Fractures In Horses Research Articles

Use of a new aiming compression device and technique for the repair of navicular bone fractures in horses: A cadaveric study.

To assess the use of a newly developed aiming compression device (ACD) for screw insertion in non-fractured navicular bones (NB) in cadavers. Cadaveric study. A total of 10 cadaveric front limbs of adult horses. Placement of a 3.5 mm cortical screw in non-fractured NB under radiographic guidance was performed in 10 cadaver limbs in a standing position. An ACD was used to stabilize the NB and to guide the drilling process. Preparation and surgical time as well as the number of radiographic images were noted. A postoperative scoring system was used to assess screw placement by cone beam computed tomography (CBCT) and gross examination by two evaluators. The total procedure time was 25-62 min (median 33.5). During the procedure, 11-21 radiographs (median 18.5) were taken. The postoperative gross examination revealed an excellent screw placement in nine NB and poor in one. This could not be reliably assessed with post-procedure CBCT. The described technique achieves an excellent screw placement in 9/10 bones without disrupting the articular or flexural surface of the NB and with no protrusion of the screw head or tip, in a median procedure time of under 35 min. Adequate screw placement is paramount for NB fracture repair. The described approach under radiographic guidance allows adequate screw placement using the ACD to stabilize the NB by lateral to medial compression. This technique facilitates adequate screw placement within the NB without the use of advanced imaging techniques.

Navicular bone fractures in horses: Prognosis after conservative and surgical treatment

The aim of this retrospective study is to describe and compare conservative and surgical treatment of navicular fractures in horses. An attempt is made to identify critical points that can favorably influence the prognosis of this orthopedic disease. All horses treated for a navicular fracture at the Equine Clinic, Vetsuisse Faculty, University of Zurich between 2005 and 2017 were included in this study. The severity of lameness at initial examination, radiographic assessment, hoof conformation, treatment (conservative or surgical), complications and outcome were determined from the medical records. Conservative and surgical treatment consisted of stable rest, a controlled exercise program and therapeutic orthopedic shoeing. During surgical treatment, fracture reduction was also carried out with a cortical screw. Computer assisted surgery were used in five horses and computer tomography in three horses. Follow-up examinations included clinical and radiographic examinations. The outcome was divided into three categories: 1 = very good; 2 = good; 3 = poor. Twelve horses met the inclusion criteria; Four horses were treated conservatively and eight were treated surgically. After conservative treatment, two horses (50 %) had a very good outcome and two (50 %) had a good outcome. After surgical treatment, four horses (50 %) had a very good outcome and four (50 %) had a poor outcome. Overall, 67 % of horses had a very good or good outcome, although radiographic signs of bone healing was not present in any of these cases. Various complications were identified, such as the fracture of a screw, the fragmentation of the small navicular bone fragment, the development of osteoarthrosis in the coffin joint and progressive podotrochosis. This study shows that the prognosis of navicular fractures is generally cautious and that degenerative changes to the navicular apparatus worsen the prognosis. In the present study, surgical treatment did not improve the prognosis of navicular fractures despite the intrasurgical use of three-dimensional imaging. However, technical advances could reduce the complication rate in the future.

Rib fractures in horses

Rib fractures in horses

Total removal of the fourth metacarpal bone in an Icelandic horse.

Fractures of the splint bones are the most common fractures in horses. Various treatment options for splint bone fractures (MC/MT II and IV), including conservative and surgical management, have been described. This report describes an acute splint bone fracture due to external trauma in a 17-year-old Icelandic mare. The fracture was diagnosed as an open multifragment fracture of the proximal third of the fourth metacarpal bone (MCIV) in the right front limb. Surgery was performed with the horse under general anaesthesia. The distal fragments were removed, and the distal part of the proximal remnant splint bone was cut with an osteotome. During the postoperative period, a routine x-ray-control two days after surgery showed a dislocated fracture of the remaining proximal part of the fourth metacarpal bone. In a second surgery, the proximal part of MCIV was entirely removed. After a reconvalescence period of 5 month, the horse reached her previous level of performance as a leisure horse. The mare is still free of lameness 6 years after the incident.

