Hindlimb Fractures Research Articles

Effects of Intrathecal Anesthesia with Hyperbaric Bupivacaine for Hind Limb Orthopedic Surgery in Calves

Anesthesia obtained by the injection of local anesthetic into the cerebrospinal fluid is defined as intrathecal or spinal anesthesia. This study aimed to compare intrathecal anesthesia with gas anesthesia in calves operated for hind limb fractures. Twelve calves with hind leg femur and tibia fractures were included in the study. Six of these calves were subjected to intrathecal anesthesia (IT) and the other 6 to gas anesthesia (GA). Sedation with xylazine was performed after general operative preparations. In the IT group, hyperbaric bupivacaine was injected lumbosacrally, while in the GA group, general anesthesia was achieved with isoflurane after mask induction. Anesthesia onset, operation and anesthesia durations, and intraoperative parameters were recorded. Systolic and diastolic blood pressure, pulse, respiratory rate, body temperature, and electrocardiography were monitored and recorded. In addition, postoperative pain was evaluated with the postoperative pain visual analog scale (VAS), simple descriptive pain scale (SDS), and bovine pain assessment scale (BPAS). Although there were statistical differences between the hemodynamic values measured in the study, they remained within reference ranges. In conclusion, it can be said that intrathecal anesthesia is practical for hind leg surgery in calves and has advantages, especially in terms of postoperative pain management.

Increased platelet mitochondrial function correlates with clot strength in a rodent fracture model.

Thromboelastographic measures of clot strength increase early after injury, portending higher risks for thromboembolic complications during recovery. Understanding the specific role of platelets is challenging because of a lack of clinically relevant measures of platelet function. Platelet mitochondrial respirometry may provide insight to global platelet function but has not yet been correlated with functional coagulation studies. Wistar rats underwent anesthesia and either immediate sacrifice for baseline values (n = 6) or (1) bilateral hindlimb orthopedic injury (n = 12), versus (2) sham anesthesia (n = 12) with terminal phlebotomy/hepatectomy after 24 hours. High-resolution respirometry was used to measure basal respiration, mitochondrial leak, maximal oxidative phosphorylation, and Complex IV activity in intact platelets; Complex I- and Complex II-driven respiration was measured in isolated liver mitochondria. Results were normalized to platelet number and protein mass, respectively. Citrated native thromboelastography (TEG) was performed in triplicate. Citrated native TEG maximal amplitude was significantly higher (81.0 ± 3.0 vs. 73.3 ± 3.5 mm, p < 0.001) in trauma compared with sham rats 24 hours after injury. Intact platelets from injured rats had higher basal oxygen consumption (17.7 ± 2.5 vs. 15.1 ± 3.2 pmol O 2 /[s × 10 8 cells], p = 0.045), with similar trends in mitochondrial leak rate ( p = 0.19) when compared with sham animals. Overall, platelet basal respiration significantly correlated with TEG maximal amplitude ( r = 0.44, p = 0.034). As a control for sex-dependent systemic mitochondrial differences, females displayed higher liver mitochondria Complex I-driven respiration (895.6 ± 123.7 vs. 622.1 ± 48.7 mmol e - /min/mg protein, p = 0.02); as a control for systemic mitochondrial effects of injury, no liver mitochondrial respiration differences were seen. Platelet mitochondrial basal respiration is increased after injury and correlates with clot strength in this rodent hindlimb fracture model. Several mitochondrial-targeted therapeutics exist in common use that are underexplored but hold promise as potential antithrombotic adjuncts that can be sensitively evaluated in this preclinical model.

Locking Reconstruction Plate for the Management of Diaphyseal Femoral Fracture in a Dog

Fracture of the long bone is a commonly encountered orthopaedic problem in canine practice (Aithal et al.,1999). Femur fractures are one of the most common orthopaedic affections encountered in dogs comprising 35 % of hind limb fractures and 24 %of all fractures in dogs (Johnson et al., 1998). Proximal and distal epiphyseal fractures happen in young animals, whereas diaphyseal and metaphyseal fractures are more frequent in older animals(Guiot et al., 2012, Abd El Raouf, 2017). They are difficult to repair due to the fact that such dogs are recumbent and need early rehabilitation to establish speedy recovery. The closeness of the abdominal wall to the proximal femur and surrounding heavy muscles limits the use of coaptation and external skeletal fixation for femoral fractures.

