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.     

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.     

Repair of physeal fractures of the tuber olecranon in the horse, using a tension band method

Physeal fractures of the tuber olecranon of 4 horses were treated, using the tension band method of compression fracture repair. A cortical bone screw and Steinmann pin were placed through the proximal fragment into the distal parent bone parallel to the palmar border of the olecranon. The tension band was placed dorsal to the Steinmann pin and anchored in a hole through the shaft of the ulna 10 cm distal to the tuber olecranon. Of the 4 foals, 2 became pasture sound, 1 is now being worked under saddle, and the 4th showed no signs of lameness 5 months after surgery.     

The surgical treatment of fractures of the olecranon in the horse.

Methods of treating fractures of the olecranon in the horse are reviewed. A further 4 cases are recorded in which the fracture was treated by open reduction and fixation with a heavy duty Venable's plate placed on the caudal aspect of the ulna. Three cases had an oblique fracture through the semilunar notch; this was complicated in one by a fracture of the lateral half of the radial head which resulted in subluxation of the radio-humeral joint. The fracture of the radial head was treated by open reduction and fixation with a lag screw. The fourth case had an oblique fracture of the olecranon just proximal to the semilunar notch, complicated by a fracture of the anconeal process which was removed. The fractures healed within 10 weeks and the plates were removed in all 4 cases. During follow-up periods ranging from 10 to 26 months, all 4 animals became sound.     

Application of a Hook Plate for Management of Equine Ulnar Fractures

Closed fractures of the proximal aspect of the ulna were repaired in 10 horses younger than or equal to 6 months of age by application of a hook plate using a tension band principle. Ulnar fractures were classified as type 1A (2 horses), type 1B (4 horses), type 2 (1 horse), type 3 (1 horse), and type 4 (2 horses); all fractures had displacement of a proximal fragment. Complications were implant deformation (4 horses), screw pullout (1 horse), osseous sequestration (1 horse), ulnar fracture through a hole used to apply a tension device (1 horse), and metacarpophalangeal deformity associated with a displaced anconeal fragment (1 horse). Hook deformation was likely associated with failure to insert screws in all of the proximal holes of the plate and also in two horses, possibly with difficult recovery from anesthesia. Seven horses were discharged from the hospital and were being used for athletic activities. Insertion of the hook through the tendon of the triceps muscle and incorporation of the fragment within the hook can be used to effectively reduce and stabilize a fragment that might otherwise not hold screws.     

Management of fractures and exostosis of the metacarpals and metatarsals II and IV in 25 horses

Twenty-five cases of fractures of the second and fourth metacarpal and metatarsal (splint) bones were reviewed. Fourteen fractures involved a thoracic limb and 11 involved a pelvic limb. Fractures of the proximal one-third of splint bones are reported in one of two forms: fractures that are closed, or fractures with a permanent or intermittent draining sinus. Thirteen of the fractures presented were closed fractures and the remaining 12 were open. All of the closed fractures were managed by surgical excision of the distal fragment and the exostosis at the fracture site, followed by primary surgical wound closure. Lag screw fixation of the proximal fragment was used in three cases. All of the open fractures were managed surgically by excision of the distal splint fragment and debridement of the contaminated fracture site. Primary wound closure was used in 11 of the 12 cases. All closed fractures healed by primary intention, and 10 of 13 were free from lameness at one year follow-up. The 11 open wounds which were operated and subsequently closed under suture healed by primary intention. The wound left open healed by granulation, scar contraction, and epithelialisation. Eight of these horses were sound one year later. The remainder of the open fractures were lost to follow-up.     

Nonsurgical Management of Ulnar Fractures in the Horse: A Retrospective Study of 43 Cases

Forty-three cases of nonsurgically managed ulnar fractures in the horse were reviewed. Twenty-three per cent of the horses were euthanized, 44% survived but were unsound, and 33% of the horses were sound when surveyed 6 months to 11 years following fracture. Best results were obtained when treating distal semilunar notch fractures (70% sound). Prognosis was poorest for horses with fractures of the olecranon affecting the semilunar notch (0% sound).     

Surgical treatment of fractures of the olecranon in the horse: a comparative review of 25 cases

A series of 25 horses with olecranon fractures are reviewed. Twenty-one cases were treated surgically by the application of a tension band plate to the caudal aspect of the ulna. Seventy six per cent of these regained full limb function. The results of treatment are compared with two other series of conservatively and surgically treated cases.     

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.     

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.     

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.     

Management of comminuted fractures of the proximal phalanx in horses: 64 cases (1983-2001)

OBJECTIVE: To report the outcome of surgical treatment of comminuted fractures of the proximal phalanx in horses. DESIGN: Retrospective study. ANIMALS: 64 horses. PROCEDURE: Medical records and radiographs were reviewed to obtain information regarding signalment, fracture classification, and treatment. Follow-up information was obtained by telephone conversation or evaluation of production records. RESULTS: Thirty-eight horses had moderately comminuted fractures of the proximal phalanx. Two horses were euthanatized immediately. Fractures of the proximal phalanx in 36 horses were repaired with open reduction and internal fixation with a successful outcome in 33 (92%) horses. Reconstruction of the fracture was performed in most horses by use of a long curved incision, transection of the collateral ligament of the metacarpophalangeal or metatarsophalangeal joint, and open exposure of the proximal articular surface of the proximal phalanx. Twenty-six horses had severely comminuted fractures of the proximal phalanx. Six horses were euthanatized immediately. One horse was euthanatized after 9 days of treatment with a cast alone. Severely comminuted fractures of the proximal phalanx in 13 horses were treated with an external skeletal fixation device, and fractures healed in 8 of those horses. Six horses with severely comminuted fractures of the proximal phalanx were treated with transfixation pins incorporated into a fiberglass cast, and fractures healed in 4 horses. CONCLUSIONS AND CLINICAL RELEVANCE: Moderately comminuted fractures of the proximal phalanx can be successfully repaired; however, fractures that are too severe to permit accurate reconstruction of the fragments remain difficult to treat and horses have only a fair prognosis for survival.     