Pan‐carpal arthrodesis as a treatment for distal radial fracture in a pony

SummaryComplete, displaced radial fractures carry a poor prognosis in adult horses. In foals and ponies, fracture repair may have a good outcome following internal fixation. Distal radial fractures are difficult to stabilise due to limited bony purchase. Therefore, carpal arthrodesis may provide a viable option for salvaging the horse. In this report, we describe pan‐carpal arthrodesis as a treatment for distal radial fracture in an adult pony. A 12‐year‐old pony, 180 kg bodyweight, was presented due to left front non‐weight bearing lameness. Diagnosis of a closed, comminuted, displaced distal radial fracture, with antebrachiocarpal joint involvement, was made radiographically. The fracture was repaired and pan‐carpal arthrodesis was performed. Recovery was uneventful. The implants were gradually removed, in a minimally invasive standing procedure, due to surgical site infection. Two years following surgery, the horse is sound at a walk and trots freely with flexion of the affected carpus. Radiographs revealed healing of the fracture and failure of the arthrodesis. In essence, unintentionally, we performed temporary trans‐articular stabilisation by repairing a distal radial comminuted fracture, while preserving partial carpal range of motion. This technique, of temporary trans‐articular stabilisation, could be applied intentionally on other distal or proximal long bone fractures in horses.

Comparison of Radiography and Computed Tomography for Evaluation of Third Carpal Bone Fractures in Horses.

Radiographs underestimate the extent of bone injury in horses with third carpal bone (C3) fractures (Fx). We aimed to describe bone pathologies identified using computed tomography (CT) and compare the diagnostic value of digital radiography (DR) and CT in horses with C3 Fx. CT images of 15 racehorses with C3 Fx and 10 controls were reviewed (Part 1) then DR and CT images of 26 racehorses (24 Thoroughbred, 2 Standardbred) with C3 Fx (Part 2) were evaluated. Agreement on fracture geometry and concomitant bone lesions was tested between DR and CT using the kappa statistic (Part 2). For agreement analysis, 38 limbs were used (27 Fx carpi from 26 horses and 11 contralateral carpi). Intermodality agreement was good for recognition of displacement, fair for comminution, articular surface bone loss and osseous fragmentation, and poor-slight for recognition of whether the Fx was complete, additional fissures and lucencies. CT provides more detailed information than DR regarding bone pathology and fracture configuration in horses with C3 fracture. Correlation of CT findings with clinical information and outcome needs to be explored; however, the more accurate diagnosis possible with CT is likely valuable when deciding on the most appropriate management and for surgical planning.

Experience in the treatment of horses with short incomplete sagittal fractures of the proximal phalanx

Sagittal fractures are the most common injury of the proximal phalanx in horses. Choosing the optimal treatment tactics allows you to eliminate the physiological consequences of injury. The aim of this work was to compare the effectiveness of traditional and surgical methods of treatment of horses with short incomplete sagittal fractures of the putus bone. Thus, the study included horses (n=20) with short incomplete sagittal fractures of the proximal phalanx, which were then divided into two groups. In the first group (n=10), treatment was based on the application of a plaster cast, changing every 14 days. Osteosynthesis by screw fixation was performed in the second experimental group (n=10). Clinical and radiological research methods were used in the work. Complete radiographic healing was confirmed in 100% of animals in the second group, where osteosynthesis was performed by screw fixation, they returned to full athletic load without complications. However, in the first group of horses to which a plaster cast was applied, only 72.7% of animals and 27.3% of horses completely recovered their athletic qualities due to the development of complications, in the form of osteoarthritis changes, were excluded from sports. The proposed method of treating fractures in horses of the second group using the screw fixation method increases the possibility of animals returning to their previous loads. The rehabilitation technique developed and implemented in the clinic expands the possibilities of use in practical veterinary medicine.