Ultrasound‐guided sciatic nerve block in two alpacas (Vicugna pacos) as part of an anaesthesia plan for hindlimb fractures

AbstractThe present case report describes the management of two alpacas undergoing repair of a metatarsal and a distal tibial fracture, respectively. Both animals received ketamine and medetomidine intramuscularly, resulting in deep sedation. Endotracheal intubation was performed, and general anaesthesia was maintained with sevoflurane. An in‐plane ultrasound‐guided sciatic nerve block was performed at the level of the mid‐thigh with bupivacaine 0.5% before surgery as part of the analgesic treatment. Meloxicam was administered. Heart rate, arterial blood pressure and respiratory rate were stable during the surgery, despite the use of a low end‐tidal sevoflurane concentration. No opioids were required intraoperatively. Duration of the anaesthesia was 205 and 255 minutes, respectively. Extubation was performed 12 and 6 minutes after discontinuing sevoflurane administration, respectively. In both cases, regional anaesthesia of the sciatic nerve improved the intraoperative management of alpacas that required surgical treatment for fractures.

Treatment options, complications and long-term outcomes for limb fractures in pet rabbits.

Limb fractures represent the most common orthopaedic disease in pet rabbits. However, only a few studies have evaluated therapeutic details of limb fractures. There are no data available for long-term outcomes of limb fracture treatment. The medical records of six institutions were reviewed retrospectively to identify cases of traumatic limb bone fractures in pet rabbits between 1999 and 2020. The medical records (n = 387) were analysed for details of fracture prevalence, aetiology, therapy protocols, treatment complications, outcome and long-term effects. In addition to the retrospective data evaluation, 13 rabbits were re-evaluated in person in recent clinical analyses, including orthopaedic examination, radiography and computed-tomographic imaging. Details of long-term effects of fracture treatment were requested over the telephone for a further 232 animals using a standardised questionnaire. Long bone fractures accounted for the majority of all fractures (296/387; 76.5%). Hindlimb fractures (301/387; 77.7%) were more common than forelimb fractures (86/387; 22.2%), and tibial fractures and combined fractures of the tibia and fibula (119/387; 30.8%) were observed most frequently. Most fracture treatments were based on osteosynthesis procedures (243/328; 74.1%). Treatment complications occurred in 130 out of 328 (39.6%) cases. A high bodyweight (p = 0.047) and an older age (p = 0.01) were found to be significant risk factors for the emergence of therapy complications. Overall, 75.4% of animals (175/232) had a satisfactory long-term outcome. Limb posture anomalies were evaluated in 61 cases (26.3%). The multi-centre approach led to the inclusion of various institutions, veterinarians, treatment protocols and rabbit populations that might have influenced the results. The medical records were reviewed retrospectively, so there were some data that were lacking or could not be collected in a standardised manner. Furthermore, rabbit owners' evaluation of long-term outcomes might be prone to error, despite the use of a standardised interview questionnaire. Limb fractures are a common orthopaedic issue in pet rabbits. The patient's bodyweight and age are significant risk factors for the emergence of complications during the fracture treatment process. Long-term orthopaedic effects, such as abnormal limb posture and permanent lameness of the affected limb, were observed regularly.

Suspected local anaesthetic systemic toxicity (LAST) after several bupivacaine injections through an epidural catheter in a cat

AbstractA 9‐year‐old male neutered domestic short hair cat was referred to our practice after a road traffic accident. On presentation, the cat was obtunded, with bilateral hindlimb fractures. The fractures were surgically repaired, and an epidural catheter was placed for perioperative pain management. Postoperative analgesia consisted of bupivacaine administered intermittently through the epidural catheter. In the days after surgery, the cat became duller and more obtunded, and marked bilateral mydriasis with absence of a pupillary reflex was noted. After ruling out different causes for mydriasis and weaning the cat from systemic opioids, local anaesthetic systemic toxicity (LAST) emerged the primary differential diagnosis. Bupivacaine plasma concentrations were measured and found a fourfold increase in concentration over that reported after a perineural block. Mydriasis and absent pupillary light reflex, among other clinical signs, could be early indicators of LAST secondary to accumulation of the local anaesthetic in patients with an epidural catheter.

