34 research outputs found
Alternative approach for fracture fixation following implant infection in a Salter-Harris type-II fracture of the proximal phalanx in a Warmblood foal
A 2-day-old female Warmblood foal (70âkg) presented with a closed, displaced Salter-Harris type-II fracture of the proximal physis of the left hind first phalanx. The fracture was repaired with four 4.5âmm cortical screws and a wire in a figure-of-8 pattern applied on the lateral and medial aspect of the phalanx, respectively. A 4.5âmm cortical screw was additionally inserted in lag-fashion to engage the lateral metaphyseal spike. Three days postoperatively, medial and proximal displacement of the distal fracture fragment and implant infection were apparent and revision surgery was performed. Previous implants were removed and two 4.5âmm transphyseal cortical lag-screws were placed in proximolateralâdistomedial and dorsoproximalâplantarodistal direction across the physis and the fracture line. Postoperatively, the fracture healed rapidly and the implants were removed 6âweeks later. Nineteen months after implant removal, the horse did not show any sign of lameness, despite a shortening of the proximal phalanx compared to the contralateral limb. In cases of postoperative implant instability and infection, implant removal often becomes necessary. However, new implants cannot be placed safely in the previous location. To avoid this problem, this report describes an alternative approach for screw positioning in case of previous implant infection in a Salter-Harris type-II fracture of the proximal physis of the first phalanx
International survey of equine orthopaedic specialists reveals diverse treatment strategies for horses with overriding spinous processes
Background
Overriding spinous processes, also known as âkissing spinesâ, are one of the most common causes of back pain in horses. The aim of this study was to investigate which options for diagnosis and treatment are preferred by equine orthopaedic specialists and assess which techniques are used for local injection.
Methods
An online survey was distributed among members of the European/American College of Veterinary Surgeons, the European/American College of Veterinary Sports Medicine and Rehabilitation, the International Society of Equine Locomotor Pathology and nationally recognised advanced equine orthopaedic practitioners.
Results
The survey was completed by 353 respondents. The injection techniques most commonly used involve placing two needles abaxial to the interspinous space (42%) under ultrasonographic guidance (32%) or one needle in the midline (35%) between two spinous processes. The most popular combination for overriding dorsal spinous process therapy was local injection (26.7%) combined with controlled exercise (25.5%). Manual therapy was considered by 42% of European and 25% of American specialists (p = 0.01). Surgical intervention as a first-line treatment was recommended mainly by specialists working in the United States, the UK or Ireland (p = 0.001). Overall, most equine orthopaedic veterinarians (71%; n = 201) preferred conservative management and recommended surgery only for horses that did not respond to conservative therapy.
Limitations
Respondentsâ personal bias may have skewed the findings.
Conclusions
Despite a growing body of evidence, the therapeutic approach to âkissing spinesâ in horses is influenced by professional specialisation and regional preferences. Variations in injection techniques and differing criteria for surgical intervention warrant further investigation
Arthroscopic removal of osteochondral fragments of the cervical articular process joints in three horses
Objective
To report arthroscopic osteochondral fragment removal from the equine cervical spine articular process joints (APJs) including long-term follow-up.
Study Design
Case series.
Animals
Three Warmblood horses with forelimb lameness and/or reduced range of motion of the cervical spine with osteochondral fragments between the cervical vertebrae C5/C6 or C6/C7.
Method
Arthroscopy of the APJs of C5/C6 and C6/C7 was performed under general anesthesia. Following endoscopic evaluation of the joints, osteochondral fragments were removed using a rongeur.
Results
All horses recovered from anesthesia with no anesthetic or minor postanesthetic complications. One horse needed a second procedure for fragment removal. Fourteen to 31âmonths post-surgery the horses were sound for their intended use and neurological examination revealed no abnormalities.
Conclusion
Arthroscopic removal of osteochondral fragments can be performed safely in the equine cervical APJs of C5/C6 and C6/C7 resulting in a favorable long-term outcome.
Clinical Significance
Arthroscopic removal is a valid option for horses showing clinical signs that can be attributed to osteochondral fragments in the APJs of the neck
Application of locking compression plates as type 1 external fixators to treat unilateral mandibular fractures in four equids and one dromedary
Objectives
To describe a novel fixation of open, unstable, unilateral mandibular fractures applying a locking compression plate as an external skeletal fixator (ESF-LCP).
