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.     

Comparison of surgical and nonsurgical treatment of humeral fractures in horses: 22 cases (1980-1989).

Medical records of 22 horses with humeral fractures were reviewed. The horses were from 2 to 144 months old (mean, 25.8 +/- 37.3 months). Ten horses were treated with stall confinement, 3 were treated surgically, and 9 were euthanatized at the time of diagnosis. Seven of 10 horses treated nonsurgically (stall confinement) were able to be ridden 5 to 12 months after the diagnosis was made (mean, 7.5 +/- 2.6 months). One horse treated nonsurgically was euthanatized 6 months after diagnosis because of laminitis in the contralateral limb. Two horses treated nonsurgically were lost to follow-up evaluation. Two of the 3 horses treated surgically had fractures repaired with Rush pins. The fractured humerus of the third horse was repaired with lag screws. Of the 3 surgically treated horses, 1 was pasture sound 10 months after surgery, but developed varus deviation in the contralateral carpus 6 weeks after repair; 1 horse was euthanatized 2 weeks after surgery because of failure of the implant; and the other horse was sound for riding 10 months after surgery. On the basis of these findings, young horses with humeral fractures that are treated nonsurgically can become sound for riding.     

Fracture of the Supraglenoid Tubercle Treatment and Results in Five Horses

Five horses with fractures of the supraglenoid tubercle (tuber scapulae) were presented from 6 weeks to 1 year after injury. Clinical signs included lameness characterized by a shortened cranial phase of the stride and shoulder muscle atrophy. Radiographically, the fractures differed in the degree of cranioventral displacement of the fragment as well as the extent of joint involvement. Three horses were treated by resection of the fractured tubercle, including one using a new grid approach to the area of the fracture. Two of these horses have returned to athletic activity and one was euthanized due to postoperative infection. One horse with minimal displacement and joint involvement was treated with rest and raced successfully. One horse seen with a fracture of 1 year duration also was treated with rest and was a pasture sound broodmare.     

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.     

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.     

Palmar/Plantar Process Fractures of the Proximal Phalanx In 15 Horses

Fifteen fractures of the palmar or plantar process of the proximal phalanx in 15 horses are described. Ten were articular and five were nonarticular. Two modes of therapy were used depending on the location of the fracture. Nonarticular fractures were treated with stall rest or reduction in exercise, and articular fractures were treated with either surgical removal or internal fixation of the fragment. All horses that were operated on were sound within 6 months after surgery. Follow-up information was obtained on all horses through client questionnaire and race records in the racing breeds (Standardbred and Thoroughbred) and client questionnaire alone is the nonracing breeds (Quarterhorse and Arabian). Fourteen horses returned to an equal or better level of performance than before injury; one horse returned to a lower level of performance.     

DISTAL PHALANX FRACTURES IN HORSES

The case records of 274 horses with fractures of the distal phalanx were reviewed. Fifty-two horses had bilateral forelimb fractures, for a total of 326 distal phalanx fractures. The fractures were classified into one of five previously described types, based on the radiographic anatomic configuration of the fracture. Solar margin fractures, which have been briefly described in other reports and previously classified as type V fractures, were identified in 132 horses. This type of fracture is distinct from other distal phalanx fractures. Due to the high incidence of solar margin fractures, these fractures were classified as a separate type (type VI). Follow-up radiographic examinations to assess fracture healing were available for 36 horses. Twenty-two horses with distal phalanx fractures (three type I, nine type II, two type III, one type IV, one type V, and six type VI) had radiographic evidence of complete bony union of the fracture at a mean of 11 months after injury. Eight horses with complete type II fractures involving the articular surface had bony union of the body and solar margin, but not the subchondral bone at the articular surface, a mean of 11 months after injury. Six horses (four type II and two type IV) had little radiographic evidence of bony healing during the follow-up period. All fractures that eventually healed had evidence of progression toward bony union by 6 months after injury.     

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.     

Arthroscopic removal of patellar fracture fragments in horses: five cases (1989-1998)

OBJECTIVE: To evaluate the use of arthroscopy as the primary method for removal of large patellar fracture fragments. DESIGN: Retrospective study. ANIMALS: 5 performance horses of various breeds with patellar fractures. PROCEDURE: Clinical signs of lameness, external evidence of injury, and radiography were used to diagnose and determine fracture orientation. Arthroscopy of the stifle joint was performed on the affected limb with the horse positioned in dorsal recumbency and under general anesthesia. Progress after surgery was determined by evaluating medical records and via telephone conversations with owners. RESULTS: 4 of 5 horses had fractures of the medial aspect of the patella and 1 horse had a fracture of the lateral aspect of the patella. There were no postoperative complications with the joint or the arthroscopic portal incisions. Recovery periods ranged from 3 to 5 months. All horses recovered completely from surgery, and performed at the same or higher level of competition as before arthroscopy. CONCLUSIONS AND CLINICAL RELEVANCE: Femoropatellar joint arthroscopy is a favorable means by which evaluation of the stifle joint and removal of large fracture fragments can be achieved with negligible postoperative complications.     

Fractures of the central and third tarsal bones in horses

The case histories and follow-up data for 11 horses with slab fractures of the central or 3rd tarsal bones were examined for information pertaining to the diagnosis, which was difficult to identify, treatment, which was proven ineffective, and the prognosis, which was shown to be poor for return to racing. The purpose of the study was to define the results that could be obtained by nonoperative methods, in an attempt to determine whether surgical treatment was advisable. Nine of the horses were Standardbreds and 2 were Thoroughbreds; all horses were 2 to 4 years old and were being exercised at race speed when the injury occurred. The diagnosis usually was made at the referral examination, some time after injury. Distention of the tibiotarsal joint usually developed following fracture of the central tarsal bone. In some fractures, local anesthetic injection or multiple radiographic views were required for diagnosis. Not all fracture planes were demonstrable radiographically. Prolonged rest was ineffective in restoring athletic soundness. Lag screw fixation was used in 1 horse, the only horse in the series that raced successfully after injury.     