Dimethyl Fumarate Reduces Oxidative Stress and Pronociceptive Immune Responses in a Murine Model of Complex Regional Pain Syndrome.

Complex regional pain syndrome (CRPS) is a highly disabling cause of pain often precipitated by surgery or trauma to a limb. Both innate and adaptive immunological changes contribute to this syndrome. Dimethyl fumarate (DMF) works through the nuclear factor erythroid 2-related factor 2 (Nrf2) transcription factor and other targets to activate antioxidant systems and to suppress immune system activation. We hypothesized that DMF would reduce nociceptive, functional, and immunological changes measured in a model of CRPS. Male C57BL/6 mice were used in the well-characterized tibial fracture model of CRPS. Some groups of mice received DMF 25 mg/kg/d orally, per os for 3 weeks after fracture versus vehicle alone. Homozygous Nrf2 null mutant mice were used as test subjects to address the need for this transcription factor for DMF activity. Allodynia was assessed using von Frey filaments and hindlimb weight-bearing data were collected. The markers of oxidative stress malondialdehyde (MDA) and 4-hydroxynonenal (4-HNE) were quantified in the skin of the fractured mice using immunoassays along with the innate immune system cytokines IL-1β and IL-6. The accumulation of IgM in the fractured limbs and lymph node hypertrophy were used as indexes of adaptive immune system activation, and the passive transfer of serum from wildtype fractured mice to B cell-deficient fractured muMT mice (mice lacking B cells and immunoglobulin) helped to assess the pronociceptive activity of humoral factors. We observed that oral DMF administration strongly prevented nociceptive sensitization and reduced uneven hindlimb weight bearing after fracture. DMF was also very effective in reducing the accumulation of markers of oxidative stress, activation of innate immune mediator production, lymph node hypertrophy, and the accumulation of IgM in fractured limbs. The sera of fractured vehicle-treated but not DMF-treated mice conferred pronociceptive activity to recipient mice. Unexpectedly, the effects of DMF were largely unchanged in the Nrf2 null mutant mice. Oxidative stress and immune system activation are robust after hindlimb fracture in mice. DMF strongly reduces activation of those systems, and the Nrf2 transcription factor is not required. DMF or drugs working through similar mechanisms might provide effective therapy for CRPS or other conditions where oxidative stress causes immune system activation.

Comparative pattern of fracture in different animals

Incidence of bone fracture is very common in both medical and veterinary profession. There is lots of fracture management techniques applied for bone fracture. A total of 6163 clinical cases were recorded from May, 2017 to April, 2018 at the Sahidul Alam Quadery Teaching Veterinary Hospital (SAQTVH), CVASU. The objectives of the study were to find out the incidence of fracture in dogs, cats, goats and cattle and parameters were also studied for fracture occurrence in breed, age, sex and different nature and causes of fractures. A total of 6163 cases were recorded out of which 829 were surgical cases and 85 were fracture cases (dog-20, cat-19, goat-36 and cattle-10). The overall incidence of fracture was recorded as1.38% for all four species (dogs, cats, goat and cattle) of animals and 10.25% for all surgical cases of animals. Goat was the most common (42.35%) species to have a fracture among four species. Local breeds were more susceptible for fracture in dog, cat and cattle but jamunapari breeds were common in goats. Overall males were more prone for fracture and age less than six months old were also more vulnerable for fracture among four species. Closed unilateral hind limb fractures were more in all cases. Among different bones, femur fracture was the most common in dogs and cats but metacarpal bone was more common in goat and tibial bone in cattle and most of the fractures were oblique in nature. Falling from height (34.11%) was the major cause of fracture comparison to other causes but according to four species, automobile accident was common cause of fracture in dogs.

