Computer-assisted surgery for screw insertion into the distal sesamoid bone in horses: an in vitro study

OBJECTIVE: To compare the precision of computer-assisted surgery with a conventional technique (CV) using a special guiding device for screw insertion into the distal sesamoid bone in horses. STUDY DESIGN: In vitro experimental study. SAMPLE POPULATION: Cadaveric forelimb specimens. METHODS: Insertion of a 3.5 mm cortex screw in lag fashion along the longitudinal axis of intact (non-fractured) distal sesamoid bones was evaluated in 2 groups (8 limbs each): CV and computer-assisted surgery (CAS). For CV, the screw was inserted using a special guiding device and fluoroscopy, whereas for CAS, the screw was inserted using computer-assisted navigation. The accuracy of screw placement was verified by radiography, computed tomography, and specimen dissection. RESULTS: Surgical precision was better in CAS compared with CV. CONCLUSION: CAS improves the accuracy of lateromedial screw insertion, in lag fashion, into the distal sesamoid bone. CLINICAL RELEVANCE: The CAS technique should be considered for improved accuracy of screw insertion in fractures of the distal sesamoid bone.     

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.     

Computed tomographic morphology of the synovial invaginations of the distal sesamoid bone of the horse

The morphological features of the distal border synovial invaginations (SI) of the distal sesamoid bone (DSB) in horses were described by the use of computed tomography (CT). Transverse CT images were obtained on 50 cadaver forefeet from 25 Warmblood horses. Dorsal and sagittal planes were reformatted. The CT images allowed the evaluation of the number, shape, depth of penetration and direction of the SI into the bone. The total number of SI was 295 (mean 5.9). The number of invaginations in a particular DSB ranged from 3 (n = 3), 4 (n = 6), 5 (n = 11), 6 (n = 12), 7 (n = 13), 8 (n = 3), 9 (n = 1) to 11 (n = 1). The shape of the SI was 'conical' (n = 118), 'linear' (n = 109), 'lollipop' (n = 38) or 'branched' (n = 30). Penetration of the SI into the DSB was 'mild' in 195 cases, 'moderate' in 67 cases and 'deep' in 33 cases. The SI ran in a 'straight', 'dorsoproximal' and 'palmaroproximal' direction in 187, 28 and 80 cases, respectively. In only six DSBs, all SI ran in the same direction. The images obtained in this study may serve as reference for the radiographic evaluation of these SI.     

Computed tomography as a method of estimating bone mineral content in horses

With the advancement of technology, more tools and methods are being made available for the assessment of bone density in the live animal. Computed tomography (CT) is one such tool. In a CT scan, x-rays are passed through a subject and detectors record transmitted energy. The CT computer then constructs cross-sectional images from this data to represent the internal anatomy.The first objective of this study was to investigate CT as a means of estimating bone mineral content of the equine third metacarpal bone. Our hypothesis was that the cross-sectional area of the third metacarpal bone, as measured on CT images, would correlate significantly with ash weight of that section. Our second objective was to use CT to measure and compare bone density in the dorsal, palmar, lateral and medial cortices of the equine third metacarpus. We hypothesized that CT would detect differences in density by cortex.Twelve cadaver thoracic limb specimens, from horses of varying age, breed and prior use, were scanned on a CT 9800 (GE Medical Systems). Scanned sections of the limb were then skinned, dried, ether-extracted and ashed in a muffle furnace. Bone mineral content was expressed as grams of ash/cm section of bone. The image recorded by the CT was developed and assessed using an imaging photodensitometer and a corresponding software package to estimate the area of each bone section. Correlation was determined using SAS (6.12). Differences in bone density by cortex were calculated using a simple t-test. The maximum, minimum and mean estimates of third metacarpal bone cross-sectional area as determined by CT were 519, 351 and 423 mm², respectively, while the maximum, minimum and mean ash weights were 8.9, 4.8 and 6.4 g/cm, respectively. Estimates of bone mineral content by ash and cross-sectional area as determined by CT were significantly correlated (r=.91, P=.0001). There was no difference in CT density numbers between lateral and medial cortices, however the dorsal cortex was lower in density than the lateral (P<.05) and the palmar cortex was lower in density than all other cortices (P<.05). This data suggests that in a research setting, CT is an effective method by which to calculate cross-sectional area and, hence, estimate bone mineral content. Computed tomography was also able to detect differences in bone density by cortex.     

