Treatment of a congenital lateral patellar luxation by recession trochleoplasty in a donkey foal

The present report describes the surgical treatment of a congenital lateral patellar luxation in a 6-month-old female donkey foal. The foal was presented with a slight crouched position, muscle atrophy, moderate lameness, reluctance to flex the right hindlimb at a walk and slight effusion of the right stifle joint. The foal responded painfully to the stifle flexion test. Irreducible lateral luxation of the right patella was confirmed on physical examination and radiography. The animal was treated surgically by recession trochleoplasty and imbrication of the medial joint capsule. The animal gradually improved after surgery, and good clinical results were reported after 6 months post-operatively. In conclusion, congenital lateral luxation of the patella should be considered as a congenital cause of lameness in donkeys and surgical repair by recession trochleoplasty and medial imbrication of the joint capsule can be helpful to treat this problem.     

Short‐ and long‐term results following standing fracture repair in 34 horses

Reasons for performing study: Standing fracture repair in the horse is a recently described surgical procedure and currently there are few follow‐up data. This case series contains 2 novel aspects in the standing horse: repair of incomplete sagittal fractures of the proximal phalanx and medial condylar repair from a lateral aspect. Objectives: To describe outcome in a case series of horses that had lower limb fractures repaired under standing sedation at Rossdales Equine Hospital. Method: Case records for all horses that had a fracture surgically repaired, by one surgeon at Rossdales Equine Hospital, under standing sedation and local anaesthesia up until June 2011, were retrieved. Hospital records, owner/trainer telephone questionnaire and the Racing Post website were used to evaluate follow‐up. Results: Thirty‐four horses satisfied the inclusion criteria. Fracture sites included the proximal phalanx (incomplete sagittal fracture, n = 14); the third metacarpal bone (lateral condyle, n = 12, and medial condyle, n = 7); and the third metatarsal bone (lateral condyle, n = 1). One horse required euthanasia due to caecal rupture 10 days post operatively. Twenty horses (66.7% of those with available follow‐up) have returned to racing. Where available, mean time from operation to return to racing was 226 days (range 143–433 days). Conclusions: Standing fracture repair produced similar results to fracture repair under general anaesthesia in terms of both the number of horses that returned to racing and the time between surgery and race. Potential relevance: Repair of lower limb fracture in the horse under standing sedation is a procedure that has the potential for tangible benefits, including avoidance of the inherent risks of general anaesthesia. The preliminary findings in this series of horses are encouraging and informative when discussing options available prior to fracture repair.     

Successful surgical management of a medial humeral epicondyle fracture in a Thoroughbred foal

A 2-week-old 75 kg Thoroughbred filly was presented for the investigation of an acute forelimb lameness. Radiographs revealed a fracture of the medial epicondylar physis of the left humerus (Salter–Harris type II fracture). The fragment was removed via arthrotomy under general anaesthesia. Two months post-operatively, the foal was sound and at 2 years had resumed normal turn out. This case report describes a previously unreported surgical treatment for a fracture of the medial epicondylar physis in a foal.     

Collateral ligament reconstruction in two horses following traumatic avulsion fracture using a knotless suture anchor construct

This case report describes a technique for repair of medial collateral ligament avulsions in two horses. Both horses sustained traumatic injuries resulting in avulsion fractures at the origin of their medial tarsal and carpal collateral ligaments. This report describes the use of a knotless suture anchor to mechanically reconstruct medial collateral ligament avulsion injuries in two horses. The first horse, a 9‐year‐old Hannovarian Warmblood gelding presented for an acute nonweightbearing lameness in the right hindlimb. The injury was localised to the medial malleolus of the tibia and an avulsion fracture of the origin of the short medial collateral ligament of the tibiotarsal joint with disruption of the ligament was found on radiographs and ultrasound. The horse was taken to surgery and a reconstruction of the short medial collateral ligament was performed with a modified single row construct using a biocompatible, multistrand, long chain ultra‐high molecular weight polyethylene braided composite suture tape (2 mm Fibertape) and a single knotless suture anchor (5.5 × 19.1 mm PEEK SwivelLock C). The second horse, a 5‐year‐old Thoroughbred gelding presented for an acute nonweightbearing lameness in the left forelimb. The injury was localised to the medial styloid process of the radius and an avulsion fracture of the origin of the medial collateral ligament of the antebrachial carpal joint was found on radiographs and ultrasound. The horse was taken to surgery and a similar reconstruction procedure was performed to the collateral ligament. Both horses were recovered in a Robert Jones bandage without the use of casts or splints and recovered without incident. Both horses are sound and returned to previous level of athletic performance at 18 months and 8 months, respectively.     

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 skull fractures in four horses using cuttable bone plates.

Three horses with severely comminuted, open facial bone fractures and one horse with a comminuted, open orbital rim fracture were referred for treatment. Severe facial bone asymmetry and epistaxis were apparent in all cases and subcutaneous emphysema was present in two, however physical and neurological examinations were otherwise normal. Radiography and endoscopy were of some use in assessing the degree of damage, although the true extent of the damage was more apparent at surgery. Surgical reduction of the fractures was recommended to maximise cosmetic and functional outcome. After surgical debridement and reduction of the fractures the bone fragments remained unstable and were not amenable to stabilisation with interfragmentary wires alone, so 2 mm cuttable bone plates were used to maintain fracture alignment. Screw migration occurred in three horses and in one of these horses the plate had to be removed. Other complications were minor and in all horses the fractures healed with good cosmetic and functional outcome. The use of cuttable bone plates should be considered as a reasonable alternative to inter-fragmentary wiring for unstable, comminuted fractures of the facial bones, even where fractures are open.     

