Arthroscopic Removal of Traumatic Fractures of the Proximal Medial Trochlear Ridge of the Talus: A Retrospective Analysis of 18 Horses.

The research examines the significance of flexed radiographs for trauma involving the Proximal Medial Trochlear Ridge (PMTR) of the talus in horses, and assesses the outcomes following the arthroscopic removal of Traumatic Osteochondral Fragments (TOCF).

Objectives and Research Methods

• The researchers aimed to determine the value of employing flexed radiographs of the PMTR upon experiences of trauma involving the medial tarsus, which is the joint high up in the hindleg of the horse.
• Another objective was to appraise the outcome after arthroscopic removal of traumatic osteochondral fragments (TOCF) resulting from a direct injury to the PMTR. The latter is a groove in the horse’s ankle bone, while TOCF are chipped bone fragments caused by trauma.
• Patient history, the cause of the fracture, preoperative diagnostics, and intraoperative findings were documented from the medical records of patients who had wounds to the medial tarsus and had TOCF of the PMTR.
• Post-operative performance data was collected utilizing the Thoroughbred Racing database or a telephone questionnaire.

Results and Observations

• All cases studied were found to have wounds along with simultaneous synovial sepsis of the tarsocrural joint. Synovial sepsis is a severe joint infection that can occur due to puncture wounds.
• Standard weight-bearing radiographs were performed before surgery in 15 cases, but they failed to identify PMTR pathology in 13 of them, highlighting the shortcoming of these radiographs.
• The utility of flexed radiographs (which includes a distinctly defined flexed plantaroproximolateral dorsodistomedial oblique) became apparent when they were acquired in 8 cases and identified the PMTR lesions correctly. This suggests that flexed radiographs are more effective in detecting PMTR lesions in horses’ ankles.
• During the initial surgery, the TOCF from the PMTR areas were removed, or in 3 cases, they were removed in a subsequent arthroscopy, which was performed due to unresolved synovial sepsis. This shows that removing TOCF can aid in managing joint infections.
• Of the 16 horses that could be followed up on after six months, 15 had resumed full exercise, indicating an excellent prognosis after the arthroscopic removal of TOCF from the PMTR.

Conclusions

• The study concludes that flexed tarsal radiographs should be included as a standard part of the protocol for the management of traumatic wounds involving the medial tarsus. This method of assessment may help in better identifying PMTR lesions and plan effective interventions.
• Horses may have a good prognosis following the arthroscopic removal of TOCF of the PMTR.
• The study also states that a failure to recognize and remove TOCF could result in persistent synovial sepsis in horses, stressing the importance of the detection and treatment of TOCF.