Lag screw and cancellous bone graft fixation of transverse proximal sesamoid bone fractures in horses: 25 cases (1983-1989).

Case records of 25 horses with transverse fractures of the proximal sesamoid bone were reviewed to evaluate the success of treatment. All fractures were repaired by use of lag screw fixation and an autogenous cancellous bone graft because the fracture fragments were considered too large for surgical removal and reconstruction of the suspensory apparatus was necessary. Radiography was performed in all cases, and the fractures were classified into 3 types: (1) proximal midbody fractures, which included all fractures in the proximal aspect of the sesamoid bone that resulted in fragments involving greater than one third but less than one half of the total mass of the sesamoid bone; (2) midbody fractures that divided the bone into 2 equal portions; and (3) distal midbody fractures, which included transverse fractures in the distal aspect of the sesamoid bone that resulted in fragments involving greater than one third but less than one half of the total mass of the sesamoid bone. Of these cases, race records were obtained for 9 Standardbreds and 5 Thoroughbreds. Postoperative performance criteria evaluated were the ability to train and start 1 race, ability to maintain preinjury class of racing, earnings per start, and the number of starts following surgery. In Thoroughbreds, fractures occurred most commonly in the right forelimb; in Standardbreds, the left hind limb was most commonly involved. The midbody fracture was the most common type in both breeds, and the distribution of fracture location within the sesamoid bone was similar for both breeds.(ABSTRACT TRUNCATED AT 250 WORDS)     

Genetic analyses of the radiographic appearance of the distal sesamoid bones in Hanoverian Warmblood horses

OBJECTIVE: To evaluate whether additive genetic correlations existed between certain aspects of the radiographic appearance of the distal sesamoid (navicular) bones (RNB) or between RNB and other types of radiographic changes in the limbs of Hanoverian Warmblood horses. ANIMALS: 5,157 horses. PROCEDURES: Quasi-linear and binary traits were defined by the appearance of canales sesamoidales (CSs) and the structure and contour of the forelimb navicular bones (NBs). Prevalences of osseous fragments in the metacarphophalangeal and metatarsophalangeal (fetlock) and tarsocrural joints and deforming arthropathy in tarsal joints were analyzed as binary traits. Genetic parameters were estimated by use of multivariate linear models. RESULTS: Heritability estimates for the RNB traits ranged from 0.10 to 0.34. Additive genetic correlations among those traits were usually close to unity. Extensive radiographic changes in the NBs, including changes in CSs and alterations in structure and contour, had correlations with less distinct radiographic changes. Negative additive genetic correlations were observed between small numbers of short and conical CSs in the central portion of the distal border of the NB and osseous fragments and arthropathy, and between most types of radiographic findings in the NBs and osseous fragments in tarsal joints. CONCLUSIONS AND CLINICAL RELEVANCE: The genetic bases for different types of RNB were not identical. The detection of correlations between normal RNB and findings of short and conical CSs versus deformed CSs and structural and contour changes warrants further study. Genetically justified distinction between physiologic and pathologic NB changes will increase the efficiency of selecting against NBs with radiographically apparent alterations.     

