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Surgical Repair of Mid‐body Proximal Sesamoid Bone Fractures in 25 Horses
Author(s) -
BUSSCHERS EVITA,
RICHARDSON DEAN W.,
HOGAN PATRICIA M.,
LEITCH MIDGE
Publication year - 2008
Publication title -
veterinary surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.652
H-Index - 79
eISSN - 1532-950X
pISSN - 0161-3499
DOI - 10.1111/j.1532-950x.2008.00445.x
Subject(s) - medicine , sesamoid bone , surgery , bone healing , fixation (population genetics) , radiography , reduction (mathematics) , medical record , clinical significance , lag screw , internal fixation , population , geometry , environmental health , mathematics
Objective— To describe the characteristics of unilateral mid‐body proximal sesamoid bone (PSB) fractures, to determine factors associated with the outcome of horses after surgical repair, and to describe a technique for arthroscopically assisted screw fixation in lag fashion. Study Design— Retrospective case series. Animals— Horses (n=25) with unilateral mid‐body PSB fracture. Methods— Medical records (1996–2006), radiographs, and arthroscopic videos of horses with surgically repaired unilateral mid‐body PSB fractures were reviewed. Retrieved data included signalment, affected limb and PSB, fracture characteristics, and surgical technique. Outcome was established by radiographic assessment of healing and race records; categorical data were analyzed using Fisher's Exact test. Results— Medial forelimb PSBs were most commonly affected (80%). Surgical technique and degree of reduction were significantly associated with outcome; 44% of horses with screw repair and none of the horses with wire fixation raced ( P =.047). Factors that may have influenced this outcome were differences in fracture reduction (improved reduction in 22% wire repairs and 88% screw repairs, P =.002) and use of external coaptation (22% wire repair and 88% lag screw repair, P =.002). None of the horses with unimproved reduction raced after surgery. Conclusions— Only 28% of horses with mid‐body PSB fractures raced after surgery. Compared with wire fixation, screw fixation in lag fashion resulted in good reduction and is seemingly a superior repair technique. Clinical Relevance— For mid‐body PSB fractures, arthroscopically assisted screw fixation in lag fashion and external coaptation for anesthesia recovery and initial support provides the best likelihood of return to athletic use.