Operative treatment of splint bone fractures in horses

In this study; it is aimed to present the operative treatment and results, which are indicated for the continue of their racing life in splint bone fractures which are frequently occurred in race horses. The 2nd and 4th metacarpal (Mc-II and Mc-IV) and metatarsal bones (Mt-II and Mt-IV) of the horse are accessory structures that support the carpus and tarsus. Fractures of these bones in horses are called “splint bone fractures”. Splint bone fractures are relatively common in horses and usually seen in forelimbs. Fractures of the proximal part are rarer and represent 2.7-5% of all splint bone fractures, but challenging to manage. In the present study, 5 cases of splint bone fractures in different horses were evaluated. The distribution of the fractures were Mc-II in three, Mc-IV and Mt-IV in one each. Localization of the fractures were distal 1/3 in 4 and diaphyseal in 1 horse. For the management of these fractures, surgical removal of the fractured fragments were performed under general anaesthesia. Functional limb usage was achieved following the 30th day postoperatively in all cases.

Standing oral surgery for the management of mandible and maxilla fractures in horses: a case series of 15 horses

Fractures of the mandible and maxilla are common in horses. The present study was conducted on fifteen horses referred for the management of mandible or maxilla fractures. Fixation methods were used to repair the fractures in these horses, including tension band and cerclage wires, dynamic compression plates, and lag screw fixation. All procedures were performed under chemical restraint and regional nerve block anesthesia in the standing position. According to the results, the long term follow-up of the horses was satisfactory, and no severe complications were observed. Jaw fractures are most successfully treated by early diagnosis and fracture fixation. The surgical management of most oral region injuries may be readily performed in the standing position, to avoid the risks associated with general anesthesia in horses.

Influence of screw head diameter on ex vivo fixation of equine lateral condylar fractures with 5.5 mm cortical screws.

To determine the influence of screw head diameter on equine condylar fracture fixation with 5.5 mm cortical screws. Ex vivo, biomechanical study, blinded, matched-pair design. Fifteen pairs of equine third metacarpal (MC3) bones. Lateral condylar fractures were simulated by parasagittal osteotomies and repaired pairwise by 2 × 5.5 mm cortical screws of 8 mm (standard) or 10 mm (modified) head diameter. Interfragmentary compression at maximum screw insertion torque was measured. The instrumented specimens were pairwise stratified for biomechanical testing under the following modalities (n=5): (1) screw insertion torque to failure, (2) quasi-static axial load to failure, and (3) cyclic axial load to 2 mm displacement followed by failure. Tests (1) and (2) were analyzed for yield, maximum, and failure torque/angle and load/displacement, respectively. Number of cycles to 2 mm displacement and failure was assessed from test (3). Maximum insertion torque was greater, and failure angle smaller, when constructs repaired with modified screws were tested (8.1 ± 0.5 vs. 7.4 ± 0.5Nm; P=.0047 and 550 ± 104 vs. 1130 ± 230; P=.008). Axial yield (7118 ± 707 vs. 5740 ± 2267 N; P=.043) and failure load (12 347 ± 3359 vs. 8695 ± 2277 N; P=.043) were greater for specimens repaired with modified screws. No difference was detected between constructs in the number of cycles to 2 mm displacement. Condylar MC3 osteotomies repaired with modified 5.5 mm cortical screws sustained greater maximal hand torque insertion, smaller insertion failure angle and 1.4 fold greater quasi-static failure forces than constructs repaired with standard 5.5 mm screws. Use of modified screws with larger heads may improve the fixation of condylar fractures in horses. These results provide evidence to justify clinical evaluation in horses undergoing fracture repair.

Rib fractures in adult horses as a cause of poor performance; diagnosis, treatment and outcome in 73 horses.