Differences in the morphology of distal border synovial invaginations of the distal sesamoid bone in the horse as evaluated by computed tomography compared with radiography

Reasons for performing study: Distal border synovial invaginations of the distal sesamoid bone are radiographically assessed during the selection process of horses admitted as breeding stallions or in purchase examinations. Nowadays, many moderately or some deeply penetrating proximally enlarged synovial invaginations are considered as moderate or severe radiographic findings. Objective: To measure the difference between and agreement of the morphology of distal border synovial invaginations on radiography vs. computed tomography (CT). It was hypothesised that the morphology of distal border synovial invaginations would be better evaluable on CT compared with radiography. Methods: Computed tomography scans and 3 dorsoproximal–palmarodistal oblique (DPr‐PaDiO) radiographs were obtained on 50 cadaver forefeet from 25 Warmblood horses. Computed tomography was assumed to be the gold standard. The number, shape and depth of penetration of distal border synovial invaginations into the distal sesamoid bone were evaluated with both methods, and the comparison of their measurements was statistically described. Results: A statistically significant mean difference for number of distal synovial invaginations between CT and all 3 DPr‐PaDiO projections was found and was approximately equal to 2, meaning that CT permits visualisation of an average of 2 more invaginations than radiography. In none of the cases did radiography have a higher number observed than CT. A large variation in the difference of measurements for depth of penetration against their mean difference between CT and the 3 radiographic projections was seen. Radiography underestimated the depth of invaginations, and more so when these were deeper. There was no statistically significant mean difference found between the techniques for depth. A moderate to good agreement between measurements on CT and the three DPr‐PaDiO projections for shape was seen, in which the D55°Pr‐PaDiO projection showed the best agreement. A high specificity (90–99%) and low sensitivity (65%) for all projections for shape were found. Conclusions and potential relevance: Radiography differs considerably from CT concerning the morphology of distal navicular border synovial invaginations. For the evaluation of the number, depth and shape of distal synovial invaginations in the distal sesamoid bone, radiography shows only partially the morphology seen on CT.     

Condylar fracture of the cannon bone with axial sesamoid fracture in three horses

The case histories of three young thoroughbred racehorses with displaced lateral condylar fractures combined with an axial fracture of the lateral sesamoid bone are described. In two cases the condylar fracture was repaired surgically but both horses developed severe degenerative joint disease and remained lame. The third horse was destroyed humanely. It is important that axial fractures of the sesamoid bone are recognised so that a poorer prognosis can be given for treatment of condylar fractures in racing thoroughbreds.     

Use of magnetic resonance imaging to diagnose distal sesamoid bone injury in a horse

CASE DESCRIPTION: A 5-year-old Appaloosa mare was examined for severe left forelimb lameness of 4 months' duration. CLINICAL FINDINGS: Lameness was evident at the walk and trot and was exacerbated when the horse circled to the left. Signs of pain were elicited in response to hoof testers placed over the frog of the left front hoof, and a palmar digital nerve block eliminated the lameness. Radiographs revealed no abnormalities, but magnetic resonance imaging (MRI) revealed increased bone density in the medullary cavity of the distal sesamoid (navicular) bone in the proton density and T2-weighted images and a defect in the fibrocartilage and subchondral bone of the flexor cortex. TREATMENT AND OUTCOME: Because of the absence of improvement after 4 months and the poor prognosis for return to soundness, the mare was euthanatized. An adhesion between the deep digital flexor tendon and the flexor cortex defect on the navicular bone was grossly evident, and histologic evaluation revealed diffuse replacement of marrow trabecular bone with compact lamellar bone. Changes were consistent with blunt traumatic injury to the navicular bone that resulted in bone proliferation in the medullary cavity. CLINICAL RELEVANCE: Use of MRI enabled detection of changes that were not radiographically evident and enabled accurate diagnosis of the cause of lameness. Navicular bone injury may occur without fracture and should be considered as a differential diagnosis in horses with an acute onset of severe unilateral forelimb lameness originating from the heel portion of the foot.     