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.     

ULTRASONOGRAPHIC DIAGNOSIS OF COXOFEMORAL SUBLUXATION IN HORSES

The clinical and ultrasonographic features of seven horses with coxofemoral subluxation are presented. Affected horses included five adult geldings (11–20 years), one large pony (6 years) and a 3-month-old filly. All were lame at the walk except for the pony with grade 3/5 lameness. Lameness was acute in all horses, but three horses progressed after initial improvement. Crepitus, muscle atrophy, and pelvic asymmetry were inconsistent findings. Ultrasonographic diagnosis of subluxation required dynamic visualization of femoral head displacement from the acetabulum while placing weight on the affected limb and subsequent replacement into its normal position upon limb resting. Acetabular rim fractures and joint effusion were visible regardless of weight bearing status in six horses each. No fractures were identified in the pony; the only patient with a good outcome. Six horses had a poor outcome with severe chronic lameness, four of which were euthanized. Postmortem ventrodorsal radiographs obtained in two horses confirmed subluxation only on extended limb projections, but not on hip-flexed projections. Acetabular rim fractures were not visible radiographically in either horse but were confirmed at necropsy. Subluxation was due to an elongated but intact ligament of the head of the femur in both horses. Osteoarthrosis was evident ultrasonographically, radiographically, and at necropsy. Dynamic ultrasonography was readily performed in the standing horse and produced diagnostic images with a low frequency curvilinear transducer. The apparent poor prognosis for horses with subluxation and acetabular fracture illustrate the importance of this imaging technique to identify affected horses.     

NAVICULAR BONE FRACTURE IN THE PELVIC LIMB IN TWO HORSES

The case history, radiographic and scintigraphic findings of two horses with pelvic limb navicular bone fractures are presented. In both cases the fractures were of traumatic origin. One horse had a bilateral fracture of the navicular bone, distal border, the other horse had a fracture of the proximal articular border in one pelvic limb navicular bone.     

Incomplete Oblique Sagittal Fractures of the Dorsal Cortex of the Third Metacarpal Bone in Six Horses

Objective —To describe incomplete oblique sagittal dorsal cortical fractures of the equine third metacarpal bone, their surgical repair, and subsequent performance of the horses.
Study Design —Retrospective examination of medical records and racing performance.
Animal Population —Six Thoroughbred race horses, 2 to 4 years of age.
Methods —Radiographic confirmation of all fractures preceded general anesthesia and surgical correction. Three fractures were treated by intracortical compression using screws placed in lag fashion, and five fractures were treated by osteostixis. Race records were reviewed for each horse to determine performance after surgery.
Results —Fractures were best observed on palmarodorsal radiographic projections. Three horses treated by intracortical compression returned to racing, but fracture recurred in one horse and was treated by osteostixis. This horse and the other three horses treated by osteostixis raced after surgery.
Conclusions —Horses with incomplete oblique sagittal fractures of the dorsal cortex of the third metacarpal bone can race after surgical management of the fracture by screws placed in lag fashion or osteostixis. The authors' preferred surgical procedure for managing this fracture is osteostixis.
Clinical Relevance —Palmarodorsal radiographic projections of the third metacarpal bone are recommended in young Thoroughbred race horses suspected of having dorsal metacarpal stress fractures.     

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 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.     

INTERNAL FIXATION OF FRACTURES OF THE ULNA IN THE HORSE

SUMMARY Surgical repair of ulnar fracture was attempted in 7 horses. Of 6 animals in which tension band plates were used, 4 recovered, one was killed after implant failure and one died of respiratory failure during post-operative recovery. The treatment of one horse with a Steinman Pin and figure-8 tension band wire was unsuccessful. One horse with bilateral ulnar fractures was given only stall rest and it recovered.     

STRESS REMODELING AND STRESS FRACTURE OF THE HUMERUS IN FOUR STANDARDBRED RACEHORSES

Two 2-year-old pacers, a 3-year-old pacer and a 2-year-old-trotter with acute forelimb lameness were admitted for nuclear scintigraphic examination. Horses were grade 3-4/5 lame. There was increased radiopharmaceutical uptake (IRU) in the distal cranial medial aspect of the humerus in one horse and along the caudal humeral cortex in the other three horses. Two of the four horses were affected bilaterally. Radiographic abnormalities consisted of thickening of the caudal cortex of the mid-diaphysis of the humerus but radiographic changes were not present in all horses. All horses were managed with stall rest initially then stall rest with hand-walking followed by limited turn out for a total of four months. None of the horses had raced before injury. One horse has returned to race training and the other three horses have returned to racing. Average time to return to racing was 329 days. Humeral stress fractures in Standardbred horses are rare. Diffuse patterns of IRU have not been reported in the humerus and are likely indicative of severe stress remodeling. Standardbred racehorses with stress fractures or stress remodeling of the humerus appear to have a good prognosis for return to racing.     

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.     

Fractures of the distal phalanx in horses

Summary. Nineteen cases of fracture of the distal phalanx in horses are reviewed. This represented 1.1% of the total number of horses seen at Murdoch University Veterinary Hospital (MUVH) over a 32-month period. All horses were managed conservatively. Eight horses made a complete recovery. Three are being trained again and are not lame. Four horses made a limited recovery. Two horses are still resting and one horse was killed humanely when it still showed lameness after 2 years. One horse was killed humanely after the fracture was first diagnosed.