Jan M. Kuemmerle

A clinical study on the effect in horses during medetomidine–isoflurane anaesthesia, of butorphanol constant rate infusion on isoflurane requirements, on cardiopulmonary function and on recovery characteristics

OBJECTIVE To test if the addition of butorphanol by constant rate infusion (CRI) to medetomidine-isoflurane anaesthesia reduced isoflurane requirements, and influenced cardiopulmonary function and/or recovery characteristics. STUDY DESIGN Prospective blinded randomised clinical trial. ANIMALS 61 horses undergoing elective surgery. METHODS Horses were sedated with intravenous (i.v.) medetomidine (7 μg kg(-1)); anaesthesia was induced with i.v. ketamine (2.2 mg kg(-1)) and diazepam (0.02 mg kg(-1)) and maintained with isoflurane and a CRI of medetomidine (3.5 μg kg(-1) hour(-1)). Group MB (n = 31) received butorphanol CRI (25 μg kg(-1) i.v. bolus then 25 μg kg(-1) hour(-1)); Group M (n = 30) an equal volume of saline. Artificial ventilation maintained end-tidal CO2 in the normal range. Horses received lactated Ringers solution 5 mL kg(-1) hour(-1), dobutamine <1.25 μg kg(-1) minute(-1) and colloids if required. Inspired and exhaled gases, heart rate and mean arterial blood pressure (MAP) were monitored continuously; pH and arterial blood gases were measured every 30 minutes. Recovery was timed and scored. Data were analyzed using two way repeated measures anova, independent t-tests or Mann-Whitney Rank Sum test (p < 0.05). RESULTS There was no difference between groups with respect to anaesthesia duration, end-tidal isoflurane (MB: mean 1.06 ± SD 0.11, M: 1.05 ± 0.1%), MAP (MB: 88 ± 9, M: 87 ± 7 mmHg), heart rate (MB: 33 ± 6, M: 35 ± 8 beats minute(-1)), pH, PaO2 (MB: 19.2 ± 6.6, M: 18.2 ± 6.6 kPa) or PaCO2. Recovery times and quality did not differ between groups, but the time to extubation was significantly longer in group MB (26.9 ± 10.9 minutes) than in group M (20.4 ± 9.4 minutes). CONCLUSION AND CLINICAL RELEVANCE Butorphanol CRI at the dose used does not decrease isoflurane requirements in horses anaesthetised with medetomidine-isoflurane and has no influence on cardiopulmonary function or recovery.

Short incomplete sagittal fractures of the proximal phalanx in ten horses not used for racing

OBJECTIVE To describe short incomplete sagittal fractures of the proximal phalanx (type Ia P1 fractures) in horses not used for racing and report outcome. STUDY DESIGN Retrospective study. ANIMALS Horses (n=10) with type Ia P1 fractures. METHODS Retrieved data of horses with type Ia P1 fractures were signalment, history and results of orthopedic examination. Radiographs were re-evaluated for position and length of the fracture line, presence of osteoarthritis or subchondral cystic lesions (SCL), periosteal new bone formation and subchondral sclerosis. Conservative treatment (n=4) included box confinement for 2 months followed by 1 month of hand walking. Surgical therapy (n=6) consisted of internal fixation by screws inserted in lag fashion in 5 horses. Concurrent SCL were debrided by curettage via a transcortical drilling approach. In 1 horse, only SCL curettage but not internal fixation was performed. Outcome was assessed on a clinical and radiographic follow-up examination in all horses. RESULTS Mean follow-up time was 27 months (median, 13.5 months; range, 9 months to 9 years). All horses treated with internal fixation were sound at follow-up and had radiographic fracture healing. Of the 4 horses managed conservatively, 3 remained lame and only 1 horse had radiographic evidence of fracture healing. Catastrophic fracture propagation occurred in 2 horses not treated by internal fixation, 20 and 30 months after diagnosis, respectively. CONCLUSIONS Horses with a type Ia P1 fracture treated surgically had a better outcome than those managed conservatively and lack of fracture healing seemingly increases the risk of later catastrophic fracture. CLINICAL RELEVANCE Surgical repair of type Ia P1 fractures should be considered to optimize healing and return to athletic use.

