measured with a pressure-sensing device placed between the simulated fracture fragments during screw insertion for fragment stabilization. Subsequently, screws were pushed out of the stabilized bone fragments in a single cycle to failure. A paired t test was used to assess differences between site preparation, screw insertion, fragment compression, and screw pushout variables, with significance set at P <.05. RESULTS: Measured drilling variables were comparable for AO and AP specimens. However, the AP tap had significantly greater insertion torque and force. Mean maximum screw insertion torque was significantly greater for AO screws. For fragment compression, AP screws generated 65% and 44% of the compressive pressure and force, respectively, of AO screws. AP screws tended to have higher overall pushout strength. Pushout stiffness was similar between both screw types. CONCLUSION: The 6.5-mm tapered AP screw generated less interfragmentary compressive pressure and force but had similar pushout stiffness. Evaluation of failure patterns demonstrated that AP screws had greater pushout strength compared with 4.5-mm AO screws for fixation of a simulated complete lateral condylar fracture. CLINICAL RELEVANCE: The 6.5-mm tapered AP screw should provide ample holding strength but would provide less interfragmentary compression than 4.5-mm AO screws for repair of complete lateral condylar fractures in horses.     

Effect of diameter of the drill hole on torque of screw insertion and pushout strength for headless tapered compression screws in simulated fractures of the lateral condyle of the equine third metacarpal bone

OBJECTIVE: To compare variables for screw insertion, pushout strength, and failure modes for a headless tapered compression screw inserted in standard and oversize holes in a simulated lateral condylar fracture model. SAMPLE POPULATION: 6 pairs of third metacarpal bones from horse cadavers. PROCEDURE: Simulated lateral condylar fractures were created, reduced, and stabilized with a headless tapered compression screw by use of a standard or oversize hole. Torque, work, and time for drilling, tapping, and screw insertion were measured during site preparation and screw implantation. Axial load and displacement were measured during screw pushout. Effects of drill hole size on variables for screw insertion and screw pushout were assessed by use of Wilcoxon tests. RESULTS: Drill time was 59% greater for oversize holes than for standard holes. Variables for tapping (mean maximum torque, total work, positive work, and time) were 42%, 70%, 73%, and 58% less, respectively, for oversize holes, compared with standard holes. Variables for screw pushout testing (mean yield load, failure load, failure displacement, and failure energy) were 40%, 40%, 47%, and 71% less, respectively, for oversize holes, compared with standard holes. Screws could not be completely inserted in 1 standard and 2 oversize holes. CONCLUSIONS AND CLINICAL RELEVANCE: Enlarging the diameter of the drill hole facilitated tapping but decreased overall holding strength of screws. Therefore, holes with a standard diameter are recommended for implantation of variable pitch screws whenever possible. During implantation, care should be taken to ensure that screw threads follow tapped bone threads.     

Lag screw fixation of dorsal cortical stress fractures of the third metacarpal bone in 116 racehorses

Reasons for performing study: The effectiveness and best method to manage dorsal cortical stress fractures is not clear. This study was performed to evaluate the success of lag screw fixation of such fractures in a population of Thoroughbred racehorses. Hypothesis: Lag screw fixation of dorsal cortical stress fractures is an effective surgical procedure allowing racehorses to return to their preoperative level of performance. Methods: The records of 116 racehorses (103 Thoroughbreds) admitted to Equine Medical Centre, California between 1986 and 2008 were assessed. Information obtained from medical records included subject details, limb(s) affected, fracture configuration, length of screw used in repair and presence of concurrent surgical procedures performed. Racing performance was evaluated relative to these factors using Fisher's exact test and nonparametric methods with a level of significance of P<0.05. Results: Of 92 Thoroughbred horses, 83% raced preoperatively and 83% raced post operatively, with 63% having ≥5 starts. There was no statistically significant association between age, gender, limb affected, fracture configuration or presence of concurrent surgery and likelihood of racing post operatively or of having 5 or more starts. The mean earnings per start and the performance index for the 3 races following surgery were lower compared to the 3 races prior to surgery; however, 29 and 45% of horses either improved or did not change their earnings per start and performance index, respectively. Conclusions and potential relevance: Data show that lag screw fixation is successful at restoring ability to race in horses suffering from dorsal cortical stress fractures.     

