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Topic:Fractures

Fractures in horses refer to the disruption in the continuity of a bone, often resulting from trauma, excessive stress, or pathological conditions. These injuries can vary in severity, from simple, non-displaced fractures to complex, comminuted fractures involving multiple bone fragments. Fractures can affect any bone in a horse's body, but they are most commonly observed in the limbs due to the high mechanical loads these structures endure. Diagnosis typically involves clinical examination and imaging techniques such as radiography or ultrasound to assess the extent and nature of the fracture. Treatment strategies depend on the type and location of the fracture and may include rest, immobilization, surgical intervention, or a combination of these approaches. This page aggregates peer-reviewed research and scholarly articles focusing on the etiology, diagnosis, management, and outcomes of fractures in horses, providing insights into current veterinary practices and advancements in equine orthopedic care.
Equine “Idiopathic” and Infundibular Caries-Related Cheek Teeth Fractures: A Long-Term Study of 486 Fractured Teeth in 300 Horses.
Frontiers in veterinary science    May 28, 2021   Volume 8 646870 doi: 10.3389/fvets.2021.646870
Dixon PM, Kennedy R, Reardon RJM.Background: Limited objective information is available on the prevalence of non-traumatic equine cheek teeth fractures, the signalment of affected horses, and the clinical features and treatment of these fractures. Objectives: This study aims to document patterns of idiopathic and infundibular caries-related cheek teeth fractures in a referral population and evaluate associations between fracture patterns and horse age, Triadan position of affected teeth, clinical signs, and deemed necessity for treatment. Study Design: A retrospective case review. Methods: The clinical records at Edinburgh Un...
Sudden death caused by spinal cord injury associated with vertebral fractures and fetlock failure in a Thoroughbred racehorse. Samol MA, Uzal FA, Blanchard PC, Arthur RM, Stover SM.The most prevalent causes of death in racehorses are musculoskeletal injuries, causing ~83% of deaths within the racing industry in California and elsewhere. The vast majority of these injuries have preexisting lesions that predispose to fatal injury. A 4-y-old Thoroughbred colt suffered an acute suspensory apparatus failure, including biaxial proximal sesamoid bone fractures of the right front fetlock, causing loss of support of the fetlock joint and consequent fall with fractures of the cervical and sacral spine. Cervical fracture caused spinal cord damage that resulted in sudden death. A pr...
Determination of correlation of proximal sesamoid bone osteoarthritis with high-speed furlong exercise and catastrophic sesamoid bone fracture in Thoroughbred racehorses.
American journal of veterinary research    May 26, 2021   Volume 82, Issue 6 467-477 doi: 10.2460/ajvr.82.6.467
Cresswell EN, Ruspi BD, Wollman CW, Peal BT, Deng S, Toler AB, McDonough SP, Palmer SE, Reesink HL.To examine whether proximal sesamoid bone (PSB) articular cartilage and bone osteoarthritic changes or palmar osteochondral disease (POD) scores were associated with exercise history and catastrophic PSB fracture in Thoroughbred racehorses. Methods: PSBs from 16 Thoroughbred racehorses (8 with and 8 without PSB fracture). Methods: Exercise history was collected, and total career high-speed furlongs was used as the measure of total exercise per horse. At necropsy, medial and lateral condyles of the third metacarpus from each forelimb were assigned a POD score, followed by imaging with micro-CT ...
Pelvic and acetabular trauma in amateur equestrian enthusiasts – A retrospective review.
The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland    May 8, 2021   Volume 20, Issue 3 164-168 doi: 10.1016/j.surge.2021.04.001
Francis AO, McCabe F, McCabe P, O'Daly BJ, Leonard M.Horse riding related accidents can present with devastating pelvic and acetabular fractures. This study examines the nature, management and treatment outcomes of severe pelvic and acetabular trauma in amateur horse riders presenting to a national tertiary referral centre. We also aim to define certain at-risk groups. Methods: This was a retrospective descriptive cohort of all patients who were referred to the National Centre for Pelvic and Acetabular trauma resulting from horse riding accidents. All patients who were referred to the National Centre for Pelvic and Acetabular Trauma between Janu...
How does bone strain vary between the third metacarpal and the proximal phalangeal bones of the equine distal limb?