An Ultrasound Assisted Anchoring Technique (BoneWelding® Technology) for Fixation of Implants to Bone – A Histological Pilot Study in Sheep

The BoneWelding® Technology offers new opportunities to anchor implants within bone. The technology melted the surface of biodegradable polymer pins by means of ultrasound energy to mould material into the structures of the predrilled bone. Temperature changes were measured at the sites of implantation in an in vitro experiment. In the in vivo part of the study two types of implants were implanted in the limb of sheep to investigate the biocompatibility of the method. One implant type was made of PL-DL-lactide (PLA), the second one was a titanium core partially covered with PLA. Healing period was 2 and 6 months, with 3 sheep per group. Bone samples were evaluated radiologically, histologically and histomorphometrically for bone remodeling and inflammatory reactions. Results demonstrated mild and short temperature increase during insertion. New bone formed at the implant without evidence of inflammatory reaction. The amount of adjacent bone was increased compared to normal cancellous bone. It was concluded that the BoneWelding® Technology proved to be a biocompatible technology to anchor biodegradable as well as titanium-PLA implants in bone.

Treatment of a coxofemoral luxation in a pony using a prosthetic capsule technique.

OBJECTIVE To report open reduction and joint stabilization using a prosthetic capsule technique for treatment of a craniodorsal coxofemoral luxation in a lightweight pony. STUDY DESIGN Clinical report. ANIMALS Pony stallion (8 years old, 113 kg). METHODS A craniodorsal approach to the coxofemoral joint was performed under general anesthesia. After open reduction, a prosthetic capsule technique was used. Four 3.5 mm self-tapping cortical anchor screws were implanted: 2 screws were inserted above the cranial aspect of the dorsal acetabular rim, and 2 screws were inserted into the femoral neck. Subsequently, a #5 USP ultra-high molecular weight polyethylene suture was placed through these anchor screws in figure-8 fashion to serve as a prosthetic capsule. Routine closure and a medial patellar desmotomy completed the surgical procedure. Postoperatively, the pony was cross tied for 4 weeks to prevent it from lying down. RESULTS Neither short-term nor long-term complications occurred and the pony was sound at the follow-up examination performed 15 months postoperatively. CONCLUSIONS A prosthetic capsule technique can be used successfully to stabilize the coxofemoral joint after open reduction of a craniodorsal luxation in a lightweight pony.

Bacterial meningitis after sinus surgery in five adult horses.

OBJECTIVE To report meningoencephalitis as a complication after paranasal sinus surgery in 5 horses. STUDY DESIGN Case series. ANIMALS Adult horses (n = 5). METHODS Medical records (2005-2010) of 5 horses that developed neurologic signs after sinus surgery were reviewed to identify potential risk factors, cause(s), or common pathways for infection. RESULTS Underlying diseases were primary (n = 1) and secondary sinusitis (4) because of apical dental infection (1), sinus cyst (2), or masses in the ethmoturbinate region (2). Horses were treated by conventional surgical approaches and aftercare including repeated sinus lavage. Four horses had undulating pyrexia postoperatively despite antimicrobial therapy. All horses developed neurologic signs, eventually unresponsive to treatment. Suppurative meningoencephalitis was diagnosed macro- and/or microscopically on necropsy in all horses. CONCLUSION Meningitis is a rare but fatal complication after sinus surgery in horses.Objective To report meningoencephalitis as a complication after paranasal sinus surgery in 5 horses. Study Design Case series. Animals Adult horses (n = 5). Methods Medical records (2005–2010) of 5 horses that developed neurologic signs after sinus surgery were reviewed to identify potential risk factors, cause(s), or common pathways for infection. Results Underlying diseases were primary (n = 1) and secondary sinusitis (4) because of apical dental infection (1), sinus cyst (2), or masses in the ethmoturbinate region (2). Horses were treated by conventional surgical approaches and aftercare including repeated sinus lavage. Four horses had undulating pyrexia postoperatively despite antimicrobial therapy. All horses developed neurologic signs, eventually unresponsive to treatment. Suppurative meningoencephalitis was diagnosed macro- and/or microscopically on necropsy in all horses. Conclusion Meningitis is a rare but fatal complication after sinus surgery in horses.