Comparison of computer-assisted surgery with conventional technique for the treatment of axial distal phalanx fractures in horses: an in vitro study

OBJECTIVES: To compare the precision obtained with computer-assisted screw insertion for treatment of mid-sagittal articular fractures of the distal phalanx (P3) with results achieved with a conventional technique. STUDY DESIGN: In vitro experimental study. SAMPLE POPULATION: Thirty-two cadaveric equine limbs. METHODS: Four groups of 8 limbs were studied. Either 1 or 2 screws were inserted perpendicular to an imaginary axial fracture of P3 using computer-assisted surgery (CAS) or conventional technique. Screw insertion time, predetermined screw length, inserted screw length, fit of the screw, and errors in placement were recorded. RESULTS: CAS technique took 15-20 minutes longer but resulted in greater precision of screw length and placement compared with the conventional technique. CONCLUSION: Improved precision in screw insertion with CAS makes insertion of 2 screws possible for repair of mid-sagittal P3 fractures. CLINICAL RELEVANCE: CAS although expensive improves precision in screw insertion into P3 and consequently should yield improved clinical outcome.     

Computed tomography in the diagnosis of malignant sinonasal tumours in three horses

Malignant tumours are uncommon in horses, but when they do occur, they are most frequently found in the head. Clinical findings, such as facial swelling and nasal discharge, are frequently encountered but are nonspecific. To highlight the usefulness of a computed tomography (CT) examination in malignancy in the equine head, this Case Report describes the CT features of a leiomyosarcoma, an osteosarcoma and a sarcoma in 3 horses. CT of the equine head was able to provide more information about the extent and severity of lesions than conventional radiography in these cases.     

Comparison of computer assisted surgery with conventional technique for treatment of abaxial distal phalanx fractures in horses: an in vitro study

Objective— To (1) evaluate and compare computer-assisted surgery (CAS) with conventional screw insertion (conventional osteosynthesis [COS]) for treatment of equine abaxial distal phalanx fractures; (2) compare planned screw position with actual postoperative position; and (3) determine preferred screw insertion direction.
Study design— Experimental study.
Sample population— Cadaveric equine limbs (n=32).
Methods— In 8 specimens each, a 4.5 mm cortex bone screw was inserted in lag fashion in dorsopalmar (plantar) direction using CAS or COS. In 2 other groups of 8, the screws were inserted in opposite direction. Precision of CAS was determined by comparison of planned and actual screw position. Preferred screw direction was also assessed for CAS and COS.
Results— In 4 of 6 direct comparisons, screw positioning was significantly better with CAS. Results of precision analysis for screw position were similar to studies published in human medicine. None of evaluated criteria identified a preferred direction for screw insertion.
Conclusion— For abaxial fractures of the distal phalanx, superior precision in screw position is achieved with CAS technique compared with COS technique.
Clinical Relevance— Abaxial fractures of the distal phalanx lend themselves to computer-assisted implantation of 1 screw in a dorsopalmar (plantar) direction. Because of the complex anatomic relationships, and our results, we discourage use of COS technique for repair of this fracture type.     

Excision of the distal sesamoid bone for treatment of infection of the digit in a heifer.

An 8-month-old Holstein heifer was evaluated for right hind limb lameness of 3 weeks' duration. Diagnoses were osteomyelitis and fracture of the distal sesamoid bone, septic arthritis of the distal interphalangeal joint, and osteomyelitis of the third phalanx. After excision of a section of tissue from the plantar aspect of the digit and partial section of the deep digital flexor tendon, the distal sesamoid bone was excised. The third phalanx was curetted, and the surgical wound was lavaged. Twenty months after surgery, the heifer was fully weightbearing on the affected digit. Surgical exploration of the digit should be considered an alternative to claw amputation in cattle that have severe digital infections.     

