Three cases of olecranon fracture repair in the standing horse

Standing repair of long frontal plane fractures of the proximal phalanx in UK Thoroughbred racehorses: A retrospective analysis of 13 fractures

BACKGROUND

Sagittal plane fractures of the proximal phalanx (P1) are commonly observed in the UK Thoroughbred racehorse, with the technique and outcome following standing lag screw fixation widely reported. Long frontal plane P1 fractures propagating from the central third of the proximal articular surface occur less frequently, with information concerning repair methods and outcomes currently lacking.

OBJECTIVE

To describe a surgical technique for standing lag screw fixation of long frontal P1 fractures and report on post-operative performance in a UK Thoroughbred population.

STUDY DESIGN

Single centre retrospective case series.

METHODS

Horses with long frontal plane P1 fractures propagating from the central third of the proximal articular surface were identified within Donnington Grove Equine Hospital records. Patient history, fracture location, preoperative diagnostics, surgical rubrics, and follow-up examinations were documented. Pre- and post-operative performance data were collected using an online database. Descriptive data were generated including median and range and percentage success.

RESULTS

Eleven horses fulfilled inclusion criteria. Two horses sustained frontal fractures of 2 separate limbs on different occasions for a total aggregate of 13 fractures. All fractures occurred in hindlimbs and were biarticular in two cases, uniarticular and complete in three cases, and incomplete in eight cases. Repair was performed with a median of four screws (range 2-5) and median surgical time was 30 min (18-104 min). Seventy-three per cent (8/11) of horses returned to racing at a median of 356 days (178-728 days); 2 horses had <6 months follow-up. A post-operative complication necessitating removal of the screws at 257 days occurred in one case.

MAIN LIMITATIONS

Small number of patients fulfilling inclusion criteria.

CONCLUSION

Select long frontal fractures of P1 can be successfully repaired in the standing horse. The post-operative performance data are comparable to that of sagittal P1 fractures, with a good outcome for return to racing. This study provides data on a previously under-reported condition.

Standing repair of short frontal plane fractures involving the dorsoproximal articular surface of the proximal phalanx in six Thoroughbred racehorses

OBJECTIVE

To describe a technique and report outcomes for internal fixation of short frontal-plane fractures involving the dorsoproximal articular surface of the proximal phalanx (P1) in standing horses.

STUDY DESIGN

Short case series.

ANIMALS

Six Thoroughbred racehorses with short, frontal plane fractures involving the dorsoproximal P1.

METHODS

All fractures were located in the hindlimb. Horses presented with moderate lameness and marked effusion of the affected metatarsophalangeal joint. Fractures had a medial bias extending from the central aspect of proximal P1 to involve the dorsomedial prominence. Fractures were repaired under standing sedation, local anesthesia and radiographic guidance using a single 3.5 mm self-tapping cortical screw placed in lag fashion.

RESULTS

Surgery was postponed by 24 h for one patient due to excessive movement during surgical preparation. The mean proximo-distal length of the radiographically apparent fracture plane was 23 mm (range: 19-28 mm). Mean time for screw placement was 13 min (range: 9-21 min). In five horses, postoperative radiographs were acquired and indicated resolution of the fracture plane. All horses raced postoperatively. The mean time from surgery to first race was 205 days (range: 144-284 days) and mean number of starts was 21 (range: 9-37). No complications were reported relating to the repair method.

CONCLUSION

Standing internal fixation of short, incomplete frontal plane fractures of the proximal phalanx, using a 3.5 mm self-tapping cortical screw, is a feasible method of repair. The technique should be viewed as an advanced standing fracture repair.