Rib fractures in adult horses are poorly documented. To describe the presenting signs, diagnosis, treatment and outcome of horses diagnosed with rib fracture. Retrospective case series. The clinical records and diagnostic images of all adult horses diagnosed with a rib fracture at three referral centres over a 15-year period were reviewed. Seventy-three horses met the inclusion criteria. Horses presented due to either resistance to ridden work and poor performance (n=41), lameness (n=21) or trauma (n=7). In four horses, the presenting complaint was not recorded. Clinical assessment and palpation localised the site of injury in 18/47 cases where recorded. Nuclear scintigraphic examination identified all fracture sites in which it was performed (59/59). In 10/24 horses, radiographic examination confirmed rib fracture. Ultrasonographic examination confirmed rib fracture in 58/59 horses (98%; 95% CI 92-100). Six horses underwent surgery due to ongoing clinical signs and non-healing fracture; all other horses were managed conservatively. Fifty-five horses were available for long-term follow up (>1year), of which 28 (51%; 95% CI 38-64) returned to their previous level of exercise. Twelve horses did not return to their previous level of exercise due to lameness unrelated to the rib fracture and seven horses were subjected to euthanasia, of which three were as a result of the rib fracture. Eight horses did not return to their previous level of exercise for other reasons. Incomplete data set due to retrospective case series. Although uncommon, rib fractures should be considered in cases of reduced performance or resistance during ridden exercise. Palpation may be unrewarding. Scintigraphy and ultrasonography are useful in identifying the fracture site. Rib fractures in horses carry a fair prognosis and can be managed conservatively in most cases.

Effects of an articular cartilage lubrication with a viscosupplement in vitro and in vivo following osteochondral fractures in horses.

To assess whether the combination of hyaluronan, sodium chondroitin sulfate, and N-acetyl-d-glucosamine (HCSG) lubricates articular cartilage in vitro and modulates joint lubrication in vivo. 16 healthy adult horses. The effects of HCSG injections on SF lubricant properties and joint health, immediately after injury and 2 weeks later, were analyzed by use an equine osteochondral fracture model of post-traumatic osteoarthritis (OA). Middle carpal joints of adult horses were randomly assigned to 1 of 4 surgical treatment groups as follows: normal nonsurgical group (n = 8), normal sham-surgical group (8), OA-induced surgical group with HCSG injection (8), or OA-induced surgical group with saline (0.9% NaCl) solution injection (8). Synovial fluid was aspirated periodically and analyzed for boundary lubrication function and lubricant molecules. At 17 days, joints were screened for gross pathological changes. Induction of OA led to an impairment of SF lubrication function and diminished hyaluronan concentration in a time-dependent manner following surgery, with HCSG injection lessening these effects. Certain friction coefficients approached those of unaffected normal equine SF. Induction of OA also caused synovial hemorrhage at 17 days, which was lower in joints treated with HCSG. After induction of OA, equine SF lubricant function was impaired. Hyaluronan-sodium chondroitin sulfate-N-acetyl-d-glucosamine injection restored lubricant properties at certain time points and reduced pathological joint changes.

Basisphenoid bone fracture in two juvenile horses with different clinical presentation

AbstractBasilar skull fractures in horses can occur at any age, although young horses are particularly prone to this type of injury. This manuscript describes two foals with a basisphenoid bone fracture, with clinical presentations ranging from mild neurological signs up to severe neurological compromise. The absence of neurological signs does not exclude a fracture of this bone, as lethargy and retropharyngeal swelling may be the only clinical signs. Radiography can help define skeletal trauma involving the basilar region of the head, but superimposition of complex skull anatomy limits its use. Endoscopy of the guttural pouches region can be also helpful, but it does not provide enough evidence for a diagnosis. Thus, computed tomography is the optimal imaging technique for a rapid and straightforward diagnosis, as it is superior to radiography defining the type of fracture and the location of the fragments as well as the soft tissue involvement.

