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Equine veterinary journal2021; doi: 10.1111/evj.13481

Computed tomographic guidance for internal fixation of type II distal phalangeal fractures in 51 horses.

Abstract: Type II distal phalanx (P3) fractures are a well-described cause of lameness in horses. Reports on outcome following internal fixation of type II P3 fractures are lacking, and with little emphasis on complications. Objective: To describe a technique for internal fixation of type II P3 fractures, and evaluate whether specific variables influenced post-operative complications or a horse's ability to return to work. Methods: Retrospective case series. Methods: Medical records of 51 horses with CT-guided internal fixation of type II P3 fractures were reviewed. Outcome data were acquired from race records and telephone interviews. Associations between independent variables and outcome were analysed using multivariable logistic regression. Results: Eighty-six per cent (95% CI 74%-94%; n = 44) successfully returned to work. Implant infection (n = 15) and distal interphalangeal joint osteoarthritis (n = 9) were the most common complications, with the latter reducing the likelihood of success (OR = 0.09, 95% CI 0.01-0.7, P = .02). Implant infection increased the time to return to work (HR = 0.5, 95% CI 0.2-0.9, P = .03). The odds of delayed infection decreased by filling the hoof defect with acrylic hoof adhesive rather than poly(methyl methacrylate) and deeply countersinking the screw head (OR = 0.08, 95% CI 0.02-0.38, P = .001); the individual effect of each treatment is unknown. Radiographic healing was not associated with likelihood of success. Conclusions: Study limitations included variation in follow-up methods, lack of control population for comparison and lack of randomisation of treatment protocols. Conclusions: Internal fixation of type II P3 fractures is an effective treatment that allows horses to return to athletic use, with similar improved success rates as those reported for conservative management. Infection rates were reduced by deeply countersinking the screw head and filling the hoof defect with an acrylic that mimics hoof wall flexibility and provides a secure seal. Recommencement of training should be based on clinical rather than strictly radiographic findings.
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Publication Date: 2021-06-09 PubMed ID: 34107077DOI: 10.1111/evj.13481Google Scholar: Lookup
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Summary

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The research article discusses a technique for treating type II distal phalangeal fractures in horses using computed tomographic (CT) guidance for internal fixation, and evaluates factors influencing post-operation complications and horse’s successful return to work.

Research Methodology

  • The study is a retrospective case series investigation, which involves the analysis of past records to better understand a specific surgical procedure.
  • The researchers reviewed medical records of a total of 51 horses that had undergone CT-guided internal fixation of type II distal phalangeal (P3) fractures.
  • Data on each horse’s post-surgery outcome was obtained from both race records and telephone interviews.
  • The possible relationships between various independent variables and the outcome were analyzed using multivariable logistic regression, a statistical technique used to predict the outcome of a categorical dependent variable based upon one or more predictor variables.

Findings

  • The study reports an 86% success rate, assessed by the horse’s ability to return to work post-surgery.
  • The most common complications were implant infection and distal interphalangeal joint osteoarthritis, with the latter being associated with reduced likelihood of successful return to work.
  • According to the findings, implant infection extended the time taken for the horse to return to work.
  • The use of acrylic hoof adhesive in place of poly(methyl methacrylate), and deeply countersinking the screw head significantly dropped the odds of delayed infection, however, the individual effect of each treatment methodology is unknown.
  • Success was not linked with radiographic healing (the healing seen on an X-Ray) of the fracture.

Conclusion

  • The study acknowledges certain limitations, including differences in follow-up methods, absence of a control group for comparison, and lack of randomizing the treatment protocols.
  • Despite these limitations, the study concludes that the internal fixation of type II P3 fractures using CT guidance is a practical and effective treatment that allows horses to return to athletic use. The success rates align with those found for conservative management of these fractures.
  • The researchers advocate for deep countersinking of screw heads and filling the hoof defect with flexible, secure acrylic adhesive to reduce infection rates.
  • The decision to recommence training should be based on clinical findings, rather than strictly relying on radiographic evidence of healing.

Cite This Article

APA
Smanik LE, Stefanovski D, Reilly PT, Richardson DW. (2021). Computed tomographic guidance for internal fixation of type II distal phalangeal fractures in 51 horses. Equine Vet J. https://doi.org/10.1111/evj.13481

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English

Researcher Affiliations

Smanik, Lauren E
  • Department of Clinical Sciences, New Bolton Center, University of Pennsylvania, Kennett Square, PA, USA.
Stefanovski, Darko
  • Department of Clinical Sciences, New Bolton Center, University of Pennsylvania, Kennett Square, PA, USA.
Reilly, Patrick T
  • Farrier Department, New Bolton Center, University of Pennsylvania, Kennett Square, PA, USA.
Richardson, Dean W
  • Department of Clinical Sciences, New Bolton Center, University of Pennsylvania, Kennett Square, PA, USA.

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This article includes 23 references
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