Minimally invasive plate fixation of lower limb injury in horses: 32 cases (1999-2003)

Incidence of surgical site infection after internal fixation of the first phalangeal bone and the third metacarpal/metatarsal bone fractures in Thoroughbred racehorses

Surgical site infection (SSI) is one of the major complications of equine fracture surgery. The purpose of this study was to investigate the incidence of and risk factors for SSI after internal fixation of the first phalangeal bone (P1) and the third metacarpal/metatarsal bone (MC3/MT3) fractures in Thoroughbred racehorses. Between 2011 and 2020, 451 cases underwent surgery with screws or a locking compression plate (LCP) for sagittal fractures of P1 or condylar fractures of MC3/MT3. Overall, 2.9% (13/451) of the cases developed an SSI. The incidence was significantly higher in plate fixation (21.4%) than in screw fixation (2.3%). There was no significant association with other variables, such as sex, age, number of screws, experience of surgeon, or prophylactic antimicrobials. The median duration of hospitalization for screw fixation was 14 days without an SSI and 20 days with an SSI, and those for plate fixation were 26 and 25-88 days, respectively, indicating that the development of SSI prolongs the duration of hospitalization. On the other hand, there were no significant differences in discharge and race resumption rates between cases with and without an SSI. These data indicate that the incidence of SSI in this study was low and that it was higher following plate fixation than screw fixation.

Proximal Interphalangeal Arthrodesis in Horses: A Meta-Analysis of Retrospective Studies

The aim of this study was to determine the clinical outcomes reported in retrospective studies of proximal interphalangeal arthrodesis (PIA) in horses through a meta-analysis of retrospective studies. CAB Abstracts, PubMed, ScienceDirect, Web of Science, and Scopus were searched. The primary outcomes included survival and surgical site infection (SSI) rates, return to activities, and time of hospital stay and casting. Subgroups were formed for fractures and other conditions. Meta-analyses were performed with fixed and random effects models to estimate proportions, mean values, and effect size by odds ratio (OR) with 95% confidence intervals (CI). Twenty-one full articles were included, totaling 458 horses. The survival rate was 90% (95% CI [86%-93%]), return to activities was 65% (95% CI [61%-70%]), and SSI was 12% (95% CI [8%-16%]). The mean hospitalization was 25 days (95% CI [18-35 days]) and time of casting was 29 days (95% CI [21-42 days]). The OR of survival (P = .769), return to activities (P = .576), and SSI (P = .467) were similar between cases of fractures and other conditions. PIA is an efficient and safe method to treat injuries in the pastern region, with a high survival rate and low SSI. However, the rate of return to soundness for intended use was modest, being potentially lower for fracture cases. Thus, investigations of more efficient interventions are needed to improve this outcome.

The Comparison of Latero-Medial versus Dorso-Palmar/Plantar Drilling for Cartilage Removal in the Proximal Interphalangeal Joint

The aims of the present study were to compare the percentages of articular cartilage removed using a lateral drilling approach of the proximal interphalangeal joint (PIPJ) and a dorsal drilling approach, and to assess the usefulness of digital fluoroscopy when performing a lateral drilling approach. Sixty cadaveric PIPJs were drilled using a surgical drill bit to remove the articular cartilage. The limbs were divided into three groups containing 10 forelimbs and 10 hindlimbs each. One group received the dorsal drilling approach, the second one received the lateral drilling approach and the last one received the lateral drilling approach under digital fluoroscopy guidance. The percentage of articular cartilage removed from each articular surface was assessed using Adobe Photoshop ^® software. The percentages of removed cartilage turned out to be significantly higher with lateral approach, especially under fluoroscopic guidance, both in the forelimbs (p = 0.00712) and hindlimbs (p = 0.00962). In conclusion, the lateral drilling approach seems to be a minimally invasive technique with which to perform PIPJ arthrodesis, even more efficient than the previously reported dorsal approach.

Toll-like receptor activation of equine mesenchymal stromal cells to enhance antibacterial activity and immunomodulatory cytokine secretion

OBJECTIVE

To evaluate effects of Toll-like and nucleotide-binding oligomerization domain (NOD)-like receptor (TLR, NLR) ligand stimulation of equine mesenchymal stromal cells (MSCs) on antibacterial and immunomodulatory properties in vitro.

STUDY DESIGN

Controlled laboratory study.

SAMPLE POPULATION

Equine bone-marrow-derived MSCs (three horses).