Metabolic changes associated with anaesthesia and cherry poisoning in a pony

OBSERVATIONS A case of a pony with severe cyanide intoxication as a result of cherry ingestion is presented. General anaesthesia was performed for colic surgery. Severe metabolic lactate acidosis in combination with a high arterial oxygen partial pressure and clinically good peripheral perfusion parameters were the remarkable signs during anaesthesia. Severe hypothermia was obvious during recovery. Ten hours post-surgery the pony was euthanized as a result of neurological signs. The diagnosis of cyanide intoxication was made post-mortem. CONCLUSION Cherry ingestion can lead to lethal cyanide intoxication in horses indicated by severe nonhypoxic lactic acidosis during anaesthesia.

Radiographic and Computed Tomographic Configuration of Incomplete Proximal Fractures of the Proximal Phalanx in Horses Not Used for Racing

OBJECTIVE To characterize the configuration of incomplete proximal fractures of the proximal phalanx (P1) in horses not used for racing and compare radiographic with computed tomography (CT) findings. STUDY DESIGN Historical cohort. ANIMALS Twenty-four horses with incomplete fractures of P1. METHODS Medical records of horses not used for racing diagnosed with an incomplete proximal fracture of P1 based on clinical and radiographic examination and confirmed by CT between 2008 and 2013 were retrieved. Radiographs and CT studies of these horses were analyzed using a subjective grading system and by measuring variables that characterized fracture configuration. RESULTS Twenty-four horses were included (20 Warmbloods) with a mean age of 9.5 years and mean body weight of 574 kg. Fourteen forelimbs and 10 hind limbs were affected. Mean duration of lameness was 8.7 weeks. Computed tomography was superior to radiography in both identifying the fracture and determining fracture size and location. On CT, 92% of fractures were located in the mid-sagittal plane. Mean proximodistal length of the fracture was 13 mm. Fractures were frequently not bicortical. Fractures in forelimbs were located significantly more dorsally than fractures in hind limbs. A distinct fracture pattern with 2 subchondral lines running parallel in close proximity to each other was identified in 54% of cases. CONCLUSION Incomplete proximal fractures of P1 have significant variation in their configurations, especially their dorsopalmar/-plantar location. Computed tomography examination allowed clear identification of the fracture configurations and was superior to radiography.Objective To characterize the configuration of incomplete proximal fractures of the proximal phalanx (P1) in horses not used for racing and compare radiographic with computed tomography (CT) findings. Study Design Historical cohort. Animals Twenty-four horses with incomplete fractures of P1. Methods Medical records of horses not used for racing diagnosed with an incomplete proximal fracture of P1 based on clinical and radiographic examination and confirmed by CT between 2008 and 2013 were retrieved. Radiographs and CT studies of these horses were analyzed using a subjective grading system and by measuring variables that characterized fracture configuration. Results Twenty-four horses were included (20 Warmbloods) with a mean age of 9.5 years and mean body weight of 574 kg. Fourteen forelimbs and 10 hind limbs were affected. Mean duration of lameness was 8.7 weeks. Computed tomography was superior to radiography in both identifying the fracture and determining fracture size and location. On CT, 92% of fractures were located in the mid-sagittal plane. Mean proximodistal length of the fracture was 13 mm. Fractures were frequently not bicortical. Fractures in forelimbs were located significantly more dorsally than fractures in hind limbs. A distinct fracture pattern with 2 subchondral lines running parallel in close proximity to each other was identified in 54% of cases. Conclusion Incomplete proximal fractures of P1 have significant variation in their configurations, especially their dorsopalmar/-plantar location. Computed tomography examination allowed clear identification of the fracture configurations and was superior to radiography.