Standing repair of an articular dorsal medial oblique fracture of the proximal third metacarpal bone in a racing Standardbred

The third metacarpal bone (McIII) is a common site of long bone fractures in racehorses. However, articular fractures of the dorsomedial aspect of McIII are a rare location of such injuries. This report describes the successful standing surgical repair of an articular fracture of the dorso-medial proximal McIII in a 4-year-old Standardbred racing mare using lag screw fixation.     

Clinical presentation and surgical repair of traumatic lateral patellar luxation associated with a complete tear of the vastus medialis muscle in a neonatal Cob foal

Patellar luxation associated with traumatic injury is rare in the horse, and surgical correction has not been adequately described. This case report describes the clinical findings associated with traumatic lateral patellar luxation in a 2-day-old cob colt, and the technique used for successful surgical repair. A combination of computed tomography (CT), radiography and ultrasound was used to diagnose lateral luxation of the patella due to a complete tear of the vastus medialis muscle. All patellar ligaments were intact and no congenital abnormalities associated with the patellar luxation were present. Surgical correction of the patellar luxation was achieved using a lateral release of the patella performed by transection of the lateral femoropatellar ligament along with overlying fascia, and stabilisation of the patella by medial imbrication of the medial patellar ligament and parapatellar fascia to the distal tendon of the sartorius muscle. Radiographs at 18 weeks of age showed the patella in a normal position in a well-developed trochlear groove. At 1 year of age the foal was walking and trotting sound, with normal range of motion of the affected stifle.     

Radiographic technique to improve diagnosis of sagittal axial sesamoid fracture in racing Thoroughbreds with lateral condylar fracture

The current study identified 124 lateral condylar fractures of the distal metacarpus or metatarsus over a 6-year period. Thirty of 124 lateral condylar fractures were classified as displaced. Eight of 30 displaced lateral condylar fractures and 1/86 incomplete lateral condylar fractures had concurrent sagittal axial fracture of the lateral proximal sesamoid bone. A 20-degree DMPLO view is the most sensitive radiographic projection to identify sagittal axial fracture of the lateral proximal sesamoid bone. A flexed 20-degree DMPLO projection demonstrates displacement of complete sagittal axial sesamoid fractures. Radiographic identification of axial sesamoid fracture is critical to provide the most accurate prognosis for return to racing. Arthroscopic assessment of the axial sesamoid fracture and cartilage injury on the lateral proximal sesamoid bone, as well as post-operative progression, are described in four surgical cases.     

Computed tomographic diagnosis of incomplete palmar cortical (fatigue) fracture of the third metacarpal bone in two young adult endurance horses

Two young adult endurance horses were presented for investigation of sudden-onset forelimb lameness during competition. Clinical examination revealed a severe forelimb lameness and pain on palpation of the proximal palmar metacarpal area. Initial radiographic survey of the affected forelimb was unremarkable in both cases. A week of box rest resulted in only a mild improvement in the lameness. A second radiographic examination did not reveal any significant abnormalities. In both cases, scintigraphic examination was suggested, but was declined by the owner, and the lameness had significantly improved after local infiltration of 3 mL of anaesthetic solution in the proximal suspensory region. Radiographic and ultrasonographic examinations of the carpus and proximal suspensory region were unremarkable in Case 2. Case 1 had increased thickness of the medial lobe of the proximal aspect of the suspensory ligament. A computed tomographic examination was performed and an incomplete longitudinal (fatigue) fracture of the proximal third metacarpal bone was detected. After 8 months of box rest and rehabilitation, re-examination revealed resolution of the lameness in both cases. Advanced diagnostic imaging should be considered in young endurance horses with severe lameness during competition or training, in which radiographic and ultrasonographic examinations are unremarkable or do not explain the severity of the lameness. Computed tomography imaging is considered a useful diagnostic imaging technique to detect incomplete longitudinal palmar metacarpal cortical (fatigue) fractures due to its ability to provide excellent bone detail.     

Standing removal of the proximal aspect of an olecranon fracture in a mature horse

A 12‐year‐old 450 kg Argentine polo mare presented with a dropped elbow and an unwillingness to bear weight after being kicked by another horse on the lateral aspect of the upper left forelimb. The mare was subsequently diagnosed with a displaced olecranon fracture that did not readily conform to the standard classification systems. Referral for surgical treatment involving open reduction and internal fixation was declined due to financial constraints. Due to the mare being unsuitable for breeding, and conservative treatment of displaced olecranon fractures being deemed to have an overall poor prognosis for return to full athletic performance, another treatment option was sought. Given the fracture configuration, standing surgical removal of the large proximal fragment was performed. The mare returned to full athletic performance 12 months post operatively without lameness. This case report describes an alternative treatment option for selected olecranon fractures.     

Comparison of radiography,scintigraphy and ultrasonography in the diagnosis of patellar chondromalacia in a horse,confirmed by arthroscopy

Patellar chondromalacia is rarely reported in the horse. In this study, several noninvasive diagnostic modalities were combined to diagnose patellar chondromalacia in a horse, later confirmed by arthroscopy. Radiography failed to demonstrate pathology; nuclear scintigraphy localised the disease process to the left femoropatellar region; and ultrasonography identified pathological changes within the affected joint. It is possible that this disease is underreported in the literature due to the difficulty in accurately diagnosing the condition.