Heat hypersensitivity at a site proximal to a surgically induced osteochondral fracture in horses

ObjectiveTo evaluate thermal nociceptive thresholds (TNTs) before and after inducing a standardized radiocarpal bone osteochondral fracture (OCF) in horses. Study designProspective, controlled, randomized, masked study. AnimalsA group of 10 Thoroughbred fillies aged 2 years. MethodsSkin temperature and TNTs were measured on the skin over the triceps brachii muscle in both the thoracic limbs before (week 0) and weekly (weeks 1–8) after unilateral arthroscopic induction of a radiocarpal OCF (n = 4) or sham surgery (n = 6) followed by a standardized exercise programme. The contralateral, non-operated thoracic limb was used as a control within each horse. Percentage thermal excursion (%TE) defined as %TE = 100 ∗ (TNT – skin temperature)/(cut-off temperature – skin temperature) was calculated. Data were analysed with a mixed-effects model followed by Dunnett’s and Tukey’s tests for within and between-limbs comparisons, respectively; p < 0.05 was considered significant. ResultsSkin temperature in the control limb of OCF horses was significantly higher at week 7 than at week 0 (p = 0.0125). At week 1, TNTs and %TE values in operated limbs of OCF horses were significantly reduced compared with their baseline values at week 0 (p ≤ 0.0153) and their values in contralateral control limbs (p ≤ 0.0024) and operated limbs of sham-operated horses (p ≤ 0.0162). At week 2, TNTs and %TE values in operated limbs of OCF horses remained significantly reduced compared with values in operated limbs of sham-operated horses (p ≤ 0.0248). Conclusions and clinical relevanceCreation of an OCF in a radiocarpal bone induced transitory (<2 weeks) ipsilateral heat hypersensitivity proximal to the surgery site (skin over the triceps brachii muscle) in horses. Surgically induced OCF may cause somatosensory abnormalities consistent with secondary thermal hyperalgesia.

Surgical repair of radial carpal bone fractures in two racehorses

SummaryA 3‐year‐old Standardbred gelding (Case 1) and a 2‐year‐old Thoroughbred gelding (Case 2) were referred for surgical evaluation of a left radial carpal bone (RCB) fracture, sustained during training. Clinical findings at the time of initial examination included a palpable effusion within the left middle carpal joint in both horses and marked signs of pain and reduced range of motion on flexion of the affected carpus. In both horses, the RCB fracture was evident on the following radiographic views of the carpus: dorsolateral–palmaromedial oblique (30° off lateromedial) and flexed lateromedial. An additional loose wedge‐shaped osteochondral fragment at the proximal articular surface of the RCB could be seen in Case 2. Both horses underwent surgical reduction and repair of the fracture between 1 and 2 days following the initial injury, which consisted of arthroscopic removal of any intra‐articular osteochondral fragments, and arthroscopic assisted‐interfragmentary compression via a standard dorsomedial and dorsolateral approach to the antebrachiocarpal joint (ACJ) and middle carpal joints (MCJ). The two horses returned to function as racehorses, 6 months (Case 1) and 16 months (Case 2) after surgery. The RCB is a relatively uncommon site for large carpal fractures in horses. The clinical presentation and findings from this report were similar to that of third carpal bone (C3) slab fractures, confirming that surgical repair is indicated in selected cases of RCB fractures.

External Unilateral Fixator of Own Design for the Treatment of Selected Mandibular Fractures in Horses

Most of the mandibular fractures occur as a result of accidents, kicks, or falls. The treatment of fractures located in the incisor region is quite successful with the use of the wiring method. Fractures that occur within the body of the mandible are more complicated. Some of them are open and infected and involve the cheek teeth, which makes treatment quite challenging. In these cases, using bone plates mounted directly on the bone would constitute poor technique. External skeletal fixators can be a good alternative for treatment of complicated fractures. In this article we present the construction and the possible use of a unilateral external fixator dedicated for the treatment of mandibular body fractures. The fixator consists of one rod having a diameter of 8 mm and a length of 20 cm, four booms, four connectors, and four self-threading apex pins with a diameter of 6 mm. Stainless steel was used in the production of the fixator. The device has been successfully used for the treatment of open mandible fractures. The stabilizer is light and is small in size, simple to use, and easily assembled and disassembled. It can be adjusted in three planes.