A biomechanical comparison of headless tapered variable pitch compression and ao cortical bone screws for fixation of a simulated midbody transverse fracture of the proximal sesamoid bone in horses

OBJECTIVE: To compare mechanical properties and failure characteristics of 2 methods of fixation for repair of a transverse, midbody fracture of the proximal sesamoid bone (PSB): 4.5-mm AO cortical bone screw (AO) placed in lag fashion and 4/5-mm Acutrak (AT) self-compressing screw. STUDY DESIGN: An in vitro biomechanical evaluation of intact forelimb preparations and forelimb preparations with a simulated midbody PSB fracture stabilized by a bone screw. SAMPLE POPULATION: Sixteen paired and 8 unilateral cadaveric equine forelimbs. METHODS: A midbody transverse osteotomy was created in the medial PSB of bilateral forelimbs of 8 equine cadavers. The osteotomized PSB in 1 forelimb from each cadaver was repaired with an AO screw. The osteotomized PSB in each contralateral limb was repaired with an AT screw. Eight unilateral intact control limbs were also studied. Mechanical properties were determined from axial compression, single cycle to failure, load-deformation curves. Failure characteristics were determined by evaluation of video images and radiographs. RESULTS: No statistically significant differences were found between repair groups. Both AO and AT groups had significantly lower mechanical properties than intact limbs except for stiffness. CONCLUSION: AO and AT constructs were mechanically comparable when used to stabilize a simulated midbody fracture of the medial PSB. Both constructs were mechanically inferior to intact limbs. Clinical Relevance- The AT screw should be considered for clinical use because of the potential for less soft tissue impingement and superior biocompatibility compared with the stainless-steel AO screw. However, postoperative external coaptation is necessary to augment initial fracture stability for either fixation method, and to maintain a standing metacarpophalangeal joint dorsiflexion angle between 150 degrees and 155 degrees.     

Apical fracture of the proximal sesamoid bone in standardbred horses: 43 cases (1990-1996).

OBJECTIVE: To determine whether fracture fragment dimensions, suspensory ligament damage, and racing status at the time of injury were associated with outcome in Standardbred horses with apical fracture of the proximal sesamoid bone. DESIGN: Retrospective study. ANIMALS: 43 Standardbred racehorses. PROCEDURE: Medical records, racing records, and radiographs were reviewed, and ultrasonographic findings were scored. Measurements of the fractured portion of the proximal sesamoid bone were made. RESULTS: Seventy-four percent (32/43) of horses were pacers, and 26% (11/43) were trotters. Statistical differences between trotters and pacers regarding ability to start, number of starts, or amount of money earned after injury were not detected. Females earned significantly more money per start after injury than males. Eighty-six percent (37/43) of fractures involved hind limbs and 14% (6/43) involved forelimbs. Horses with forelimb injuries earned less money per start. Severity of suspensory ligament damage did not affect postinjury racing performance. A higher proportion of horses that had raced before injury returned to racing after surgery than horses that had not raced before injury, although a significant difference between these groups was not detected. Eighty-eight percent of horses that raced before injury raced after injury. Fifty-six percent of horses that did not race before injury raced after injury. Fracture fragment dimensions did not affect outcome. CLINICAL IMPLICATIONS: Dimensions of the apical fracture fragment of the proximal sesamoid bone in Standardbred horses and degree of suspensory ligament damage did not affect outcome. Prognosis for return to racing soundness is good in horses that had raced before injury and fair in horses that had not raced before injury.     

Use of an external skeletal fixation device and bone graft for arthrodesis of the metacarpophalangeal joint in horses

Arthrodesis of the metacarpophalangeal joint was attempted in 9 adult horses, using a new external skeletal fixation device and autogenous cancellous bone graft. Four horses had excellent results, 2 horses had fair results, arthrodesis failed in 2 horses, and 1 horse fractured the third metacarpal bone. The advantages of the technique included minimal surgical trauma to the area of injury, immediate rigid fixation of the metacarpophalangeal joint, and access for treatment of soft-tissue lesions at the site of injury. Although pin loosening and pin-track infection were complications when the device was in place, all pin tracks healed without complications after device removal.