Journal of biomechanics    April 20, 2021   Volume 123 110455 doi: 10.1016/j.jbiomech.2021.110455
Singer E, Garcia T, Stover S.Strain parameters at injury prone sites of the equine third metacarpal (MC3) and proximal phalangeal (P1) bones were investigated with the aim of improving understanding of injury pathogenesis. We hypothesized that dorsal principal and shear strain patterns, magnitudes and directions would differ from proximal-to-distal; and would be similar from medial-to-lateral across each bone. Unilateral limbs from nine equine cadavers were instrumented with rosette strain gauges during limb loading to 10,500 N. Gauges were attached at seven dorsal sites: middle MC3, distal MC3 (medial, middle, lateral) ...
Use of Omics Data in Fracture Prediction; a Scoping and Systematic Review in Horses and Humans.
Animals : an open access journal from MDPI    March 30, 2021   Volume 11, Issue 4 959 doi: 10.3390/ani11040959
Lee S, Baker ME, Clinton M, Taylor SE.Despite many recent advances in imaging and epidemiological data analysis, musculoskeletal injuries continue to be a welfare issue in racehorses. Peptide biomarker studies have failed to consistently predict bone injury. Molecular profiling studies provide an opportunity to study equine musculoskeletal disease. A systematic review of the literature was performed using preferred reporting items for systematic reviews and meta-analyses protocols (PRISMA-P) guidelines to assess the use of miRNA profiling studies in equine and human musculoskeletal injuries. Data were extracted from 40 papers betw...
Ex vivo comparison of standing and recumbent repair of incomplete parasagittal fractures of the first phalanx in horses.
Veterinary surgery : VS    March 12, 2021   Volume 50, Issue 4 775-783 doi: 10.1111/vsu.13612
Labens R, Jermyn K.To assess suspensory ligament extensor branch location and fracture gap reduction with simulation of standing and recumbent cortical bone screw repair of experimental incomplete parasagittal proximal phalanx (P1) fractures. Methods: Controlled laboratory study. Methods: Twenty equine cadaver forelimbs. Methods: Simulated fractures were repaired twice in random order. A proximal cortical bone screw was placed in lag fashion with the limb unloaded (simulated recumbent repair) and loaded to 38% of body weight (range, 375-568 kg; simulated standing repair). Changes in fracture gap width were ass...
In vitro assessment of the motion of equine proximal sesamoid bones relative to the third metacarpal bone under physiologic midstance loads.
American journal of veterinary research    February 26, 2021   Volume 82, Issue 3 198-206 doi: 10.2460/ajvr.82.3.198
Shaffer SK, Sachs N, Garcia TC, Fyhrie DP, Stover SM.To assess the motion of the proximal sesamoid bones (PSBs) relative to the third metacarpal bone (MC3) of equine forelimbs during physiologic midstance loads. Methods: 8 musculoskeletally normal forelimbs (7 right and 1 left) from 8 adult equine cadavers. Methods: Each forelimb was harvested at the mid-radius level and mounted in a material testing system so the hoof could be moved in a dorsal direction while the radius and MC3 remained vertical. The PSBs were instrumented with 2 linear variable differential transformers to record movement between the 2 bones. The limb was sequentially loaded ...
Polyaxial pedicle screw external fixation to stabilize oblique mandibular fractures in three standing, sedated horses.
Veterinary surgery : VS    February 19, 2021   Volume 50, Issue 3 659-667 doi: 10.1111/vsu.13587
Nelson BB, Easley J, Steward SKT, Smanik LE, Koch DW, Rawlinson JE, Easley JT.To report the radiographic, surgical and postoperative features in horses with unstable oblique mandibular fractures secured with polyaxial pedicle screws (PPS) external fixation construct and intraoral wiring. Methods: Three client-owned horses. Methods: Short case series. Methods: Two horses each had a unilateral fracture, which did not improve after conservative management, and one horse had bilateral fractures. Clinical and radiographic features were documented. Polyaxial pedicle screw external fixators and intraoral tension band wiring were applied in standing horses after combining sedat...
Stress fracture of the palmar, distal cortex of the third metacarpal bone: A diagnostic challenge with a good prognosis.