Delayed diagnosis of radial and tibial fractures in horses – a case series considering the latest case law

Delayed diagnosis of radial and tibial fractures in horses – a case series considering the latest case law

In vitro biomechanical comparison of headless compression versus cortex screws for fixation of simulated midbody proximal sesamoid bone fractures in horses

A midbody fracture of a proximal sesamoid bone (PSB) is a severe injury, especially in racehorses. Screw fixation may be the only option for horses to return to athletic activity. In a cadaveric biomechanical study, fixation of simulated transverse midbody PSB fractures with a 4.5 mm headless compression screw (HCS) was compared to the fixation using a 4.5 mm cortex screw (CS) inserted in lag fashion. The front limbs of 8 horses were prepared with a standardized midbody transverse osteotomy in each medial PSB. The left or the right limb of each pair was randomly assigned to the CS or HCS group. Fracture reduction and fixation was controlled by radiography. Markers were fixed proximal and distal to the osteotomy to document gap opening by an image correlation measurement. Cyclic compressive loading was applied with a hydraulic cylinder in an axial manner leading to tensile cyclic loading in the PSBs. After mechanical testing all limbs were radiographed to document the mode of failure. The mean cycles to total failure were 27,803 for the HCS group and 36,624 for the CS group, respectively. A mean of 14,444 cycles (HCS group) versus 27,464 cycles (CS group) was recorded at a fracture gap opening of 10 %. The mean value of initial stiffness was 300 N/mm (HCS group) versus 590 N/mm (CS group). On post-testing radiographs, failure by screw breakage was detected in 3/8 limbs of the HCS group and in 2/8 limbs of the CS group. Screw pullout and bone failure was noted in 5 limbs in each group. In one limb of the CS group, the medial suspensory branch was disrupted and the fracture fixation was intact. None of the differences between HCS and CS constructs reached statistical significance. However, the lower absolute numbers of cycles sustained before failure, at 10 % gap opening and lower initial stiffness of HCS constructs as well as limitations of the study warrant further investigation before clinical use of the HCS for this indication can be recommended.

Management of Olecranon Fracture in a Horse

Case Description- Olecranon fractures are frequently encountered in horses especially in foals. External trauma due to kicks or falls is the most common cause of the fracture. Treatment modalities of olecranon fractures including prolonged stall rest and surgical reconstruction of the different types of fractures have been proposed with different outcomes. Clinical findings-The horse displayed a 75-day duration of right forelimb lameness while galloping. According to the owner the horse had stumbled on his right forelimb and found 2 days in a non-weight bearing stance with a painful swelling felt on the right elbow on palpation.Treatment and Outcome-This article described nonsurgical management of an olecranon fracture in an adult horse subjected to 2 months complete stall rest. The horse regained soundness and performed his job normally. Clinical relevance- Information regarding the history, clinical signs, diagnosis, management and long-term prognosis were discussed and compared with the current literature. Uncomplicated olecranon fractures with late referral to the clinic may go unnoticed because of no lameness in physical examinations.

Biomechanical study in vitro on the use of self-designed external fixator in diaphyseal III metacarpal fractures in horses

Diaphyseal fractures of the III metacarpal bone represent 22% of all fractures of the long bones in horses. Treatment of such cases is difficult. The most popular solution used in these types of fractures is two plates applied directly to the bone surface, but they are not applicable on contaminated and infected fractures. External fixators are quite commonly used in human medicine, although in veterinary practice there is no typical stabilizer designed for the treatment of diaphyseal fractures of the III metacarpal bone so far. In this study, an external semicircular fixator of our own design was used and in vitro strength tests were conducted to determine the maximum force which would lead to the destruction of non-fractured bone and fractured bone treated with the stabilizer. On the basis of the strength tests, we can conclude that the stabilizer can be strong enough to allow the horse to stand up after surgery. It also has many favorable features which make it easy to assemble and to take care of a wound, while being safe enough for the animal at the same time.