Animals
Four horses and one dromedary.
Study design
Short case series.
Methods
Animals presented with unstable, open, unilateral fractures of the mandible. Fracture fixation was performed under general anesthesia. A 4.5/5.5 narrow LCP was applied externally above the level of the skin and combined with intraoral tension band wiring.
Results
Fracture fixation was achieved successfully using an ESF-LCP. Minimal tissue manipulation was required during application and removal of the construct. The ESF-LCPs provided adequate access to the wounds at the fracture site, were well tolerated, and did not interfere with any objects in the animalsâ environment. Mild drainage at the screw-skin interface developed in all cases, requiring early implant removal due to surgical site infection in one case. The use of longer plates was associated with superficial pressure necrosis of the skin in the masseter area in two cases. Implants were removed after 3 to 12âweeks, and the long-term functional outcome after 11 to 41 (median 13) months was good in all cases.
Conclusion
Stabilization of mandibular fractures with ESF-LCP led to good outcomes in this case series. The use of longer plates positioned more caudally and in a ventrolateral position seemed associated with surgical site infection and pressure necrosis of the skin.
Clinical significance
Use of a locking compression plate as an external skeletal fixator seems to offer a viable alternative to treat unilateral mandibular fractures, especially when these are open and/or infected
Computed tomographic imaging and surgical management of distal insertional avulsion fragments of the caudal cruciate ligament in four horses
Objective
To describe cases with caudal cruciate ligament (CdCL) avulsion fragments diagnosed based on computed tomography (CT) examination and report on arthroscopic fragment removal.
Animals
Four Warmblood horses with hindlimb lameness and osseous fragments located in the caudal medial femorotibial joint (mFTJ).
Study design
Short case series.
Methods
CT and arthroscopic evaluation of the caudal mFTJ were performed. The caudal mFTJ and the insertion of the CdCL on the tibia were assessed and removal of the avulsion fragments was attempted in three horses using a cranial intercondylar approach.
Results
The fragment was not accessible via caudomedial approaches in one horse. A cranial intercondylar approach was used in three horses, allowing removal of the intra-articular fragment in two horses, and removal of two-thirds of the proximal fragment in the last horse. Acute, profuse, arterial bleeding occurred in this horse during surgery with transient postoperative soft tissue swelling. Comorbidities included medial femoral condyle cartilage defects (3), cranial cruciate ligament lesions (2), and medial collateral ligament lesions (2). Horses were followed up for 16âmonths (median, range 11â28âmonths), at which point all were back in ridden exercise; owners' satisfaction was good.
Conclusion
CT examination confirmed the diagnosis and allowed evaluation of the stifle joint for comorbidities. A cranial intercondylar arthroscopic approach facilitated the removal of CdCL insertional avulsion fragments, although not always complete.
Clinical significance
A cranial intercondylar approach can allow access to CdCL avulsion fragments, but complications and incomplete removal remain possible
Phacoemulsification Combined with Pars Plana Vitrectomy: Outcome in Horses with Acquired Cataracts Associated with Uveitis
Background: Cataracts resulting from equine recurrent uveitis (ERU) or other forms of uveitis are usually associated with rapid progression. ERU is the most common ocular disease cause of blindness and cause of cataracts in horses. The necessity for the posterior capsulorhexis (PC) during phacoemulsification (PE) is controversial. This study aimed to evaluate vision and complications after PE combined with pars plana vitrectomy (PPV) in horses with uveitis-associated cataracts and compare the PE technique with and without posterior capsulorhexis. Methods: Thirty-two eyes of 28 horses with uveitis-associated cataracts aged 14 months to 19.6 years were treated with PE-PPV under identical conditions. Twenty-three eyes of 21 horses were affected by an ERU-associated (ERU group), and nine eyes of 7 horses were affected by cataracts related to uveitis with pathogenesis different to ERU (non-ERU group). PE-PPV was performed in 12 eyes of 10 horses (PC group) and 20 eyes of 18 horses without posterior capsulorhexis (NPC group). Follow-up examination was performed at a mean of 1.7 ± 1.8 years postoperatively (range: 1 monthâ6.4 years). Results: In the period up to 1 month postoperatively, 17/20 (85%) NPC-eyes and 8/12 (67%) PC-eyes (total: 25/32 [78%]) were visual. From 1â6 months postoperatively, 16/20 (80%) NPC-eyes and 7/12 (58.3%) PC-eyes (total: 23/32 [72%]), and from 6â12 months, 7/11 (63.6%) NPC-eyes and 3/8 (37.5%) PC-eyes (total: 10/19 [52.6%]) were visual. From 12â18 months postoperatively, 3/7 (42.9%) NPC-eyes and 2/9 (22.2%) PC-eyes (total: 5/16 [31.3%]), and from 18â24 months, 3/8 (37.5%) NPC-eyes and 1/8 (12.5%) PC-eyes (total: 4/16 [25%]) were visual. After 24 months postoperatively, 2/7 (28.6%) NPC-eyes and 1/8 (12.5%) PC-eyes (total: 3/15 [20%]) were visual. Despite the higher number of visual eyes in the NPC group at each time point, differences were not significant. No obvious differences regarding postsurgical vision were observed between the ERU- and non-ERU groups at each time point. In the overall population, a significant decrease in the number of eyes with postoperative active uveitis was observed during the follow-up examinations (p < 0.001). A significant increase in the number of eyes that were blind due to retinal detachment was observed in the overall patient population as the examination period progressed (p < 0.001). Retinal detachment was the sole long-term cause of blindness. Conclusions: In horses diagnosed with uveitis-associated cataracts and treated with PE-PPV, no persistent active uveitis was observed in the present study during follow-up examinations. However, the proportion of eyes that were blind due to retinal detachment increased. Whilst PE-PPV may prevent postsurgical persistent active uveitis and remove lens opacity, the prognosis for a visual outcome is guarded. A superior outcome in postsurgical vision was observed in the NPC group. However, caution is required when interpreting these results due to several factors that affect the independent comparison of the surgical groups
Diagnosis and outcome following tenoscopic surgery of the digital flexor tendon sheath in German sports and pleasure horses
Background
Digital flexor tendon sheath (DFTS) pathology is an important cause of lameness in horses. The outcome after surgical treatment is variable and depends on the exact diagnosis.
Objectives
To (1) describe the prevalence of lesions associated with lameness caused by nonseptic DFTS tenosynovitis in a large population of German sports and pleasure horses; (2) determine the sensitivity and specificity of diagnostic imaging techniques for identifying lesions within the DFTS with tenoscopic diagnosis being the gold standard; (3) explore associations between tenoscopically diagnosed lesions and signalment, purpose, and limb affected; and (4) describe the outcome following DFTS tenoscopy with nonseptic DFTS tenosynovitis in this population.
Study design
Retrospective case series.
Methods
Medical records of horses admitted for tenoscopic surgery of nonseptic DFTS tenosynovitis between 2011 and 2020 were reviewed. Followâup information was obtained via telephone contact. Sensitivity and specificity of ultrasonography and contrast tenography were determined using tenoscopic diagnosis as gold standard and univariable analysis was used to explore associations between signalment, case history, and tenoscopic diagnosis.
Results
Medical records from 131 horses were retrieved, of which 8 horses had bilateral disease and 6 horses were presented for tenoscopy on two separate occasions (3 for tenoscopy in the same limb, 3 in a different limb), thus, making a total of 145 limbs. Lesions were most commonly diagnosed in the deep (DDFT; n = 55 limbs) and superficial (SDFT; n = 55 limbs) digital flexor tendons. Manica flexoria (MF) lesions were detected in 44 limbs and palmar/plantar annular ligament (PAL) constriction in 99 limbs. In 36 limbs, only one structure within the DFTS was injured, whereas in 109 limbs a combination of lesions was noted, the most common being the combination of a SDFT lesion with PAL constriction. All affected limbs were examined with diagnostic ultrasonography; contrast tenography was performed in 86 limbs. For diagnosis of MF and DDFT tears, tenography was more sensitive (89% [confidence interval, CI: 65.4%â95.2%]; 72% [CI: 46.4%â89.3%], respectively) than specific (64% [CI: 52.5%â77.6%]; 53% [CI: 42.2%â73.3%], respectively) whereas ultrasonography was more specific (92% [CI: 84.5%â96.3%]; 92% [CI: 83.6%â96.0%]) with lower sensitivity (64% [CI: 47.7%â77.2%]; 54% [CI: 39.5%â67.9%]). For SDFT lesions, ultrasonography was highly specific (94% [CI: 86.9%â97.9%]) with lower sensitivity (66% [CI: 51.3%â77.4%]). Followâup information following first surgery was obtained for 118 horses (132 limbs): 18 (15.3%) of 118 horses remained chronically lame, 40 (33.8%) performed at a reduced level and 60 (50.8%) performed at the same or higher level following rehabilitation after tenoscopy. Horses with DDFT lesions had the poorest outcomes with only 36.6% returning to the same or higher level of exercise.
