Results of plate fixation of type 5 olecranon fractures in 20 horses

REASONS FOR PERFORMING STUDY: Previous olecranon fracture reports contain a small proportion of type 5 fractures, mostly treated with conservative therapy. OBJECTIVES: To evaluate the clinical details and outcome of type 5 olecranon fractures in a large group of horses treated by tension band plate fixation and to compare results with other treatment methods. METHODS: Medical records of 97 cases, including 32 (33%) classified as type 5, were reviewed. Subject details, history, radiographic findings, treatment and follow-up results (2-146 months post operatively) were recorded. RESULTS: Treatment included open reduction and internal fixation using a narrow or broad dynamic compression plate (n = 20), conservative therapy (n = 7) and euthanasia (n = 5). Long-term follow-up was available in 15 cases treated surgically, of which 2 were sound and in training, 11 sound and performing athletically and 2 unsound. Distal semilunar notch involvement, comminution or open status did not appear to affect prognosis. CONCLUSIONS: Internal plate fixation provides an excellent prognosis for an animal to be capable of athletic performance. POTENTIAL RELEVANCE: Describing tension band plate fixation and results offers a method of fracture repair that should improve treatment and prognosis for type 5 olecranon fractures.     

Racing prognosis of horses following surgically repaired olecranon fractures

Olecranon fracture is a common orthopedic problem in juvenile horses. Prognosis for complete fracture healing when various methods of internal fixation are used is good; however, the impact of olecranon fracture stabilization on the likelihood that foals will start on a racecourse is unknown. Medical records of foals undergoing internal fixation for an olecranon fracture were reviewed. The dam's foaling records were obtained and lifetime racing records were then retrieved for both the affected foals and 1 of their siblings. Twenty-two of 24 repaired fractures healed completely, subsequently, 16 of the foals started in at least 1 race. Statistical calculations suggest that when compared with their siblings, the occurrence of olecranon factures requiring internal fixation in juvenile racehorses will not significantly reduce the likelihood that they will race; however, the siblings had significantly more lifetime race starts and higher career earnings.     

Lag screw fixation of sagittal navicular bone fractures in five horses

A sagittal fracture of the navicular bone in five horses was treated by means of lag screw. Intra-operative radiographic monitoring and a specially developed guide apparatus was necessary to implant the screw precisely along the transverse axis of the navicular bone. Internal fixation resulted in progressive radiographic narrowing of the fracture zone. In all five patients the fracture healed (bony union) without superfluous callus formation.     

Repairable fractures in horses

If the leg is adequately immobilized one should notice an immediate improvement in the patient's condition. The pulse will decrease, the heart rate will decrease, one should evidence a decrease in pain. If this sort of immobilization is carried out the animal can then be safely referred to a veterinary clinic that is capable of doing orthopedic surgery. The splint can be left on until the horse is anesthetized and positioned on the operating table and then be removed and further x-rays can be taken and a more accurate prognosis can be given to the owner.     

Complete biceps brachii tenotomy to facilitate internal fixation of supraglenoid tubercle fractures in three horses

OBJECTIVE: To describe a method for internal fixation of supraglenoid tubercle fractures in conjunction with complete tenotomy of the biceps brachii tendon. ANIMALS: Three horses, ranging in age from 8 months to 2 years and weighing from 300 to 400 kg. METHODS: Fractures were repaired by open reduction-internal fixation using bone screws placed in lag fashion and complete tenotomy of the biceps brachii tendon. OUTCOME: All three horses were sound for their intended use with a good cosmetic result 6 months after surgery. CONCLUSIONS: Complete transection of the biceps brachii tendon facilitates supraglenoid tubercle fracture repair by reducing tensile forces exerted on the supraglenoid tubercle. Complete tenotomy does not appear to preclude return to a successful athletic career.     