METHODS

MSCs were stimulated with TLR (polyinosinic:polycytidylic acid [pIC] and lipopolysaccharide [LPS]) and NLR agonists (γ-d-Glu-mDAP [IE-DAP]) for 2 h, and plated at 1 × 10⁵ cells/well 24 h. MSC-conditioned media (MSC-CM) were collected and assessed for antimicrobial peptide cathelicidin/LL-37 production, bactericidal action against multidrug-resistant planktonic and biofilm Staphylococcus aureus and neutrophil phagocytosis. Bacterial growth was measured by plating bacteria and counting viable colonies, reading culture absorbance, and live-dead staining with confocal microscopy imaging. Following initial comparison of activating stimuli, TLR3-agonist pIC protocols (cell density during activation and plating, culture time, %serum) were further optimized for bactericidal activity and secretion of interleukin-8 (IL-8), monocyte-chemoattractant-protein (MCP-1), and cathelicidin/LL37.

RESULTS

MSCs stimulation with pIC (p = .004) and IE-DAP (p = .03) promoted increased bactericidal activity, evidenced by reduced viable planktonic colony counts. PIC stimulation (2 × 10⁶ cells/ml, 2 h, 10 μg/ml) further suppressed biofilm formation (p = .001), enhanced neutrophil bacterial phagocytosis (p = .009), increased MCP-1 secretion (p < .0001), and enhanced cathelicidin/LL-37 production, which was apparent when serum concentration in media was reduced to 1% (p = .01) and 2.5% (p = .05).

CONCLUSION

TLR-3 pIC MSCs activation was most effective to enhance antibacterial and cytokine responses, which were affected by serum reduction.

CLINICAL SIGNIFICANCE

In vitro TLR-3 activation of equine MSCs tested here may be a strategy to improve antibacterial properties of MSCs to treat antibiotic-resistant infections.

Regenerative Medicine for Equine Musculoskeletal Diseases

Simple Summary

Lameness due to musculoskeletal disease is the most common diagnosis in equine veterinary practice. Many of these orthopaedic disorders are chronic problems, for which no clinically satisfactory treatment exists. Thus, high hopes are pinned on regenerative medicine, which aims to replace or regenerate cells, tissues, or organs to restore or establish normal function. Some regenerative medicine therapies have already made their way into equine clinical practice mainly to treat tendon injures, tendinopathies, cartilage injuries and degenerative joint disorders with promising but diverse results. This review summarises the current knowledge of commonly used regenerative medicine treatments and critically discusses their use.

Abstract

Musculoskeletal injuries and chronic degenerative diseases commonly affect both athletic and sedentary horses and can entail the end of their athletic careers. The ensuing repair processes frequently do not yield fully functional regeneration of the injured tissues but biomechanically inferior scar or replacement tissue, causing high reinjury rates, degenerative disease progression and chronic morbidity. Regenerative medicine is an emerging, rapidly evolving branch of translational medicine that aims to replace or regenerate cells, tissues, or organs to restore or establish normal function. It includes tissue engineering but also cell-based and cell-free stimulation of endogenous self-repair mechanisms. Some regenerative medicine therapies have made their way into equine clinical practice mainly to treat tendon injures, tendinopathies, cartilage injuries and degenerative joint disorders with promising results. However, the qualitative and quantitative spatiotemporal requirements for specific bioactive factors to trigger tissue regeneration in the injury response are still unknown, and consequently, therapeutic approaches and treatment results are diverse. To exploit the full potential of this burgeoning field of medicine, further research will be required and is ongoing. This review summarises the current knowledge of commonly used regenerative medicine treatments in equine patients and critically discusses their use.

Comparison of a 3-hole 4.5-mm Dynamic Compression Plate and a 7-hole 5.5-mm Y Locking Compression Plate for Arthrodesis of the Proximal Interphalangeal Joint in Horses-an Ex Vivo Biomechanical Study