Main limitations
Retrospective analysis of clinical records and subjective outcome assessment based on owner followâup with potential recall bias. Findings on diagnostic imaging are impacted by many factors including equipment quality and operator expertise and experience.
Conclusion
Diagnostic imaging techniques were complimentary and contrast tenography was sensitive and ultrasonography was specific for the diagnosis of MF and DDFT lesions. Following tenoscopic surgery for nonseptic tenosynovitis of the DFTS, approximately half the cases were able to return to preinjury level of exercise
Single-cut osteotomy for correction of a complex multiplanar deformity of the radius in a Shetland pony foal
Objective
To describe the surgical correction of a multiplanar deformity of the radius in a pony using a single-cut osteotomy.
Study design
Case report.
Animals
A 9-week-old male Shetland pony foal with a bodyweight of 47âkg.
Methods
The foal presented with a complex multiplanar deformity of the right radius. A 3-dimensional model of the bone was created based on computed tomography (CT) imaging. To correct the deformity, the cutting plane for a single-cut osteotomy was calculated following the mathematical approach described by Sangeorzan et al. After osteotomy, the bone was realigned and stabilized with two 4.5 locking compression plates (LCPs).
Results
Recovery from surgery was uneventful, and the foal remained comfortable. A CT exam 15âweeks after surgery revealed that diaphyseal deformities improved substantially in procurvatum (from 8° to 1°), varus (from 27° to 0°), and rotation (30° to 5°). The operated radius was 2.1 cm shorter than the left. Eighteen-month follow up confirmed a functionally and cosmetically acceptable outcome.
Conclusion
The single-cut osteotomy resulted in the successful correction of a multiplanar equine long-bone deformity with a favorable outcome in a Shetland pony.
Clinical significance
Single-cut osteotomy is an alternative surgical technique for the correction of complex diaphyseal long-bone equine deformities. Computed tomography data and the possibility of printing 3D models provides a significant advantage for rehearsing the procedure and for evaluating the correction that was achieved
Modified toggle pin technique combined with prosthetic capsular reconstruction for surgical stabilization of coxofemoral luxation in a Shetland pony
Objective
To describe open reduction and surgical stabilization of a coxofemoral luxation in a pony using a modified toggle pin technique and prosthetic joint capsule reconstruction without osteotomy of the greater trochanter.
Animal
A 2-year-old Shetland pony with a bodyweight of 167âkg.
Study design
Case report.
Methods
Radiographic examination confirmed craniodorsal luxation of the left coxofemoral joint. An open reduction with the aid of a pulley system was performed. A toggle pin was inserted through a bone tunnel extending from the level of the femoral shaft through the femoral head and the center of the acetabulum for the pin to be positioned on the medial wall of the acetabulum. FiberWire was subsequently passed through the cranial and caudal aspects of the acetabulum as well as a transverse tunnel in the femoral neck in a figure of 8 to facilitate capsular reconstruction. The pony was placed in a sling for 8âweeks and gradually returned to normal activity over 2Â months.
Results
Postoperative radiographic examination confirmed the position of the femoral head in the acetabulum with the implants in place. On 2-year follow-up the pony was sound at walk and trot.
Conclusion
A combined intra- and extra-articular stabilization technique for coxofemoral luxation in a pony resulted in successful long-term reduction and excellent outcome