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Ex vivo comparison of standing and recumbent repair of incomplete parasagittal fractures of the first phalanx in horses
Author(s) -
Labens Raphael,
Jermyn Kieri
Publication year - 2021
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/vsu.13612
Subject(s) - medicine , cadaver , anatomy , cadaveric spasm , sagittal plane , reduction (mathematics) , phalanx , implant , repeated measures design , nuclear medicine , orthodontics , surgery , statistics , geometry , mathematics
Objective 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. Study design Controlled laboratory study. Sample population 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). Conclusion 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. Clinical significance Unloading during standing repair of incomplete parasagittal proximal P1 fractures may not be required to optimize fracture reduction.