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.     

A technique for internal fixation of scapulohumeral luxation using scapulohumeral tension sutures in three alpacas and one miniature steer

Objective— To report a technique for open reduction and internal fixation of scapulohumeral joint luxation in large animals, and outcome.
Study Design— Clinical case reports.
Animals— Mature alpacas (n=3) and immature miniature steer (1).
Methods— Shoulder joint luxation was diagnosed by physical examination and confirmed by radiography. Open reduction was performed with internal fixation using lateral tension band sutures.
Results— Animals maintained shoulder joint reduction and were sound with radiographically normal shoulder joints (n=2) and normal range of motion without appreciable gait abnormalities (4) at follow-up 8–36 months later.
Conclusions— In contrast to previous reports of open reduction with internal fixation of shoulder joint luxation in large animals, open reduction and use of lateral scapulohumeral tension sutures resulted in functionally normal shoulder joints.
Clinical Relevance— Stabilization of the shoulder joint with lateral scapulohumeral tension sutures after open reduction is effective, technically simple, and should be considered in large animal species weighing <100 kg.     

Tension band stabilization of fractures and luxations of the thoracolumbar vertebrae in dogs and cats: 38 cases (1993-2002)

OBJECTIVE: To determine the outcome of dogs and cats in which a tension band technique was used to stabilize traumatic fractures and luxations of the thoracolumbar vertebrae. DESIGN: Retrospective study. ANIMALS: 38 client-owned animals (22 dogs and 16 cats) weighing between 1.4 and 45 kg (3 and 99 lb). PROCEDURE: Medical records of cats and dogs that underwent tension band stabilization of thoracolumbar fractures and luxations at the University of Zurich between 1993 and 2002 were reviewed. The stabilization technique was a modification of a spinal stapling technique with a figure 8 hemicerclage wire placed in a tension band fashion across the lesion. Neurologic status, lesion location and type, and concomitant traumatic injuries were assessed from the medical records and preoperative radiographs. Clinical outcome and complications were determined through follow-up examinations or telephone conversations with the owners. RESULTS: Complete or satisfactory neurologic recovery was achieved in 30 (79%) patients. Seven patients were euthanatized (6 owing to poor neurologic recovery and 1 owing to implant failure), and 1 dog was managed at home despite paraplegia. Clinically, only 4 patients (11%) had evidence of implant or fixation failure; all were dogs weighing > 16 kg (35 lb). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that the tension band technique may be appropriate for stabilization of fractures and luxations of the thoracolumbar vertebrae in cats and small- or medium-sized dogs. In larger dogs, fixation strength may be insufficient to stabilize certain fracture types and ancillary external or internal fixation methods may be needed.     

Racing performance after arthroscopic removal of apical sesamoid fracture fragments in Thoroughbred horses age < 2 years: 151 cases (1989--2002)

REASONS FOR PERFORMING STUDY: Studies on arthroscopic removal of apical proximal sesamoid fracture fragments in Thoroughbred (TB) horses age > or = 2 years have reported a high success rate. However, there are no reports documenting the racing prognosis of TB horses that undergo such surgery as weanlings or yearlings. OBJECTIVES: To describe the incidence of apical proximal sesamoid fractures in immature TB horses, age < 2 years and determine probability and quality of racing performance after arthroscopic removal of such fractures in 151 TB weanlings and yearlings. METHODS: The medical records of TB horses age < 2 years that underwent arthroscopic surgery for removal of apical proximal sesamoid fracture fragments were reviewed. Follow-up information was obtained from race records. Student's t tests were used to compare performance variables of operated racehorses to that of their maternal siblings. RESULTS: Ninety-two percent (139/151) of fractures occurred in the hindlimbs and 8% (11/151) in the forelimbs (fracture of both fore- and hindlimb, n = 1). Horses with forelimb fractures had a greatly reduced probability of racing (55%) compared to those with hindlimb fractures (86%). Overall, 84% of the horses raced post operatively and had performance records similar to that of their maternal siblings, 78% (787/1006) of which raced. CONCLUSIONS: Arthroscopic removal of apical proximal sesamoid fracture fragments in TB weanlings and yearlings carries an excellent prognosis for racing in horses with hindlimb fractures and a reduced prognosis in those with forelimb fractures. Medial fractures of the forelimb carry the worst prognosis. POTENTIAL RELEVANCE: The determination of prognosis increases knowledge on apical sesamoid bone fractures and potential for arthroscopic restoration of the ability to race; and enables the value of yearlings for subsequent sale to be established.     

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.     

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.     

Surgical Repair of Tibial Tuberosity Avulsion Fractures in Four Horses

Four horses, 2 to 17 years old, were treated for unilateral avulsion fractures of the tibial tuberosity. Two horses were treated successfully with tension band wiring or plating in combination with lag screw fixation. One horse was euthanatized because of implant failure during recovery and one was euthanatized on day 11 because a longitudinal fracture of the tibial tuberosity occurred through the plane of the screws used for stabilization.