Management of fractures in endurance horses

This paper provides relevant information for veterinarians responsible for treatment of endurance horses, including a retrospective study of fractures in endurance horses presenting to one referral hospital and to treatment clinics at 3 different race venues. Treatment and case outcome were also noted. The information presented provides clinicians working with high level endurance horses increased awareness of common sites of fractures, of prefracture stress related bone injury within this population of athletes and guidelines in order to manage them more effectively. The most common fractures involve the metacarpo‐(tarso‐)phalangeal joint. Most distal limb fractures can be diagnosed radiographically, but magnetic resonance imaging or scintigraphy may be required in some cases.     

Nonsurgical management of type II fractures of the distal phalanx in 48 Standardbred horses

OBJECTIVE: To evaluate nonsurgical management of type II fractures of the distal phalanx in Standardbred horses. DESIGN: Retrospective study of 48 affected horses. RESULTS: Most fractures occurred on the lateral palmar process of the left forelimb or the medial palmar process of the right forelimb; 81% of horses were considered sound enough to return to training and 63% raced. Of those returning to racing, 41% competed in > 10 races, 37% in 2 to 10 races and 22% in only 1 race. There was no difference in performance before and after fracture. Twenty-four of 25 horses had a bar shoe fitted for > 50% of the treatment phase. Of those horses returning to training without a bar shoe, 89% refractured at the same site. Sixty percent of horses returning to training with a bar shoe raced successfully. The total convalescent time, the time rested in a box and the time spelled in a paddock were similar for horses returning to racing and those that did not. The age of the horse had no effect on the ability to return to racing. CONCLUSION: The prognosis for type II fractures of the distal phalanx is guarded. It is advisable to fit a bar shoe on the horse during convalescence. Horses returning to training and racing with a bar shoe appear less likely to refracture the distal phalanx. Those horses that return to racing can perform at a level similar to that prior to fracture.     

Finite element analysis of a novel pin-sleeve system for external fixation of distal limb fractures in horses

The transfixation pin cast (TPC) is an external skeletal fixation technique used to treat horses with distal limb fractures, but its use is often associated with pin-loosening and an increased risk of treatment failure. To address implant loosening, the pin sleeve cast system (PSC) was recently designed and consists of a pin-sleeve unit inserted into the bone. Each pin runs through a sleeve placed in the bone, making contact at two fixed points only within the sleeve. Each pin is attached to a ring embedded in a resin cast. In this report, the mechanical performance of a traditional TPC pin arrangement was compared with that of the PSC using validated finite element models of bone substitutes previously tested in vitro. The PSC resulted in a marked reduction in peak strain magnitude around the pins and a more even distribution of strain across the bone cortex. The two systems resulted in comparable proximal fragment displacement and had a similar stress concentration around bone defects during implant removal. The findings suggest that the PSC load transfer mechanism is effective even in geometrically complex structures like equine bones.     

Periorbital skull fractures in five horses

Periorbital skull fractures were diagnosed in 5 horses, and were associated with ophthalmic complications including corneal ulceration, uveitis, and entrapment of the eye by retrobulbar bone fragments. Physical examination was of greater diagnostic use than radiography. Surgical repair was performed on all horses and was associated with a more favorable postoperative appearance in horses treated acutely; however, the cosmetic results were considered acceptable in all horses. Major postoperative complications were not observed.     

Bone plate fixation of distal radius and ulna fractures in small- and miniature-breed dogs.

Bone plate fixation was reviewed in 29 distal radial fractures of small- and miniature-breed dogs. Twenty-two fractures in 18 dogs were available for follow-up. Number of complications and return to function were evaluated. Complications occurred in 54% of the fractures. Catastrophic complications occurred in 18% of fracture repairs with follow-up, while minor complications occurred in 36%. Sixteen (89%) of 18 dogs had a successful return to function. Bone plate fixation is a successful repair method for distal radius and ulna fractures in small-breed dogs, compared to previously reported methods.     