Arterial branching pattern of the rabbit femoral artery.

Rabbits have highly developed hindlimb muscles, whereas their bones are fragile, thus resulting in frequent hindlimb fractures. To repair these fractures, it is important to understand the arterial branching pattern of the femoral artery, as it provides the main blood supply to the hindlimb. Since the descriptions from prior studies are insufficient, the aim of the present study was to determine the detailed arterial branching pattern of the rabbit femoral artery. Therefore, to address this issue, we examined 30 male and 20 female New Zealand White rabbits after colored latex injections into the femoral artery. Results showed that the femoral artery gave rise to the pudendoepigastric trunk, along with the deep femoral, lateral circumflex femoral, superficial caudal epigastric, saphenous, descending genicular, and proximal and middle caudal femoral arteries, in conjunction with frequent individual variations. In all the observed halves, the last branch from the femoral artery was the distal caudal femoral artery. Individual variations in the branching pattern of these arteries occurred independently in the proximal and the distal portions of the femoral artery, and they were, respectively, categorized into four and three major types based on the number of the branching levels along the proximodistal axis of the femoral artery. The individual variations in the arterial branching pattern of the rabbit femoral artery that were demonstrated in the present study may provide an important anatomical basis for refining the orthopedic surgical procedure in the rabbit.

Comparative occurrence pattern of fractures in cattle and buffaloes

Background and Aim:Dairy animals play an important role in the Indian economy. Knowledge of the occurrence pattern of long bone fractures in bovine may help in strategizing the possibilities of treatment and prognosis. This study aimed to find out the comparative occurrence pattern of fractures in cattle and buffaloes.Materials and Methods:A total of 278 fractures of bovine (171 in cattle and 107 in buffaloes), presented to the Department of Veterinary Surgery and Radiology, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab, India, during a study of 1 year, were investigated for the occurrence pattern, in relation to species, age, body weight, gender, bone involved, type of fracture (closed or open), and the presentation of bovine as standing or in recumbent state.Results:The overall hospital occurrence of fractures in bovine was 4.24% and most of the fractures resulted from slipping and falling on hard floor. Of 278 fractures, the majority (90.28%) involved long bones (n=251; 103 buffaloes and 148 cattle). Forelimb fractures were recorded more common in buffaloes (64.08%), whereas the cattle suffered more of hind limb fractures (60.23%). Cattle also included 11 cases of bilateral fractures of metacarpal (n=3), tibia (n=1), radius and ulna (n=1), and mandible (n=6). Fracture of olecranon constituted 6.83% (n=19) and majority (n=15) were in buffaloes. The cattle had higher percent of open fractures (54.38%) as compared to that in buffaloes (17.76%). Marginally higher percentage of cattle (33.33%) suffering from fracture were recumbent as compared to buffaloes (23.36%) and femur fractures were found to be a leading cause of recumbency (100% in cattle and 75.00% in buffaloes).Conclusion:Species-specific differences in the occurrence pattern of fractures exist among cattle and buffaloes. Cattle are found to be more susceptible (1.5 times) to fractures as compared to buffaloes. The buffaloes are vulnerable to forelimb fractures while the cattle to the hind limb. As compared to forelimb, long bone fractures of hind limb are more commonly associated with recumbency in bovine. Cattle are more prone to mandible fractures and the open fractures of long bones as compared to buffaloes.

Comparison of Different Internal Implants for Repair of Hind Limb Fracture

Bone fracture is termed as any discontinuity in the integrity of bone structure. Basic principal of treatment of fracture include reduction and retention. Modern age has developed number of methods to treat fracture; one of them is usage of Compression plate that are held in place with the help of screws. Limited Contact Dynamic Compression Plate (LC-DCP) is the new version of Dynamic Compression Plate (DCP) and is better than DCP in terms of providing aid in early healing, playing its role as providing low degree of plate-bone contact and decreased incidence of porosity and better vascularization, which reduces healing time and optimizes callus formation, leading to early healing and return of limb function.