Equine veterinary journal    February 17, 2021   Volume 54, Issue 1 74-81 doi: 10.1111/evj.13426
Shan R, Johnston AS, Rosanowski SM, O'Shea J, Riggs CM.Transverse stress fracture of the palmar cortex of the distal aspect of the third metacarpal bone (TSF PCD McIII) is poorly documented. Objective: To describe the typical signalment of this injury, the common clinical and radiological signs and prognosis. Methods: A retrospective hospital-based case series with follow-up of racing records. Methods: All cases of TSF PCD McIII diagnosed among racehorses in training at the Hong Kong Jockey Club between 2011 and 2019 were identified. Clinical records were reviewed and documented signs were recorded for each case. Findings from a predefined list of...
Surgical Repair of a Unicortical Condylar Fracture in a Thoroughbred Racehorse Using a Bioabsorbable Screw.
Journal of equine veterinary science    January 16, 2021   Volume 99 103384 doi: 10.1016/j.jevs.2021.103384
Ravanetti P, Hamon M, Lechartier A, Zucca E.Surgical repair of unicortical fractures of the distal condyles of the third metacarpal/metatarsal bones (MCIII/MTIII) has been described. In the present case, a bioabsorbable screw was used to stabilize a unicortical fracture in the palmar aspect of the medial condyle of MCIII in a National Hunt Thoroughbred racehorse. The clinical, radiographic, and magnetic resonance imaging findings before and after surgery were recorded. Eighteen weeks after surgery, the lameness had resolved and the bone surrounding the fracture had recovered its normal architecture. One year after surgery, the horse was...
Microstructural properties of the proximal sesamoid bones of Thoroughbred racehorses in training.
Equine veterinary journal    December 21, 2020   Volume 53, Issue 6 1169-1177 doi: 10.1111/evj.13394
Ayodele BA, Hitchens PL, Wong ASM, Mackie EJ, Whitton RC.Proximal sesamoid bone fractures are common catastrophic injuries in racehorses. Understanding the response of proximal sesamoid bones to race training can inform fracture prevention strategies. Objective: To describe proximal sesamoid bone microstructure of racehorses and to investigate the associations between microstructure and racing histories. Methods: Cross-sectional. Methods: Proximal sesamoid bones from 63 Thoroughbred racehorses were imaged using micro-computed tomography. Bone volume fraction (BVTV) and bone material density (BMD) of the whole bone and four regions (apical, midbody d...
Characteristics of complete tibial fractures in California racehorses.
Equine veterinary journal    November 27, 2020   Volume 53, Issue 5 911-922 doi: 10.1111/evj.13375
Samol MA, Uzal FA, Hill AE, Arthur RM, Stover SM.Tibial fractures cause ~3% of racehorse deaths. Pre-existing stress fractures have been associated with multiple racing and training fractures, but not complete tibial fractures. Objective: To describe racehorse tibial fractures and compare signalment and exercise histories of affected and control racehorses. Methods: Retrospective analysis of necropsy reports. Methods: Racehorses that had a complete tibial fracture (1990-2018) were retrospectively reviewed. Signalment and exercise histories of affected horses were compared to 1) racehorses that died because of non-tibial musculoskeletal injur...
Occlusal Fissures in Equine Cheek Teeth: A Prospective Longitudinal in vivo Study.
Frontiers in veterinary science    November 17, 2020   Volume 7 604420 doi: 10.3389/fvets.2020.604420
Pollaris E, Broeckx BJG, Vlaminck L. It has been suggested that fissures of the occlusal surface of equine cheek teeth may develop into crown fractures. To examine the evolution of fissures present on the occlusal surface of cheek teeth. Furthermore, to investigate the presence of a fissure as a risk factor for the development of a subsequent crown fracture. Observational longitudinal study. Bi-annual dental examinations were performed on 36 horses for 3 years. Video-recordings were made to evaluate the evolution of detected fissures. The effect of possible predictors on the development of tooth fractures was investigated by ...
Malunion of an In Utero Metacarpal Fracture in a Standardbred Mare Presenting for Dystocia.
Journal of equine veterinary science    November 10, 2020   Volume 96 103321 doi: 10.1016/j.jevs.2020.103321
Lection J, Delvescovo B, Percival A, Wu T, Southard T, Diel de Amorim M, Cheong SH.In utero fracture and malunion of long bones is a rare condition in horses. Most foals with in utero fractures are aborted, and the identification of a fetal in utero fracture in a mare with dystocia has not been reported. A 7-year-old multiparous Standardbred mare presented to a referral center for correction of dystocia. Assisted vaginal delivery and controlled vaginal delivery attempts were unsuccessful mainly because of contracted tendons impeding mutation. As the foal was alive, a cesarean section was elected. The foal was delivered but ultimately euthanized because of the congenital abno...
