Fixation of supraglenoid tubercle fractures using distal femoral locking plates in three Warmblood horses

Fixation of a scapular body fracture in a 5 month old foal using three 4.5/5.0 mm locking compression plates

OBJECTIVE

To report a surgical technique and an outcome for the repair of a displaced, transverse scapular body fracture with locking compression plates (LCPs) in a colt.

ANIMALS

One 5 month old Thoroughbred colt.

STUDY DESIGN

Case report.

METHODS

A colt sustained an unstable, comminuted, transverse fracture of the scapular body. Three 4.5/5.0 mm LCPs were used with 6.5 mm cancellous screws, 4.5 mm cortex screws, and 5.0 mm locking head screws. Implants were removed 2 months after surgery.

RESULTS

Surgical site infection was identified by purulent discharge at the distal aspect of the suture line 3 days after surgery. The surgical site infection resolved with daily lavage within 15 days after surgery. Three months after internal fixation of the scapular body fracture, the colt was sound and was turned out to pasture. One year later, the colt was sound and in training to be a flat racehorse.

CONCLUSION

Repair of a scapular body fracture using LCP provided a good outcome with an early return to soundness. The LCP system can therefore be considered for the repair of scapular body fractures in small equids.

Evaluation of the optimal plate position for the fixation of supraglenoid tubercle fractures in warmbloods

Objectives: To determine scapular cortex thickness, distal scapular bone density and describe the exact suprascapular nerve course to evaluate the best plate position for the fixation of supraglenoid tubercle fractures in horses.

Methods: Twelve equine cadaveric shoulders were examined with computed tomography. Computed tomography morphometry and density measurements (Hounsfield units [HU]) of the scapula were recorded. Statistical comparisons were made between the cranial and caudal aspects of the scapula. Dissection of each shoulder was performed and the suprascapular nerve course was described morphometrically and morphologically.

Results: The suprascapular nerve was found on the periosteum and embedded in connective tissue at the cranial aspect of the scapula. It ramified proximally and distally into the supraspinatus muscle, coursed caudo laterally at a median of 2 cm (1–2 cm) distal to the scapular spine and ramified proximally and distally into the infraspinatus muscle. The scapular cortex measurements (HU) cranially were significantly larger than caudally at most levels of the scapula. The bone density of the distal scapula cranially (651.3 ± 104.2) was significantly lower than caudally (745.7 ± 179.1).

Clinical significance: For surgical access to the supraglenoid tubercle, knowledge of the anatomy is important. It is easiest to avoid the suprascapular nerve at the most cranial aspect of the scapula, where it has not yet ramified. For a stable fixation, knowledge of the characteristics of the equine scapula, such as scapular cortex thickness, is important.

Supraglenoid tubercle fractures repair with transverse locking compression plates in 4 horses

OBJECTIVE

To report on a series of 4 horses with supraglenoid tubercle fractures repaired with locking compression plates.

STUDY DESIGN

Case series.

ANIMAL

Four horses ranging in age from 6 weeks to 20 months and weighing from 121 to 425 kg with supraglenoid tubercle fractures of 1 day to 6 weeks in duration.

METHODS

Supraglenoid tubercle fractures were reduced and stabilized with transversely positioned locking compression plate(s) with and without additional tension band wiring.

RESULTS

All fractures reached bony union. Two postoperative surgical site infections were managed with drainage and antibiotherapy. Three of the 4 horses continued onto athletic careers including flat racing, dressage, and hunter/jumper competition. The remaining horse was lame for a prolonged period, but was sound at 4 years.

CONCLUSIONS

The application of one or two, transversely positioned LCPs should be considered for the repair of SGT fractures because of the relative ease of the technique, and its elimination of a biceps brachii tenotomy. All screws can be inserted in a lateral to medial direction without transection or drill penetration of the biceps brachii tendon.

CLINICAL RELEVANCE

SGT fractures of various durations can be repaired in a wide range of horses with transversely positioned LCPs, and allow return to athletic function.