Catestatin, vasostatin, cortisol, and pain assessments in dogs suffering from traumatic bone fractures

BackgroundTraumatic bone fractures cause moderate to severe pain, which needs to be minimized for optimal recovery and animal welfare, illustrating the need for reliable objective pain biomarkers for use in a clinical setting. The objectives of this study were to investigate catestatin (CST) and vasostatin (VS) concentrations as two new potential biomarkers, and cortisol concentrations, scores of the short form of the Glasgow composite measure pain scale (CMPS-SF), and visual analog scale (VAS) in dogs suffering from traumatic bone fractures before and after morphine administration in comparison with healthy dogs.MethodsFourteen dogs with hind limb or pelvic fractures and thirty healthy dogs were included. Dogs with fractures were divided into four groups according to analgesia received before participation. Physical examination, CMPS-SF, pain and stress behavior VAS scores were recorded in all dogs. Saliva and blood were collected once in healthy dogs and in dogs with fractures before and 35–70 min after morphine administration. Blood samples were analyzed for CST, VS, and cortisol. Saliva volumes, however, were insufficient for analysis.ResultsCatestatin and cortisol concentrations, and CMPS-SF, and VAS scores differed significantly between dogs with fractures prior to morphine administration and healthy dogs. After morphine administration, dogs with fractures had significantly decreased CMPS-SF and VAS scores and, compared to healthy dogs, CST concentrations, CMPS-SF, and VAS scores still differed significantly. However, CST concentrations remained largely within the normal range. Absolute delta values for CST significantly correlated with delta values for CMPS-SF. Catestatin and cortisol did not differ significantly before and after morphine administration. Vasostatin concentrations did not differ significantly between groups.ConclusionsCatestatin and cortisol concentrations, CMPS-SF, and VAS scores differed significantly in the dogs with traumatic bone fractures compared to the healthy dogs. Morphine treatment partially relieved pain and stress according to the subjective but not according to the objective assessments performed. However, because of the large degree of overlap with normal values, our results suggest that plasma CST concentrations have a limited potential as a clinically useful biomarker for pain-induced stress.

Síndrome da queda de grande altura em gatos: 43 casos atendidos no município do Rio de Janeiro

This study was done in a private veterinary clinic, specialized in cats in Botafogo, Rio de Janeiro.&nbsp;We evaluated 43 cats diagnosed with high-rise syndrome from January 2010 to December 2012. The cats&nbsp;fell from the 2nd to the 12th floor. The average age of the cats was 2 years and 9 months and the average&nbsp;height of the fall was 4.6 meters. From the diagnosed cats 72.42% were mixed-breed and 60.47% were&nbsp;male. The falls happened at any time of the day and, although it was not statistically significant, they&nbsp;happened more frequently during the weekends when compared to the weekdays. The falls occurred&nbsp;in similar proportion throughout the year not being noticed a seasonal incidence as it happens in&nbsp;temperate climates. In 86.05% of the cases, the falls happened from homes where none of the windows had screens. And 13.95% of the falls happened from homes where all the windows had screens. The falls&nbsp;occurred from heights equivalent to up to the 6th floor in 35/43 of the cases and only 8/43 falls occurred&nbsp;from height equivalent to the 7th floor on. 41.86% of the cats had forelimb fractures; 30.23% had hindlimb&nbsp;fracture; 4.65% had forelimb and hindlimb luxation each; 2.33% had spine fracture and 9.30% had&nbsp;spine luxation; 4.65% had pelvic fracture; 6.98% had fracture of the symphysis; 6.98% had fracture of&nbsp;the mandible; 9.30% had luxation of the temporomandibular joint; 18.60% had hard palate fractures;&nbsp;11.62% had tongue injury and 44.18% had facial injury. It was also observed epistaxis in 22.58% of the&nbsp;cases; shock in 6.97%; hypothermia in 11.62%; hypotension in 4.65%; dyspnea in 18.6%; thoracic trauma&nbsp;in 41.86%, being 38.88% pneumothorax and 61.11% pulmonary contusion. It was also diagnosed visceral&nbsp;injury in 6.98% of the cases. From the 43 diagnosed cats, 51.16 had emergency treatment and 44.19% had&nbsp;non-emergency treatment. Six cats died. From these six, two (4.65% arrived dead. We can conclude that&nbsp;young cats are more liable to the risk of falling and the falls can occur at any time. As we live in a tropical&nbsp;climate where the temperatures don´t vary much throughout the year, a seasonal incidence is not related&nbsp;to the falls. In high-rise syndrome fractures and facial injury are frequently noticed, however, we must be&nbsp;aware to identify pulmonary trauma because when they are not properly treated, they can be the cause&nbsp;of death as well as visceral injury.

