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 17 horses with nonarticular fractures of the tibial tuberosity

REASONS FOR PERFORMING STUDY: Fractures of the tibial tuberosity (FTT) are caused by direct trauma, and are the second most commonly reported injury in event horses with stifle trauma. Conservative management of horses with FTT has been advocated, but results and prognosis for this method of therapy are unknown. OBJECTIVES: To report and review the findings of a retrospective study of 17 horses admitted to a veterinary teaching hospital from 1986-2001 with nonarticular FTT that received conservative management. METHODS: Subject details, aetiology of the accident, limb affected, degree of lameness at time of admission, size and degree of displacement of the fracture fragment, complications such as comminution of the fracture fragment or damage to soft tissue structures within the affected stifle, and treatment recommendations were obtained from medical records. Owners and trainers were contacted regarding the horse's return to athletic use. The follow-up period consisted of 11-154 months. RESULTS: Two horses were reportedly sound, but unable to return to competition for unrelated reasons. Of the horses that completed the rehabilitation period, 12/15 (80%) returned to athletic use at the same level as before the injury. Three horses were diagnosed with damage to soft tissue supporting structures of the affected stifle and could not return to their former level of competition. CONCLUSIONS: Concurrent soft tissue damage, diagnosed at the time of the initial injury, was statistically significant in precluding horses from returning to athletic careers. All other variables were found to have no effect upon outcome. POTENTIAL CLINICAL RELEVANCE: This retrospective study suggests that the conservative management of nonarticular FTT is a viable treatment modality in managing athletic equine patients presenting with these fractures.     

Conservative management of cystorrhexis in four adult horses

Rupture of the urinary bladder is rare in adult horses with various standing or recumbent surgical repair techniques historically reported as the treatments of choice. This case series describes the successful conservative management of cystorrhexis in 4 adult horses. Conservative management is therefore a potentially viable treatment option which forgoes the risks of general anaesthesia and may reduce the post operative complications associated with surgery of the bladder.     

Conservative treatment of a minimally displaced fracture of the radius of a horse

The successful conservative treatment of an open, displaced fracture of the radius of a horse suggests that conservative treatment should not be ignored when surgery is not an option. The importance of proper soft-tissue management and the use of broad-spectrum antimicrobial treatment in the management of orthopedic injuries is emphasized.     

Conservative management of fractures of the mandibular condyloid process in three cats and one dog

Three cats and 1 dog with fracture of the mandibular condyloid process and concomitant fracture(s) of the rostral portion of the mandible were treated successfully by wire fixation of the rostral mandibular fracture(s) and by conservative management of the mandibular condylar fracture. All animals regained satisfactory dental occlusion and normal, pain-free motion of the jaw. Fracture of the mandibular condyloid process is an infrequently diagnosed injury that usually occurs with other mandibular fractures. If satisfactory dental occlusion can be achieved by surgical stabilization of the noncondylar fractures, surgical repair of the mandibular condyloid fracture may not be necessary.     

Management of laterally displaced proximal tibial physeal fractures in three dogs

Fractures of the proximal tibial physis are uncommon in dogs, and are rarely associated with marked instability and lateral displacement of the proximal tibial epiphysis. Three dogs with proximal tibial physeal fractures demonstrating marked instability and lateral displacement were treated with two different principles of fixation. Healing of the physeal fracture was achieved with rigid internal fixation in one case, and with adaptational osteosynthesis supplemented with a temporary transarticular external skeletal fixator in two cases. Duration of surgery and technical difficulty was reduced using a modified adaptational osteosynthesis approach, suggesting that surgical treatment of these uncommon and challenging fractures may be more appropriately achieved by this technique.     

Conservative treatment of intra-articular distal phalanx fractures in horses not used for racing

OBJECTIVE: To determine the success rate and whether specific patient and treatment factors influenced the outcome after conservative treatment with a bar shoe with quarter clips of intra-articular fractures of the distal phalanx in horses not used for racing. DESIGN: Retrospective study. SAMPLE POPULATION: Thirty-two client-owned horses. PROCEDURE: Hospital records of horses that had been treated conservatively for intra-articular fractures of the distal phalanx at Skara Equine Hospital or Halland Animal Hospital in Sweden between 1995 and 2001 were reviewed. Racehorses in active training and horses affected with other musculoskeletal diseases were excluded from the study. Follow-up was performed by questionnaire and telephone inquires to the owners 1 to 7 years after injury. RESULTS: Twenty-two horses (69%) returned to their previous or expected level of use and did not wear their bar shoe when they were put back into training. There was no statistically significant correlation between outcome and patient or treatment variables, or bony union of the fracture. CONCLUSIONS AND CLINICAL RELEVANCE: Conservative treatment of intra-articular fractures of the distal phalanx carries a fair prognosis for return to previous or expected level of use in horses not used for racing. Radiographic evidence of fracture healing and age of the patient do not seem to influence the prognosis. Horses not used for racing do not need to be shod with a bar shoe with quarter clips for the rest of their athletic career.     