In vitro biomechanical properties of 2 compression fixation methods for midbody proximal sesamoid bone fractures in horses

OBJECTIVE: To evaluate 2 methods of midbody proximal sesamoid bone repair--fixation by a screw placed in lag fashion and circumferential wire fixation--by comparing yield load and the adjacent soft-tissue strain during monotonic loading. STUDY DESIGN: Experimental study. SAMPLE POPULATION: 10 paired equine cadaver forelimbs from race-trained horses. METHODS: A transverse midbody osteotomy of the medial proximal sesamoid bone (PSB) was created. The osteotomy was repaired with a 4.5-mm cortex bone screw placed in lag fashion or a 1.25-mm circumferential wire. The limbs were instrumented with differential variable reluctance transducers placed in the suspensory apparatus and distal sesamoidean ligaments. The limbs were tested in axial compression in a single cycle until failure. RESULTS: The cortex bone screw repairs had a mean yield load of 2,908.2 N; 1 limb did not fail when tested to 5,000 N. All circumferential wire repairs failed with a mean yield load of 3,406.3 N. There was no statistical difference in mean yield load between the 2 repair methods. The maximum strain generated in the soft tissues attached to the proximal sesamoid bones was not significantly different between repair groups. CONCLUSIONS: All repaired limbs were able to withstand loads equal to those reportedly applied to the suspensory apparatus in vivo during walking. CLINICAL RELEVANCE: Each repair technique should have adequate yield strength for repair of midbody fractures of the PSB immediately after surgery.     

Minimally invasive plate fixation of lower limb injury in horses: 32 cases (1999-2003)

REASONS FOR PERFORMING STUDY: Complications of osteosynthesis including superficial and deep infections continue to affect adversely outcome in equine surgery of the lower limb. OBJECTIVE: To describe a technique for minimally invasive plate fixation in horses and evaluate clinical results of the technique. HYPOTHESIS: Lower complication rates would occur in horses treated with a minimally invasive approach compared with conventional techniques. METHODS: Cases of minimally invasive plate fixation from January 1999 to December 2003 were evaluated. Case records, radiographs and race records for horses that sustained distal third metacarpal/metatarsal (Mc/tIII) condylar fractures were assessed. Follow-up information was obtained and results analysed. In addition, results for horses that received arthrodesis by a conventional, open approach during the same period were evaluated and statistical analysis was performed. RESULTS: Thirty-two cases of minimally invasive plate fixation were identified (22 incomplete distal Mc/tIII condylar fractures with a spiralling or diaphyseal component, 10 metacarpophalangeal arthrodeses and 4 pastern arthrodeses). For both types of arthrodesis, surgery times and infection rates were lower and survival rates higher in the minimally invasive group, but no statistical difference was found. Spiralling condylar fractures were successfully managed, without catastrophic fracture. CONCLUSIONS AND POTENTIAL RELEVANCE: Minimally invasive percutaneous plate osteosynthesis (MIPPO) can be successfully used for select applications in horses, and may reduce morbidity and mortality in equine fracture repair.     

A.O. hook plate fixation for metaphyseal fractures and corrective wedge osteotomies

The Prieur technique was employed to hook plates to fractures and corrective osteotomies. The technique permits rigid internal fixation when one component of the bone is particularly small.     

Intramedullary fixation of fractures

Extract

Mr. President, I would like to take this opportunity of thanking you for inviting me to address your Association this morning. Before commencing on my subject, I wish to pay tribute to your profession. The pathways of our professions have met on many occasions during the centuries we have practised our respective arts and sciences. Both professions have contributed in no mean way to the advancement of the other, and symbiotically we have advanced to the greater benefit of mankind as a whole.     

Splinting device for hindlimb fractures in horses

A Robert Jones bandage modified to include a steel walking bar frame and, in one case, side-supporting bars, was applied as a splinting device in 4 horses with hindlimb fractures (3 tarsal and 1 middle phalangeal). The modification was used as an adjunct to previous casting therapies or as a means for handling casting failures or soft tissue problems encountered during the casting period. This means of stabilization is easily adapted to replace a problematic cast in various clinical settings, is easily applied in the standing patient, is easily changed and adjusted on a regular basis, has minimal complications, is comfortable, and can be used for support for a long period.     

Incomplete linear tibial fractures in two horses

Incomplete linear tibial fractures were identified in two horses with the aid of scintigraphy. Both horses were treated successfully by strict stall confinement, and both returned to normal athletic activity. Scintigraphy can be used to facilitate the generally difficult diagnosis of incomplete tibial fractures.