Outcome of lag-screw treatment of incomplete fractures of the frontal plane of the radial facet of the third carpal bone in horses

AIM: To describe outcomes for horses diagnosed with incomplete, non-displaced fractures of the frontal plane of the radial facet (INFR) of the third carpal bone (C3) treated by placement of a lag screw across the fracture under arthroscopic guidance. METHODS: Horses (n=13) diagnosed with INFR and treated between December 1999 and January 2005 using a lag screw placed over the fracture were studied. For each case, five horses matched for sire, age and sex which were not known to have INFR were sought for comparison. Racing performance data were collected from a commercial online database. The racing performance of cases pre- and post-operatively, and of cases and matched horses in the post-operative period was compared. RESULTS: Sixteen INFR were found in the 13 horses. Radiographic evidence of healed fracture lines 2-4 months after surgery was seen in 11/16 (69%) fractures; 11/13 (85%) cases raced again after a median recovery period of 292 (range 149-681) days. Treatment was considered successful in 9/13 (69%) cases, which were still in training or had been retired for reasons other than lameness localised to the middle carpal joint at the end of the study period. Just 6/13 (46%) cases had raced prior to injury. The racing ability pre- and post-operatively of five cases was compared, three (60%) of which performed better post-operatively than they had before. There was no significant difference in racing longevity or ability post-operatively between patients and matched (control) horses. CONCLUSIONS: Post-operatively, there was little difference in the racing performance between horses diagnosed with INFR which had a lag screw placed across the fracture line and horses matched for sire, age and sex which were not known to have INFR. CLINICAL RELEVANCE: Horses which were diagnosed with INFR of C3 and had a lag screw placed across the fracture had a good prognosis for future racing performance.     

Arthroscopic guided repair of a slab fracture of the fourth carpal bone in an 8-month-old thoroughbred horse

An 8-month-old thoroughbred colt presented with sudden onset right forelimb lameness. A radiographic series of the right carpus was performed, and it revealed a slab fracture of the fourth carpal bone and fracture of the proximal part of the third metacarpal bone. Arthroscopically guided repair of the slab fracture of the fourth carpal bone with a 3.5 mm cortex screw and lag screw fixation of the fracture of the proximal part of the third metacarpal bone were performed. The horse started to race at 32 months old and started in 65 races over three years without any trouble associated with the right carpus.     

Surgical treatment of dorsal cortical fractures of the third metacarpal bone in thoroughbred racehorses: 53 cases (1985-1989).

Between January 1985 and May 1989, 53 Thoroughbred horses (mean age 3.2 years) were surgically treated for dorsal cortical fractures of the third metacarpal bone (MC III). All horses were treated with cortical drilling through the fracture line (osteostixis). Diagnosis of the fractures was confirmed by xeroradiography. Lifetime racing records were obtained for all horses. Forty-seven horses returned to racing after surgery (89%). The mean time between surgery and the first race was 6.8 months. Horses had a mean of 10.9 starts before surgery and 16.1 starts after surgery. The mean earnings per start before surgery was $6,459 and after surgery was $5,685. Of the 47 horses that raced after surgery, 70% raced at the same class or improved. Complications related to surgery were seen in 10 horses. Two horses had a second fracture of MC III at the same site, and were again treated by osteostixis, after which both horses returned to competition. Fractured drill bits were left in the MC III of 4 horses. One of these horses had catastrophic failure of MC III. Two horses developed subcutaneous infections and 2 horses had catastrophic failure of MC III in the surgically treated limb. Osteostixis appears to be an effective treatment for returning horses affected with dorsal cortical fractures to racing.     

Radiographic evaluation of sclerosis of the third carpal bone associated with exercise and the development of lameness in Standardbred racehorses

REASONS FOR PERFORMING STUDY: Sclerosis of the third carpal bone is a common radiographic finding in both lame and sound racehorses, but there are no guidelines correlating degree of sclerosis and incidence of lameness. OBJECTIVES: To develop a protocol for describing subchondral bone sclerosis in C3 on dorsoproximal-dorsodistal oblique (DPr-DDiO) radiographs of the carpus and to correlate these changes with exercise history and carpal lameness. METHODS: One hundred and six Standardbreds entering their first year of training (exercise group) and 7 age-matched Standardbreds at pasture (controls) were examined at approximately 3 month intervals over 12-18 months. Examinations consisted of lameness evaluation and carpal radiographs (DPr-DDiO and flexed lateromedial projections). A grading system (very mild, mild, moderate and severe) for C3 sclerosis seen on the DPr-DDiO radiograph was developed that utilised a combination of the criteria of trabecular thickening (trabecular score; TS) and total percent area of the C3 radial facet affected (TAA). RESULTS: Exercise group horses showed significant increase in TS and TAA throughout training compared to control horses. Middle carpal joint lameness developed in 32/106 (30%) exercise group horses and none of the control horses. Incidence of middle carpal joint (MCJ) lameness was lower in horses with mild (2/30, 6.7%) than moderate (10/32, 31.2%) and severe (20/44, 45.4%) sclerosis throughout training. CONCLUSIONS: Horses with higher grades of sclerosis, as defined by this novel grading system, were more likely to develop MCJ lameness at some point of training. The proposed grading system gave a quantitative assessment of radiographic sclerosis that could then be used to correlate increasing severity of sclerosis with increasing incidences of lameness. POTENTIAL RELEVANCE: These results serve as a basis for further investigation into determining the degree of C3 sclerosis at which pathological changes and lameness can be expected.