The equine fracture patient

42 September/October 2015 • equine HealtH © 2 01 5 M A H ea lth ca re L td N ot so long ago, if a horse fractured a limb the most likely veterinary recommendation would be euthanasia on humane grounds. However, advances in veterinary medicine over the past three decades new, improved anaesthesia drugs and enhanced surgical techniques, mean that many equines are spared this fate. Horses do not cope well on three legs. The inability to use the fractured limb combined with the associated pain, can cause considerable anxiety. Frantic attempts to use the affected leg to right himself or balance can cause the horse to exacerbate the fracture beyond repair; the stabilisation of the limb is therefore, of paramount importance. Proper splinting and transportation of the patient significantly improves the outcome. In some cases it may literally be a case of life and death. Sedation may be necessary to splint or cast the injured limb and care should be taken with the dose, as too much may result in the horse becoming unsteady on his feet. If the fracture is open or likely to be surgically repaired, antibacterial treatment should be commenced. NSAIDs should also be administered to help control pain and reduce inflammation. When travelling a horse with a forelimb fracture, it is recommended to travel him facing backwards in the trailer so that he can use his hind end to brace when the vehicle is slowing down, conversely a horse with a fractured hindlimb should be travelled facing forwards. If possible, unload hindlimb fractures forwards and forelimb fractures backwards to allow the horse to navigate the trailer ramp safely.

Retrospective study on fractures in dogs

Patients referred to the Veterinary Medical Center at Chungbuk National University were analyzed. This study aimed to provide information to clinicians in Korea on the factors affecting fracture incidence in patients adapted to Korean companion animal culture. Eighty cases showingbone fractures were investigated from January, 2005 to December, 2011. Fractures were mainly observed in miniature dogs such as Yorkshire terrier (12%), Poodle (12%), and Maltese (9%). Almost 50% of all cases were less than 1 year old. Total bone fractures in summer and fall constituted 62%. Fracture incidence was higher in male dogs (54%) than female dogs (46%). Hindlimb fracture (37%) was the most common. Distribution of limb fractures was higher in the femur (19), followed by the tibia/fibula (15), radius/ulna (13), humerus (11), and mandible (8). Pelvic fracture was observed in 19 cases. Simple fracture (84%) was the most common fracture type, followed by comminuted fracture (16%). Distal portion was the most common fracture site in long bones (67%), followed by middle (26%) and proximal bones (7%). Fractures were mainly caused by traffic accidents (43%), whereas 28.5% of fractures were due to falling down. Plate & screw (26%) was the most common method of fracture repair, followed by intramedullary pin (24%), wire (11%), external skeletal fixation (10%), screw (9%), amputation (7%), cross pin (6%), IM pin and wire (5%), and rush pin (1%). Among 80 patients, 79%of patients showed a good prognosis after surgery, whereas 13% patients did not experience a good result. This study shows that miniature dogs are prone to falling and fractures, especially in the distal part of long bones.