The objective of this study was to compare the biomechanical properties in a single cycle axial loading test and the types of failures in two constructs (a 3-hole 4.5-mm dynamic compression plate (DCP) and 7-hole 5.5-mm Y locking compression plate (Y-LCP)) in equine proximal interphalangeal joint (PIJ) arthrodesis. One limb in each pair was randomly assigned to PIJ arthrodesis using a 3-hole 4.5-mm DCP combined with two transarticular 5.5-mm cortical screws, whereas the contralateral limb was submitted to PIJ arthrodesis using a 7-hole Y-shaped 5.0-mm LCP in conjunction with one transarticular 4.5-mm cortical screw inserted through the central plate hole. Cortical screws were inserted in lag fashion. Constructs were submitted to a single axial load cycle to failure. Construct stiffness, load, and deformation were analyzed. Dynamic compression plate and Y-LCP arthrodesis constructs did not differ significantly and were equally resistant to axial loading under the conditions studied (DCP and Y-LCP group stiffness, 5685.22 N/mm and 6591.10 N/mm, respectively). Arthrodesis of the PIJ using a DCP and two transarticular 5.5-mm cortical screws or a Y-LCP yielded biomechanically equivalent outcomes under the test conditions considered. However, Y-LCP provides less impact in the palmar/plantar bone. Application of Y-LCP with unicortical screws has equivalent biomechanical characteristics of DCP and may be a safe option for PIJ arthrodesis, where potential trauma secondary to applying bicortical screws in the palmar/plantar aspect of the pastern can be avoided.

Racing performance after surgical repair of medial condylar fracture of the third metacarpal/metatarsal bone in thoroughbred racehorses

OBJECTIVE

To report the performance of thoroughbred racehorses after surgical repair of a medial condylar fracture of the third metacarpal/metatarsal bone.

STUDY DESIGN

Retrospective cohort study.

SAMPLE POPULATION

Forty-three horses surgically treated for medial condylar fractures, 30 with previous racing experience, 13 without previous racing experience (nonexperienced).

METHODS

Medical records (2009-2017) were reviewed for signalment, radiographic fracture characteristics, repair technique, and postoperative morbidity and mortality. Each experienced horse was matched with two horses randomly selected from its most recent race to serve as healthy controls. Racing performance parameters (race rating, competitive level, speed rating, performance index) and career racing statistics were compared with multiple regression models between injured experienced horses and controls. The career racing statistics for nonexperienced horses were evaluated. Reasons for nonreturn to racing were obtained.

RESULTS

The median duration of follow-up was 6 years (minimum 2, maximum 10). Twenty-one of 43 (49%) horses raced again as well as 18 of 30 (60%) experienced horses and three of 13 (23%) nonexperienced horses. Experienced horses were five times more likely than nonexperienced horses to return to racing (95% confidence interval = 0.07-0.58, P = .003). Higher preoperative racing performance parameters were associated with return to racing. Racing performance parameters were lower after the date of fracture in injured horses compared with controls.

CONCLUSION

Experienced horses were more likely to return to racing after medial condylar fracture repair, although their performance was generally lower than that of comparably uninjured horses.

CLINICAL SIGNIFICANCE

Owners should be aware that horses with medial condylar fractures likely will race at a lower level than their uninjured peers.

Ex vivo study of minimally invasive procedures for cartilage removal from the metacarpophalangeal or metatarsophalangeal joint and for fetlock tension band application

OBJECTIVE

To describe reliable minimally invasive procedures for (1) removing cartilage by joint distraction and articular drilling for equine metacarpophalangeal (MCP)/metatarsophalangeal (MTP) arthrodesis; (2) applying a palmar/plantar tension band without MCP/MTP joint luxation.

STUDY DESIGN

Experimental study.

SAMPLE POPULATION

Cadaveric equine limbs (n = 12).

METHODS

All limbs were used to evaluate the drilling technique. First the MCP/MTP joint was distracted with a 5.5-mm cortical screw. Then, through four stab incisions, articular cartilage was removed with a 4.5-mm drill. Six randomly chosen limbs were then tested for minimally invasive tension band application with a specially designed cannula. Accurate positioning of the tension band was assessed radiographically. All MCP/MTP joints were disarticulated, and the areas of removed cartilage were visually assessed and measured by using planimetry.

RESULTS

The mean percentage of removed cartilage was 66.8% ± 7.6% for the metacarpus/metatarsus surface, 67.9% ± 8.6% for the proximal phalanx surface, and 59.5% ± 1% for the two sesamoid bones. The tension band could be accurately placed through four stab incisions with the cannula.

CONCLUSION

This minimally invasive technique for cartilage removal was efficient and should be favorable for joint fusion in some clinical situations. The minimally invasive tension band application through stab incisions was feasible and repeatable.

CLINICAL SIGNIFICANCE

These procedures should allow total minimally invasive MCP/MTP arthrodesis and be used in selected clinical cases.