Treatment of radial fractures in adult horses: an analysis of 15 clinical cases

Fifteen cases of radial fractures in adult horses weighing more than 300 kg are discussed. Four of the horses were destroyed on humane grounds immediately because of a poor prognosis and expense of internal fixation; and two horses at five days and five weeks, respectively after treatment by cast application was initiated. Internal fixation was used in nine horses but of these only two horses recovered completely and resumed their former activities. In eight cases, two plates were applied, one lateral or medial and the other cranial. The internal fixation techniques of all nine horses were scrutinised and suggestions made for the future treatment of radial fractures. These suggestions are (1) the use of ASIF 5.5 mm cortical bone screws using the total width or thickness of the bone in each case. (2) Application of the dynamic condylar screw with its plate in distal or proximal fractures to allow more support. (3) Incorporation of a cancellous bone graft to the fracture. (4) Possible table recovery to prevent breakdown of the fixation during recovery. It is important that bone plates are applied over the total length of the bone. The fact that only two out of 15 horses survived and recovered completely underlines the problems associated with treatment of radial fractures in the adult horse.     

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.     

Nuclear scintigraphic evaluation of third metacarpal and metatarsal bone fractures in three horses

Nuclear scintigraphy was used to evaluate healing of third metacarpal bone (MC III) fractures in 2 horses (horses 1 and 2) and a third metatarsal bone fracture in 1 horse (horse 3) after stabilization of each fracture with 2 broad dynamic compression plates. In horse 1, the fracture had uniform uptake of 99mTc methylene diphosphonate on days 1, 15, and 30 after surgery. The fracture healed, and the horse was discharged from the clinic on day 52. In horse 2, a 6-cm photopenic region (ie, area of low radioactivity) was seen over the diaphysis of MC III on day 3. The region persisted and became more distinct by day 32. The diaphysis of MC III sequestered, and horse 2 was euthanatized on day 44. In horse 3, vascularity was seen bridging the fracture on day 5, with a 3-cm photopenic region over the dorsal diaphysis of the third metatarsal bone. By days 18 and 32, uptake of 99mTc methylene diphosphonate in the region had increased, indicating vascularization of the site. the fracture healed, and horse 3 was discharged from the clinic on day 47. Our findings indicated that serial nuclear scintigraphy can be used to evaluate fracture vascularization after surgery in horses.     

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.     

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.     

Diagnosis, management, and outcome in 19 horses with deltoid tuberosity fractures

Objective: To describe the diagnosis and treatment of fractures of the deltoid tuberosity. Study Design: Case series. Methods: Medical records (1992–2009) of 19 horses with radiographic confirmation of deltoid tuberosity fractures were reviewed. Data retrieved included signalment, clinical and diagnostic imaging findings, and treatment. Outcome was determined by telephone questionnaire of owners and referring veterinarians. Results: Most horses were markedly lame on admission and 53% had reduced protraction of the affected limb. All fractures were identified on a cranio45° medial‐caudolateral oblique projection; however, only 32% (6 horses) were detected on a mediolateral projection whereas 86% were evident ultrasonographically. Treatment by local wound care and stall rest resulted in return to athletic function without lameness for 13 of 14 horses that had follow‐up. Conclusions: A cranio45° medial‐caudolateral oblique radiographic view was better than a mediolateral projection for identification of deltoid tuberosity fractures. Ultrasonographic detection of fractures was similar except when gas accumulation obscured the fracture site. Deltoid tuberosity fractures can cause severe lameness but can be treated successfully with conservative management.     

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.     

Three cases of non-displaced radial fracture in horses

Three horses with non-displaced fractures of the radius were examined. The affected animals showed a sudden onset of severe forelimb lameness with swelling of the antebrachium. Two cases had associated wounds on the medial aspect of the distal radius. The diagnoses were confirmed on radiographic examination. All three cases were treated conservatively by box rest. In one case slight further displacement of the fracture occurred three weeks after the initial injury but all the fractures went on to heal. The three horses returned to work but two were limited to light ridden exercise.     

Disseminated pythiosis in three horses

Three cases of equine subcutaneous pythiosis with dissemination to the internal organs were investigated. The subcutaneous lesions were observed on the mammary gland, nostrils and limbs of the infected horses. Histopathological analysis of the infected tissues revealed a strong eosinophilic reaction, with macrophages, mast cells and giant cells. Sparsely septated hyphal filaments of 4-6 microm diameter were identified in the center of the eosinophilic areas. Specific fluorescent antibody against Pythium insidiosum confirmed the hyphae in the infected tissues in three examined horses. In one of the three cases, the DNA sequences amplified from the infected subcutaneous tissues and internal organs, revealed that P. insidiosum's 18S SSU rDNA amplicons shared 100% identity with those sequences deposit in GenBank. This is the first report confirming by immunochemical and genetic techniques that P. insidiosum can disseminated from superficial to deep structures.     

Surgical management of suspected congenital luxation of the radial head in three dogs

Abstract

CASE HISTORIES: Three dogs, aged between 11 and 20 weeks, were presented with unilateral forelimb lameness, with an associated bony prominence on the lateral elbow.

CLINICAL FINDINGS AND DIAGNOSIS: Radiographs revealed a caudolateral luxation of the radial head in all cases, consistent with a diagnosis of suspected congenital luxation of the radial head. Surgical reduction and stabilisation involved open reduction of the radial head, and in two cases the use of a trans articular pin.

CLINICAL RELEVANCE: Congenital luxation of the radial head is an uncommon condition that has conflicting reports in the literature regarding its cause, heritability, breed predisposition, treatment and prognosis. The three cases here occurred in young dogs of English Bull Terrier, Jack Russell Terrier, and Staffordshire Bull Terrier breeds. Surgical reduction and stabilisation provided successful outcomes, in all cases. Only six cases of congenital luxation of the radial head managed surgically have previously been reported in the literature.