J P Watkins

Proximal interphalangeal joint arthrodesis using a combination plate‐screw technique in 53 horses (1994–2003)

REASONS FOR PERFORMING STUDY A method for proximal interphalangeal joint (PIP joint) arthrodesis that provides a stable fixation and minimal duration of cast support is evaluated retrospectively. OBJECTIVES Evaluate the clinical use of a combined plate-screw method for PIP joint arthrodesis in a large number of horses. METHODS The records of 53 horses undergoing PIP joint arthrodesis were reviewed. Arthrodesis was performed with a dorsally placed 3-, 4- or 5-hole narrow dynamic compression plate (DCP) with 2 transarticular cortex screws placed in lag fashion either side of the plate. Subject details, clinical presentation, radiographic findings, surgical technique, post operative treatment and complications were recorded. Long-term follow up (mean 3 years) was obtained for 46 horses. RESULTS Arthrodesis procedures (n = 58) were performed on 53 horses with a DCP in combination with transarticular cortex screws placed in lag fashion. Conditions treated were osteoarthritis (OA) of the PIP joint, fracture of middle phalanx, PIP joint subluxation, subchondral cystic lesions and degenerative joint disease secondary to sepsis. Time of post operative cast application was 14 days. Overall 40/46 (87%) horses could be used as intended including 20/25 (81%) forelimb and 20/21 (95%) hindlimb arthrodeses. Twenty-three of 27 (85%) horses used for performance had successful outcomes. Complications included implant infection, cast sores and partial implant failure. CONCLUSIONS PIP joint arthrodesis using a DCP and transarticular cortex screws placed in lag fashion provides a stable construct and short casting period with minimal complications. The prognosis for return to performance was excellent for horses treated with hindlimb PIP joint arthrodesis and good for forelimb arthrodesis. POTENTIAL RELEVANCE Use of a combination technique for PIP joint arthrodesis allows a high proportion of horses with pastern joint disease to be returned to their athletic potential.

Results of plate fixation of type 5 olecranon fractures in 20 horses

REASONS FOR PERFORMING STUDY Previous olecranon fracture reports contain a small proportion of type 5 fractures, mostly treated with conservative therapy. OBJECTIVES To evaluate the clinical details and outcome of type 5 olecranon fractures in a large group of horses treated by tension band plate fixation and to compare results with other treatment methods. METHODS Medical records of 97 cases, including 32 (33%) classified as type 5, were reviewed. Subject details, history, radiographic findings, treatment and follow-up results (2-146 months post operatively) were recorded. RESULTS Treatment included open reduction and internal fixation using a narrow or broad dynamic compression plate (n = 20), conservative therapy (n = 7) and euthanasia (n = 5). Long-term follow-up was available in 15 cases treated surgically, of which 2 were sound and in training, 11 sound and performing athletically and 2 unsound. Distal semilunar notch involvement, comminution or open status did not appear to affect prognosis. CONCLUSIONS Internal plate fixation provides an excellent prognosis for an animal to be capable of athletic performance. POTENTIAL RELEVANCE Describing tension band plate fixation and results offers a method of fracture repair that should improve treatment and prognosis for type 5 olecranon fractures.

Intrathecal deep digital flexor tenectomy for treatment of septic tendonitis/tenosynovitis in four horses.

Objective: To describe partial removal of the intrathecal component of the deep digital flexor tendon (DDFT) in horses with chronic septic DDF tendonitis and tenosynovitis unresponsive to conventional therapy, and to report long-term outcome. Study Design: Case series. Animals: Horses (n=4). Methods: Four horses with chronic septic DDF tendonitis and tenosynovitis were treated by surgical tenectomy of the intrathecal component of the DDFT, followed by stabilization in casts and subsequent corrective shoeing. All horses were previously managed unsuccessfully with combinations of conventional therapy consisting of systemic antibiotics, through and through tendon sheath lavage/open drainage, regional limb perfusions, tenoscopy with debridement and transection of the palmar/plantar annular ligament, and intrathecal antibiotics. Results: Time from initial injury/diagnosis to tenectomy ranged from 10 to 210 days. Mean hospitalization time after surgery was 82 days. Long-term follow-up (>1.5 years; mean, 3.8 years) was available. All 4 horses were able to walk comfortably at pasture and were used as broodmares. Conclusions: Intrathecal tenectomy is a viable surgical procedure for treatment of chronic septic tenosynovitis of the digital sheath that is complicated by septic tendonitis of the DDFT.OBJECTIVE To describe partial removal of the intrathecal component of the deep digital flexor tendon (DDFT) in horses with chronic septic DDF tendonitis and tenosynovitis unresponsive to conventional therapy, and to report long-term outcome. STUDY DESIGN Case series. ANIMALS Horses (n=4). METHODS Four horses with chronic septic DDF tendonitis and tenosynovitis were treated by surgical tenectomy of the intrathecal component of the DDFT, followed by stabilization in casts and subsequent corrective shoeing. All horses were previously managed unsuccessfully with combinations of conventional therapy consisting of systemic antibiotics, through and through tendon sheath lavage/open drainage, regional limb perfusions, tenoscopy with debridement and transection of the palmar/plantar annular ligament, and intrathecal antibiotics. RESULTS Time from initial injury/diagnosis to tenectomy ranged from 10 to 210 days. Mean hospitalization time after surgery was 82 days. Long-term follow-up (>1.5 years; mean, 3.8 years) was available. All 4 horses were able to walk comfortably at pasture and were used as broodmares. CONCLUSIONS Intrathecal tenectomy is a viable surgical procedure for treatment of chronic septic tenosynovitis of the digital sheath that is complicated by septic tendonitis of the DDFT.