Percutaneous Plate Arthrodesis

Arthrodesis is an elective surgical procedure that aims at eliminating pain and dysfunction by promoting deliberate osseous fusion of the involved joint(s). Percutaneous plating can be used to perform carpal and tarsal arthrodeses in dogs and cats. After cartilage debridement is performed, the plate is introduced through separate plate insertion incisions made remote to the arthrodesis site and advanced along an epiperiosteal tunnel, and screws are inserted through the 3 existing skin incisions. The primary advantage of this technique is a decreased risk of soft-tissue complications, including postoperative swelling, ischemia, and wound dehiscence. Preliminary clinical results have been promising.

Arthrodesis of the metacarpophalangeal and metatarsophalangeal joints to treat osteoarthritis in 17 horses

OBJECTIVE

To describe arthrodesis of the metacarpophalangeal (MCP) or metatarsophalangeal (MTP) joint with a locking compression plate (LCP) and a metallic tension band and report the outcome of horses treated for osteoarthritis (OA) with this technique.

STUDY DESIGN

Retrospective case series.

ANIMALS

Seventeen horses with OA of the MCP or MTP joint treated with arthrodesis.

METHODS

Medical records (2004-2017) of horses treated for OA with arthrodesis of the MCP or MTP joint with an LCP and metallic tension band were reviewed. Preoperative variables included age, sex, breed, affected limb, and lameness grade. Surgical variables included implants used, surgery time, postoperative angle of joint, intraoperative complications, and anesthetic recovery method. Outcome was obtained from medical records and phone interviews.

RESULTS

Lameness was scored as 4 out of 5 (range, 2-4) in 13 of 17 horses. All horses survived to discharge and were alive >6 months postoperatively, without any report of long-term complications. All horses were allowed unrestricted turnout, and 1 horse was lightly ridden. No postoperative infections or implant failures were reported. The only complications consisted of cast sores (n = 4).

CONCLUSION

Arthrodesis of the MCP/MTP joint was associated with acceptable morbidity and good long-term outcomes in these 17 horses with OA refractory to medical management.

CLINICAL SIGNIFICANCE

The morbidity and prognosis after fetlock arthrodesis for OA seem more favorable than reported in horses treated with traumatic disruption of the suspensory apparatus.

Surgical site infection associated with equine orthopedic internal fixation: 155 cases (2008-2016)

OBJECTIVE

To determine the prevalence of surgical site infection (SSI) after internal fixation and to identify risk factors for SSI and nonsurvival.

STUDY DESIGN

Retrospective study.

ANIMALS

One hundred fifty-five horses with long bone fractures or arthrodesis treated by internal fixation at 1 hospital between 2008-2016.

METHODS

Signalment, diagnosis, surgical repair, surgeon, surgical time, antimicrobial use, SSI onset, bacterial identification, and adjunct treatments were recorded. Perioperative variables were analyzed to identify risk factors associated with outcomes.

RESULTS

Surgical-site infection was reported in 22 of 155 (14.2%) horses, which is lower than what has been previously reported (P = .003). Horses with fetlock arthrodesis or ulnar fracture were more likely to develop SSI. Local prophylactic antimicrobial therapy was associated with an increased risk of SSI. Horses with SSI were 12 times (P < .0001) less likely to survive to discharge than horses without SSI. Horses with a fetlock or carpal arthrodesis or those with radial/humeral/femoral fractures were less likely to survive. No association was identified between open fractures, open reduction and internal fixation, or surgical times and SSI.

CONCLUSION

The prevalence of SSI in this population was lower than what has been previously reported. Horses with fetlock or carpal arthrodesis or radial/humeral/femoral fractures were at increased risk for SSI and/or nonsurvival to discharge. A protective role of local antimicrobial therapy for SSI could not be established.

CLINICAL RELEVANCE

The impact of SSI on outcomes of cases of equine internal fixation remains substantial. Identification of cases at higher risk of SSI should influence surgical technique, postoperative management, and early intervention when SSI is suspected. Additional investigation is warranted regarding local antimicrobial therapy.

Surgical repair of propagating condylar fractures of the third metacarpal/metatarsal bones with cortical screws placed in lag fashion in 26 racehorses (2007-2015)

BACKGROUND

Despite the recommendation of plate fixation for propagating condylar fractures of the third metacarpal (McIII) or third metatarsal bone (MtIII), lag screw fixation can be a viable surgical option.

OBJECTIVES

To evaluate short-term outcome and long-term racing performance of horses that underwent lag screw fixation of long condylar fractures of the McIII/MtIII.

STUDY DESIGN

Retrospective case series.