Mast Cells

Mast Cells

Evaluation of a fracture pain model in domestic pigeons (Columba livia)

To validate a model of postfracture pain in perching birds. 21 adult domestic pigeons (Columba livia). In each bird, a standardized osteotomy of 1 femur was performed and the fracture was immobilized with an intramedullary pin. Degree of postoperative pain was evaluated 6 times/d for 4 days by use of 3 methods: an electronic perch for assessment of weight-bearing load differential of the pelvic limbs, 4 numeric rating pain scales for assessment of pain (all of which involved the observer in the same room as the bird), and analysis of video-recorded (observer absent) partial ethograms for bird activity and posture. Measurements obtained were compared with data collected before the surgery to evaluate the ability of these methods to detect pain. The weight-bearing load differential was a sensitive, specific, reliable, and indirect measure of fracture-associated pain in the model used. Two of 4 tested pain scales (fractured limb position and subjective evaluation of degree of pain) were sensitive and specific for detecting pain and were reliable in a research setting. Interobserver reliability of the 4 pain scales was excellent. Partial ethograms were sensitive for identifying pain-associated behavior in pigeons, particularly during the first 2 days after surgery. The fracture pain model was reliable and reproducible and may be useful for experimental studies involving postsurgical pain in pigeons. Weight-bearing load differential was the most sensitive and specific means of determining degree of pain in pigeons during the first 4 days after hind limb fracture induction.

Novel Prion Protein in BSE-affected Cattle, Switzerland

Novel Prion Protein in BSE-affected Cattle, Switzerland

Management and outcome of fractures of the distal phalanx: A retrospective study of 285 horses with a long term outcome in 223 cases

A multicentre study of 285 cases was performed to enhance the management of distal phalangeal fractures on the basis of clinical evidence. The outcome after treatment was available for 223 of the cases. Horses with a non-articular type I fracture had a better prognosis (91.7%) for return to original or expected level of use than horses with an articular type II or III fracture (69.6% and 74.1%, respectively). The prognosis for types IV and V fractures was fair (57.7% and 57.1%, respectively) and for type VI good (80%). Horses with a hindlimb fracture had a significantly greater chance of a successful outcome. No significant association between age or time to start treatment and success rate was noted. The best treatment option for types I-III fractures was a conservative approach (box rest). Type IV fractures were best treated by arthroscopic removal of the fragment. Immobilisation of the hoof did not seem to influence outcome. Radiological findings and clinical healing were not accurately correlated and the re-commencement of training should be based on clinical rather than radiological findings. Complete osseous union of the fracture was not essential for a successful return to athletic activity.

Associations between physiotherapy findings and subsequent diagnosis of pelvic or hindlimb fracture in racing Thoroughbreds

Physiotherapists who work in racehorse training yards routinely treat horses' backs and hindquarters and may be able to recognise signs that indicate the presence of (impending) pelvic or hindlimb fracture before it becomes catastrophic. To establish whether physiotherapy assessment findings in Thoroughbred racehorses referred for routine physiotherapy could be predictive of subsequent (within 30 days) pelvic or hindlimb fracture diagnosis. Retrospective veterinary and physiotherapy data from a cohort of Newmarket (UK) Thoroughbred racehorses, were used. A case-control study compared physiotherapy assessment findings of racehorses with and without a subsequently diagnosed pelvic or hindlimb fracture. Uni- and multivariable logistic regression was used to investigate and quantify the strength of association between physiotherapy findings and subsequent fracture diagnosis. Statistical significance was set at P<0.05. A total of 513 horses provided 14 fracture cases for analysis. Presence of pelvic bony asymmetry, muscle atrophy of the quarters, reduced reflex movements of dorsi- and/or ventroflexion and spasm or tenderness on palpation of the gluteal muscles were significantly associated with subsequent fracture diagnosis in univariable analysis. Multivariable analysis indicated that horses subsequently diagnosed with pelvic or hindlimb fracture were 11.1 times more likely to show pelvic bony asymmetry, 4.7 times more likely to display muscle atrophy of the quarters and 6.6 times more likely to have spasm or tenderness on palpation of the gluteal muscles than those that were not. Racehorses presented for physiotherapy that show pelvic bony asymmetry, muscle atrophy of the quarters and/or spasm or tenderness on palpation of the gluteal muscles should alert the physiotherapist to the potential presence of (impending) pelvic or hindlimb fracture. Earlier detection of (impending) pelvic or hindlimb fracture in racing Thoroughbreds could reduce the incidence of catastrophic fractures.