Arthroscopic evaluation of the metacarpophalangeal and metatarsophalangeal joints in horses with parasagittal fractures of the proximal phalanx.
Equine veterinary journal    September 24, 2020   Volume 53, Issue 4 746-751 doi: 10.1111/evj.13343
James FM, Smith MRW, Wright IM.Fractures of the proximal phalanx are one of the most common long bone fractures of Thoroughbred racehorses. Although the degree of disruption and damage to the articular surface is generally considered a major prognostic determinant, associated arthroscopic findings have not previously been reported. Objective: To describe the metacarpo/metatarsophalangeal (MCP/MTP) joint lesions associated with parasagittal fractures of the proximal phalanx arthroscopically identified at the time of fracture repair and compare radiographic and arthroscopic appearance of complete fractures. Methods: Retrospec...
Persistent Intracranial Hypertension in a Cranial Vault Remodeling Patient With Open Skull Fractures From Horse Kick.
The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association    September 14, 2020   Volume 58, Issue 5 658-661 doi: 10.1177/1055665620957537
Braza ME, Girotto JA.A 4-year-old female with prior cranial vault remodeling for nonsyndromic bilateral coronal craniosynostosis sustained a severe traumatic brain injury with open skull fractures from a horse kick. Her post-traumatic course was complicated by persistently elevated intracranial pressure despite neurosurgical decompressions, maximum medical therapy, and trial of multiple pressure monitoring devices. She eventually had improvement in her intracranial pressures and made a full neurologic recovery. This case highlights the potential severity of horse kick injuries, the possible etiology of persistent ...
Sidewinder gait in horses.
Journal of veterinary internal medicine    August 21, 2020   Volume 34, Issue 5 2122-2131 doi: 10.1111/jvim.15870
Aleman M, Berryhill E, Woolard K, Easton-Jones CA, Kozikowski-Nicholas T, Dyson S, Kilcoyne I.Sidewinder gait in horses is poorly understood and characterized by walking with the trunk and pelvic limbs drifting to 1 side. Objective: To report causes, clinical and diagnostic features. Methods: Horses examined at 2 institutions. Methods: Retrospective study (2000-2019). Cases with sidewinder gait, neurological and orthopedic examination, and diagnostic work up or postmortem evaluation were included. Descriptive statistics were performed. Results: Twenty-four horses (mean age 18.9 years) of various breeds and both sexes were included. Onset was acute (N = 10), subacute (N = 6), and insi...
Plate Removal after Internal Fixation of Limb Fractures: A Retrospective Study of Indications and Complications in 48 Horses.
Veterinary and comparative orthopaedics and traumatology : V.C.O.T    August 16, 2020   Volume 34, Issue 1 59-67 doi: 10.1055/s-0040-1714411
Donati B, Fürst AE, Del Chicca F, Jackson MA. The aim of this study was to determine the indications for, and complications of, plate removal surgery in horses that underwent internal fixation of limb fractures. Methods:  Medical records of horses presented to our hospital between 1990 and 2015 for the removal of plates after treatment of limb fractures were reviewed. Data collected at the time of initial presentation, including signalment, history, fracture features and treatment and information about the indications, timing and complications of implant removal were reviewed. Results:  The most common bones involved were the ulna ...
The Effect of Increasing Fracture Site Stiffness on Bone-Pin Interface Stress and Foot Contact Pressure within the Equine Distal Limb Transfixation Cast: A Finite Element Analysis.
Veterinary and comparative orthopaedics and traumatology : V.C.O.T    August 14, 2020   Volume 33, Issue 5 348-355 doi: 10.1055/s-0040-1714353
Lescun TB, Adams SB, Nauman EA, Breur GJ. The aim of this study was to determine how increasing stiffness of fracture site tissues distal to the pins in an equine distal limb transfixation cast influences stress at the bone-pin interface, within the bones distal to the transcortical pins, and contact pressure between the foot and the cast. Methods:  A transfixation cast finite element model was used to compare the bone-pin interface stress, pin stress, bone stress distal to the pins and contact pressure between the foot and the cast, using six stiffness values for a composite tissue block representing progressive stages of fractu...