METHODS

Medical records, post-surgical racing performance and outcome of 26 horses with propagating fractures of the medial and/or lateral condyle of McIII/MtIII were reviewed. Medical information included were age, breed, sex, physical examination at admission, circumstances of fracture, radiographic evaluation, anaesthesia and recovery records, surgical and post-operative management, as well as complications. Outcome included racing data and information from telephone interviews.

RESULTS

Twenty-six horses (9 Standardbreds and 17 Thoroughbreds) were admitted with a long condylar fracture of the McIII/MtIII. Fore- and hindlimbs were equally represented with the left hindlimb being more frequently involved. Most of the fractures had a spiralling component (76%) and four (15%) were comminuted. Fifteen (58%) horses raced post-surgery including nine Standardbreds (100%) and six Thoroughbreds (35%). Twelve of them were placed in at least one race and 11 won at least once. One horse sustained a severe complication in recovery. No significant difference was observed in the racing performances before and after surgery.

MAIN LIMITATIONS

Follow-up method and duration were not standardised and there is a low number of cases with six surgeons.

CONCLUSIONS

Long condylar fractures can be repaired using lag fashion technique combined with a half-limb or full-limb tight cast for recovery as a good surgical alternative. Similar results to plate fixation can be expected, with a return to racing of more than 50%, and the prognosis being even better for pacers.

Arthrodesis of the proximal interphalangeal joints of a hindlimb in a heifer

A two-year-old Braunvieh heifer was presented with a traumatic luxation of the second phalanx of the medial digit and concurrent subluxation of the second phalanx of the lateral digit of the right hindlimb. Closed reduction of both luxations was possible. Surgical arthrodesis was achieved using one narrow 4.5 mm three-hole equine locking compression plate for each joint. Placement of the bone plates resulted in stable arthrodesis of both proximal interphalangeal joints of the right hindlimb but there was persistent residual lameness. The heifer delivered a healthy calf but was slaughtered eight months after surgery because of varus deformity of the contralateral limb. Radio-graphs taken post-mortem revealed pronounced periosteal reactions involving both proximal interphalangeal joints and only partial bony bridging of the joint spaces.

Anesthetic management with sevoflurane combined with alfaxalone-medetomidine constant rate infusion in a Thoroughbred racehorse undergoing a long-time orthopedic surgery

A three-year old Thoroughbred racehorse was anesthetized with sevoflurane and oxygen inhalation anesthesia combined with constant rate infusion (CRI) of alfaxalone-medetomidine for internal fixation of a third metacarpal bone fracture. After premedication with intravenous (IV) injections of medetomidine (6.0 µg/kg IV), butorphanol (25 µg/kg IV), and midazolam (20 µg/kg IV), anesthesia was induced with 5% guaifenesin (500 ml/head IV) followed immediately by alfaxalone (1.0 mg/kg IV). Anesthesia was maintained with sevoflurane and CRIs of alfaxalone (1.0 mg/kg/hr) and medetomidine (3.0 µg/kg/hr). The total surgical time was 180 min, and the total inhalation anesthesia time was 230 min. The average end-tidal sevoflurane concentration during surgery was 1.8%. The mean arterial blood pressure was maintained above 70 mmHg throughout anesthesia, and the recovery time was 65 min. In conclusion, this anesthetic technique may be clinically applicable for Thoroughbred racehorses undergoing a long-time orthopedic surgery.

Minimally invasive repair of a calcaneus fracture in a Standardbred foal

CASE DESCRIPTION

A 4-month-old Standardbred colt was examined because of a fractured right calcaneus of 8 days' duration with increased distraction of the fracture fragment evident on sequential radiographs.

CLINICAL FINDINGS

The foal was severely lame with diffuse periarticular tarsal swelling. Radiographically, a complete, displaced long oblique fracture of the right calcaneal body was evident. Because the fracture gap was increasing with time and lameness remained severe, despite medical management, surgical repair was recommended.

TREATMENT AND OUTCOME

The foal was anesthetized, and minimally invasive fracture reduction and internal fixation were achieved by use of two 4.5-mm cortical screws placed in lag fashion via stab incisions over the lateral aspect of the calcaneus. External coaptation with a Robert-Jones bandage only was used after surgery. The foal recovered well and the fracture healed appropriately, but at 8 weeks following surgery, tenosynovitis of the tarsal sheath had developed. This was attributed to the tip of the distal screw encroaching on the sheath. The screw was removed under anesthesia and the tarsal sheath drained. The tenosynovitis resolved with rest and bandaging. Fourteen months after surgery, the colt was free of lameness.

