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Veterinary surgery : VS2021; 50(4); 775-783; doi: 10.1111/vsu.13612

Ex vivo comparison of standing and recumbent repair of incomplete parasagittal fractures of the first phalanx in horses.

Abstract: 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 assessed on computed tomography (CT) images and with intraplanar force-sensitive resistors measuring voltage ratios (V ) between loaded recumbent (R-1) and standing repair simulations (R-2). Extensor branch borders were determined relative to implant position and sagittal P1 width on transverse CT images. P ≤ .05 was considered significant. Results: Standing repair simulation-associated fracture gaps were not wider than in R-1 while controlling for confounding factors (loading weight, implant position, or animal age; P > .7, repeated-measures analysis of variance). Voltage ratio data associated with R-2 were not smaller than with R-1 (mean difference, 0.002 ± 0.052; one-sided Wilcoxon signed-rank test, P = .27). More of P1 width was approachable palmar to extensor branches when limbs were loaded (0.804 ± 0.314 cm) vs unloaded (0.651 ± 0.31 cm; paired Student's t test, P < .001). Conclusions: Simulated standing repair was not associated with inferior fracture reduction compared with loaded simulations of recumbent repairs. Limb loading affected extensor branch location relevant to implant positioning. Conclusions: Unloading during standing repair of incomplete parasagittal proximal P1 fractures may not be required to optimize fracture reduction.
© 2021 The American College of Veterinary Surgeons.
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Publication Date: 2021-03-12 PubMed ID: 33709440DOI: 10.1111/vsu.13612Google Scholar: Lookup
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  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research investigates the effect of different positions (standing and recumbent) and load conditions on the surgical repair of a particular type of bone fracture in horses. Two important factors were assessed: the positioning of a ligament and the reduction of the fracture gap. The main conclusion suggested that standing repair of these fractures is not inferior to lying-down repair, and the implication is that horses may not need to be lain down for surgery to fix these types of fractures.

Objective and methodology

  • This was a controlled laboratory study, aiming to assess the position of the suspensory ligament extensor branch and the reduction of fracture gap when simulated surgeries were performed on horse forelimbs in a standing or recumbent (lying down) position.
  • A fracture was simulated in the forelimbs of twenty deceased horses. Each simulated fracture was then repaired twice, once as if the horse was standing and once as if the horse was recumbent.
  • The leg was loaded or unloaded during the simulated surgery, to mimic the weight of the horse. The horse’s weight during the standing repair simulation was 38% of the horse’s body weight.
  • The researchers then used computed tomography (CT) scanning and resistors measuring voltage ratios to quantify changes in fracture gap, relative position of the extensor branch, and other factors.

Results

  • The study found no significant differences between the fracture gaps resulting from both simulated standing and recumbent repairs, indicating that standing repair was not associated with inferior fracture reduction.
  • No significant difference was found in voltage ratio data between both types of simulated repair.
  • The study also found that more of the bone width was approachable when the limbs were loaded as compared to when unloaded. This suggests that loading of the horse’s leg during surgery could result in better surgery access and optimization of fracture reduction even during standing repair.

Conclusion

  • The conclusion from this study is that horses may not need to be laid down during surgical repair of these types of fractures. With horse’s weight (loading) applied onto the limb, there may be more space for surgeons to work on the fracture and it may optimize the fracture reduction.

Cite This Article

APA
Labens R, Jermyn K. (2021). Ex vivo comparison of standing and recumbent repair of incomplete parasagittal fractures of the first phalanx in horses. Vet Surg, 50(4), 775-783. https://doi.org/10.1111/vsu.13612

Publication

Veterinary surgery : VS
ISSN: 1532-950X
NlmUniqueID: 8113214
Country: United States
Language: English
Volume: 50
Issue: 4
Pages: 775-783

Researcher Affiliations

Labens, Raphael
  • School of Animal and Veterinary Sciences, Faculty of Science, Charles Sturt University, Wagga Wagga, New South Wales, Australia.
Jermyn, Kieri
  • School of Animal and Veterinary Sciences, Faculty of Science, Charles Sturt University, Wagga Wagga, New South Wales, Australia.

MeSH Terms

  • Animals
  • Bone Screws / veterinary
  • Cadaver
  • Forelimb / injuries
  • Forelimb / surgery
  • Fracture Fixation / methods
  • Fracture Fixation / statistics & numerical data
  • Fracture Fixation / veterinary
  • Fractures, Bone / surgery
  • Fractures, Bone / veterinary
  • Horses / injuries
  • Horses / surgery
  • Tomography, X-Ray Computed / veterinary

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