Outcome following repair of 63 sagittal fractures of the proximal phalanx in UK Thoroughbreds using either a triangular or linear screw configuration.
Equine veterinary journal    August 12, 2020   Volume 53, Issue 3 524-529 doi: 10.1111/evj.13304
Findley JA, O'Neill HD, Bladon BM.A triangular screw configuration has been suggested as preferable for repair of sagittal fractures of the proximal phalanx. Objective: To assess the outcome of a triangular screw construct for repair of incomplete and complete minimally displaced proximal phalanx fractures under standing sedation in a population of Thoroughbred racehorses, compared with a cohort repaired using a linear screw configuration. Methods: Retrospective cohort study. Methods: Medical records and radiographs were accessed to garner clinical data. Date of return to racing was determined from www.racingpost.com. Survival...
A radiomics platform for computing imaging features from µCT images of Thoroughbred racehorse proximal sesamoid bones: Benchmark performance and evaluation.
Equine veterinary journal    August 7, 2020   Volume 53, Issue 2 277-286 doi: 10.1111/evj.13321
Basran PS, Gao J, Palmer S, Reesink HL.Proximal sesamoid bone (PSB) fractures are the most common fatal musculoskeletal injury in North American racehorses. Computed tomography has the potential to detect morphological changes in bone structure but can be challenging to analyse reliably and quantitatively. Objective: To develop a radiomics platform that allows the comparison of features from micro-CTs (µCT) of PSBs in horses that sustained catastrophic fractures with horses that did not. To compare features calculated with a radiomics approach with features calculated from a previously published study that used quantitative µCT i...
Subchondral focal osteopenia associated with proximal sesamoid bone fracture in Thoroughbred racehorses.
Equine veterinary journal    July 23, 2020   Volume 53, Issue 2 294-305 doi: 10.1111/evj.13291
Shaffer SK, To C, Garcia TC, Fyhrie DP, Uzal FA, Stover SM.Proximal sesamoid bone (PSB) fracture is the most common fatal injury in Thoroughbred (TB) racehorses in the United States. Epidemiological and pathological evidence indicates PSB fracture is likely the acute culmination of a chronic stress-related process. However, the aetiopathogenesis of PSB fracture is poorly understood. Objective: To characterise bone abnormalities that precede PSB fracture. Methods: Two retrospective case-control groups of PSBs from TB racehorses with, and without, unilateral biaxial PSB fracture. Methods: Proximal sesamoid bones were harvested post-mortem from TB raceho...
Retrospective analysis of 15 years of horse-related maxillofacial fracture data at a major German trauma center.
European journal of trauma and emergency surgery : official publication of the European Trauma Society    July 22, 2020   Volume 48, Issue 4 2539-2546 doi: 10.1007/s00068-020-01450-w
Stier R, Tavassol F, Dupke C, Rüter M, Jehn P, Gellrich NC, Spalthoff S.The purpose of this study was to estimate the effect of the mechanism of trauma (fall versus kick), rider demographics, equestrian experience, protective equipment, and whether or not a horse was shod on the anatomic site of a horse-related maxillofacial fracture, operating time, postoperative complication rate, and length of hospital stay. Methods: We retrospectively reviewed the medical records of patients treated for horse-related maxillofacial fractures at a single institution in Germany between January 2000 and March 2015. We used linear and logistic regression to test the above-mentioned...
Arthroscopic debridement of short frontal plane proximal phalanx fractures preserves racing performance.
Equine veterinary journal    July 18, 2020   Volume 53, Issue 2 267-276 doi: 10.1111/evj.13275
Elzer EJ, Bramlage LR.Outcomes have been reported for a limited number of short frontal plane fractures of the proximal phalanx following nonsurgical treatment and internal fixation. Objective: To describe a new approach, arthroscopic debridement, of short frontal plane fractures of the proximal phalanx in flat-racing Thoroughbreds and post-operative racing outcome. Methods: Retrospective case-control study. Methods: Medical records of 81 Thoroughbred racehorses treated with arthroscopic debridement for frontal plane fractures of the proximal phalanx were reviewed. Diagnostic images and operative reports were used ...