CLINICAL RELEVANCE

Findings suggested that a minimally invasive internal fixation technique for treatment of a calcaneus fracture in horses may be successful and may be associated with decreased morbidity, compared with the use of open reduction and plate fixation.

An in vitro biomechanical comparison of equine proximal interphalangeal joint arthrodesis techniques: an axial positioned dynamic compression plate and two abaxial transarticular cortical screws inserted in lag fashion versus three parallel transarticular cortical screws inserted in lag fashion

OBJECTIVES

To compare in vitro monotonic biomechanical properties of an axial 3-hole, 4.5 mm narrow dynamic compression plate (DCP) using 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion (DCP-TLS) with 3 parallel transarticular 5.5 mm cortical screws inserted in lag fashion (3-TLS) for the equine proximal interphalangeal (PIP) joint arthrodesis.

STUDY DESIGN

Paired in vitro biomechanical testing of 2 methods of stabilizing cadaveric adult equine forelimb PIP joints.

SAMPLE POPULATION

Cadaveric adult equine forelimbs (n=15 pairs).

METHODS

For each forelimb pair, 1 PIP joint was stabilized with an axial 3-hole narrow DCP (4.5 mm) using 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion and 1 with 3 parallel transarticular 5.5 mm cortical screws inserted in lag fashion. Five matching pairs of constructs were tested in single cycle to failure under axial compression, 5 construct pairs were tested for cyclic fatigue under axial compression, and 5 construct pairs were tested in single cycle to failure under torsional loading. Mean values for each fixation method were compared using a paired t-test within each group with statistical significance set at P<.05.

RESULTS

Mean yield load, yield stiffness, and failure load under axial compression and torsion, single cycle to failure, of the DCP-TLS fixation were significantly greater than those of the 3-TLS fixation. Mean cycles to failure in axial compression of the DCP-TLS fixation was significantly greater than that of the 3-TLS fixation.

CONCLUSION

The DCP-TLS was superior to the 3-TLS in resisting the static overload forces and in resisting cyclic fatigue.

CLINICAL RELEVANCE

The results of this in vitro study may provide information to aid in the selection of a treatment modality for arthrodesis of the equine PIP joint.

Clinical use of the locking compression plate (LCP) in horses: a retrospective study of 31 cases (2004-2006)

REASONS FOR PERFORMING STUDY

Fracture repair and arthrodesis in horses require rigid fixation in order to achieve early post operative comfort. The locking compression plate (LCP) was designed to allow greater stability and less periosteal disruption than conventional plates.

OBJECTIVE

To describe a series of clinical cases in which the LCP was used for fracture stabilisation or arthrodesis.

METHODS

Medical records, radiographs and follow-up for 31 horses having fracture stabilisation or arthrodesis with the LCP were reviewed. Reasons for treatment included fracture of the olecranon (n = 2), metatarsal III (n = 2), ilial shaft (n = 1), femur (n = 2), radius (n = 2), medial condylar (n = 5) and complex lateral condylar (n = 1); or arthrodesis of the metacarpophalangeal joint (n = 8), proximal interphalangeal joint (n = 8) and carpus (n = 2).

RESULTS

Of the 31 horses, 27 were discharged from the hospital. Complications included incisional infection (32%), implant infection (19%), implant loosening/ breakage (22%), contralateral limb laminitis (16%), colic (3%) and diarrhoea (3%). Follow-up was available on all horses with at least 6 weeks of follow-up ranging up to 25 months. Of the 31 horses, 25 are sound for intended purpose, one is lame and 5 were subjected to euthanasia for complications associated with the original injury.

CONCLUSIONS

The LCP is an acceptable means of fracture stabilisation and arthrodesis in the horse.

POTENTIAL RELEVANCE

The LCP should be considered for difficult fracture configurations and arthrodeses, especially when increased stability of the fixation is needed.

Less invasive techniques for equine fracture repair and arthrodesis

To repair equine fractures successfully, surgeons traditionally have done aggressive open approaches with maximal internal fixation to achieve adequate stability and comfort. Although the need for stability is unquestionable, newer technologies and imaging modalities have allowed improvement in the biology of internal fixation in selected fractures and arthrodeses.

Evidence-based musculoskeletal surgery in horses

Musculoskeletal disorders comprise a large portion of the conditions treated by equine veterinarians. Surgical intervention is the treatment of choice in many cases. The body of literature describing and exploring surgical correction of musculoskeletal disorders in horses is steadily growing but still lacking. At this juncture, we can use what information we have with the understanding that as the quality of research advances, we should apply stricter standards to the evidence we use to answer our clinical questions.