Transfixation cast technique for arthrodesis of the distal interphalangeal joint of horses.

Surgical arthrodesis of the distal interphalangeal (DIP) joint by transfixation casting was used to salvage a three-year-old filly and a yearling filly that were chronically lame because of infection of the DIP joint for breeding. Unlike previously described techniques for arthrodesis of the DIP joint, the technique used did not require insertion of implants across the joint, which may have contributed to the successful outcome.

Double plate fixation for the management of proximal interphalangeal joint instability in 30 horses (1987-2015).

REASONS FOR PERFORMING STUDY Double plate fixation has been reported in a small number of horses with comminuted fractures of the middle phalanx. There are no published reports using this technique in the management of other injuries that destabilise the proximal interphalangeal joint (PIJ), including biaxial palmar/plantar eminence fractures and disruption of the palmar/plantar soft tissue support structures of the PIJ. Furthermore, there is a paucity of information on the long-term prognosis for horses undergoing double plate fixation to manage destabilising injuries of the PIJ. OBJECTIVES To document further the clinical use of double plate fixation for management of injuries to the PIJ resulting in palmar/plantar instability and compare these results with other methods of management. STUDY DESIGN Retrospective case series. METHODS The case records and radiographs of 30 horses with destabilising injuries to the PIJ treated by double plate fixation at Texas A&M University between 1987 and 2013 were analysed. Long-term follow-up information was obtained by telephone interview with the client or referring veterinarian. RESULTS Thirty-one disruptive PIJ injuries were double plated in 30 cases. Twenty-nine of 30 horses were discharged from the hospital. The medial time for post operative external coaptation was 41 days. Long-term follow-up (>2 years) was available for 25 horses, of which 15 (60%) returned to useful function. Radiographic evidence of fracture healing and arthrodesis of the PIJ was evident in 28 (90%) repairs at 6 months following repair. CONCLUSIONS The use of 2 abaxially placed dorsal plates for management of destabilising injuries to the PIJ results in a very good prognosis for survival and a reasonable prognosis for return to functional use.

ARTHROSCOPIC TREATMENT OF SEPTIC ARTHRITIS/PHYSITIS OF THE FEMOROPATELLAR JOINT IN A FOAL: a Case report

A 1-month old 103-kg Quarter Horse foal was admitted to the Texas Veterinary Medical Center for evaluation of right rear lameness, effusion of the right femoropatellar joint, and a swollen umbilicus. At admission, the foal was non-weight beating (Grade 5) on the affected limb and marked effusion of the right femoropatellar joint was present on palpation. The umbilical region was warm, swollen and sensitive to palpation. The foals temperature was elevated (39.7°C). Radiographic examination of the right stifle revealed an osteolytic lesion in the crainal aspect of the distal femur, involving the physis (Figure 1). Because of the radiographic appearance of the lesion in conjunction with the marked effusion of the femoropatellar joint, septic physitis and osteomyelitis was tentatively diagnosed. Radiography of the contralateral stifle did not reveal the osteolytic lesion in the distal femur that was observed in the affected stifle. Ultrasonographic examination of the umbilicus revealed enlarged umbilical arteries. Arthoscopic surgery was recommended to debride the lesion in the distal femur and lavage the femoropatellar joint. In addition, surgical exploration of the umbilical region was recommended since the enlarged umbilical arteries were presumed to be the source of sepsis within the femorpatellar joint. Aspiration of synovial fluid from the femoropatellar joint for cytology, culture and susceptibility was not performed until the time of surgery.