Postinjury performance for differing humeral stress fracture locations in the racing thoroughbred.
Veterinary surgery : VS    July 17, 2020   Volume 49, Issue 7 1412-1417 doi: 10.1111/vsu.13447
Henderson B, Bramlage LR, Koenig J, Monteith G.To assess the influence of humeral stress fracture location on the time to return to racing and postinjury performance of thoroughbred racehorses. Methods: Retrospective study (1992-2015). Methods: Thoroughbred racehorses (n = 131) that presented for lameness with the sole diagnosis of humeral stress fractures in the lame limb, as determined by scintigraphy or radiology. Methods: Sex, fracture site, age, starts, earnings, and average earnings per race were examined for differences in pre-stress and post-stress fracture diagnosis for the entire population as well as individual stress fracture l...
Intrasinus bolstering of traumatic maxillary sinus fractures by using Foley catheter balloons in two foals.
Veterinary surgery : VS    April 29, 2020   Volume 49, Issue 6 1255-1261 doi: 10.1111/vsu.13433
Gardner AK, Santschi EM, Mudge MC, Belknap JK, Metzler AG.To describe the repair of unstable facial fractures by using Foley catheter balloons as intrasinus bolsters. Methods: Case report ANIMALS: Two weanling foals with unilateral fractures of the sinus and orbit secondary to kick injuries. Preoperative imaging that included positive contrast dacrocystorhinography and computed tomography confirmed severe comminution of facial fractures and nasolacrimal duct disruption in both foals. Methods: Small bone fragments were surgically removed, and large fragments were retained even when denuded of periosteum. Repair procedures included nasolacrimal canalic...
Injuries outside of horseracing: is it time to focus on injury prevention of jockeys outside of races?
The Physician and sportsmedicine    April 28, 2020   Volume 49, Issue 1 45-50 doi: 10.1080/00913847.2020.1760693
O'Connor S, Warrington G, O'Brien S, McDermott E, McGoldrick A, Pugh J, Cullen S.: Falls and injuries are frequent in professional horseracing. However, professional jockeys spend a large part of their week in horse-related activities outside of racing such as schooling, exercise riding, and yard-related activities. The injury risk related to these activities remains largely unknown internationally. This study aimed to identify the injury prevalence and injury profile of flat and jump jockeys during non-racing activities. : In total 45.6% and 38.5% of all licensed Irish professional flat and jump jockeys completed a cross-sectional self-recall questionnaire examining injur...
Career outcome of Thoroughbred racehorses with metacarpo/metatarsophalangeal joint dorsal chip fracture managed nonsurgically and surgically: A retrospective cohort study.
Equine veterinary journal    April 17, 2020   Volume 52, Issue 6 823-831 doi: 10.1111/evj.13253
Ramzan PHL, Wylie CE.Arthroscopy has been advocated as the treatment of choice for dorsal osteochondral chip fracture of the metacarpo/metatarsophalangeal (MCP/MTP) joint. However, there is no published research on racing performance outcomes of horses with this pathology managed nonsurgically. Objective: To compare racing career outcomes of Thoroughbred racehorses with nonsurgically (non-SX) or surgically (SX) managed MCP/MTP dorsal osteochondral chip fracture alongside a cohort of horses with no dorsal osteochondral chip fracture (unexposed). Methods: Retrospective cohort study conducted between 2006 and 2014. M...
Scapula fracture secondary to metastatic pulmonary carcinoma in a horse: Clinical, sonographic, radiographic, computed tomographic, and pathologic findings.
The Canadian veterinary journal = La revue veterinaire canadienne    March 14, 2020   Volume 61, Issue 3 251-256 
Pye J, Kilcoyne I, Roy M, Vaughan B, Ormond C, Spriet M.A 20-year-old Quarter horse gelding was referred for evaluation of an acute onset non-weight-bearing right forelimb lameness. Marked soft tissue swelling was apparent over the right scapula and shoulder region; no crepitus was palpable. A complete transverse fracture of the scapular neck was suspected based on ultrasonography and radiographs were obtained to confirm the presumptive diagnosis. A complete, oblique fracture of the right scapular neck with mild cranial and proximal displacement of the distal fragment was detected. Computed tomography of the upper right forelimb was performed post-...
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