Equine ulnar fracture repair with locking compression plates can be associated with inadvertent penetration of the lateral cortex of the radius

OBJECTIVE To evaluate if the use of locking head screws (LHS) in the distal holes of a locking compression plate (LCP) applied to the caudal aspect of the ulna to treat equine ulnar fractures is associated with a risk of injury to the lateral cortex of the radius. STUDY DESIGN Controlled laboratory study. SAMPLE POPULATION Cadaveric equine forelimbs (n = 8 pair). METHODS After transverse ulnar osteotomy, osteosynthesis was performed with a narrow 10-13 hole 4.5/5.0 LCP applied to the caudal aspect of each ulna. The distal 3 holes were filled with 4.5 mm cortex screws (CS) in 1 limb (group 1) and with 5.0 mm LHS contralaterally (group 2). CS were inserted in an angle deemed appropriate by the surgeon and LHS were inserted perpendicular to the plate. Implant position and injury to the lateral cortex of the radius were assessed by radiography, CT, and limb dissection. RESULTS In group 1, injury of the lateral radius cortex did not occur. In group 2, 4 limbs and 6/24 LHS were associated with injury of the lateral radius cortex by penetration of a LHS. This difference was statistically significant. CS were inserted with a mean angle of 17.6° from the sagittal plane in a caudolateral-craniomedial direction. CONCLUSIONS Use of LHS in the distal part of a LCP applied to the caudal aspect of the ulna is associated with a risk of inadvertent injury to the lateral cortex of the radius.

Locking Compression Plate Fixation of Equine Tarsal Subluxations.

OBJECTIVE To report the clinical findings and outcome of locking compression plate (LCP) fixation of tarsal subluxations in horses. STUDY DESIGN Retrospective case series. ANIMALS Horses (n = 3) and ponies (2). METHODS All horses and ponies diagnosed with tarsal subluxations and treated with LCP fixation at our institution between 2011 and 2013 were included. Data were collected from the medical records, including all radiographic and computed tomographic (CT) studies and reviewed. Long-term (>1 year) followup examination, including owner interview, and clinical and radiographic examinations were performed for all cases. RESULTS Subluxations of the tarsometatarsal (n = 3) and proximal intertarsal (2) joints were diagnosed. CT examinations revealed complex joint injuries, including a combination of avulsion fragments and compression injuries at the opposite side of the joint from the subluxation. The LCP was applied to the plantarolateral or medial side of the limb. All horses survived and were discharged from the hospital. Short-term complications included mild laminitis (n = 1) and peroneus tertius rupture (2). At long-term followup, both ponies were sound and used as intended, whereas all horses showed mild to moderate lameness at the trot and were used for pleasure riding only. Radiographic signs of osteoarthritis developed in the joint affected by subluxation in all cases and in adjacent small tarsal joints in 2 horses and 1 pony. CONCLUSION LCP fixation of tarsal subluxations resulted in stable fixation and allowed adequate healing. Subluxation of the small tarsal joints represents a complex injury and osteoarthritis commonly develops in the affected and adjacent joints.

Bacterial Meningitis After Sinus Surgery in Five Adult Horses: Bacterial Meningitis After Sinus Surgery

OBJECTIVE To report meningoencephalitis as a complication after paranasal sinus surgery in 5 horses. STUDY DESIGN Case series. ANIMALS Adult horses (n = 5). METHODS Medical records (2005-2010) of 5 horses that developed neurologic signs after sinus surgery were reviewed to identify potential risk factors, cause(s), or common pathways for infection. RESULTS Underlying diseases were primary (n = 1) and secondary sinusitis (4) because of apical dental infection (1), sinus cyst (2), or masses in the ethmoturbinate region (2). Horses were treated by conventional surgical approaches and aftercare including repeated sinus lavage. Four horses had undulating pyrexia postoperatively despite antimicrobial therapy. All horses developed neurologic signs, eventually unresponsive to treatment. Suppurative meningoencephalitis was diagnosed macro- and/or microscopically on necropsy in all horses. CONCLUSION Meningitis is a rare but fatal complication after sinus surgery in horses.Objective To report meningoencephalitis as a complication after paranasal sinus surgery in 5 horses. Study Design Case series. Animals Adult horses (n = 5). Methods Medical records (2005–2010) of 5 horses that developed neurologic signs after sinus surgery were reviewed to identify potential risk factors, cause(s), or common pathways for infection. Results Underlying diseases were primary (n = 1) and secondary sinusitis (4) because of apical dental infection (1), sinus cyst (2), or masses in the ethmoturbinate region (2). Horses were treated by conventional surgical approaches and aftercare including repeated sinus lavage. Four horses had undulating pyrexia postoperatively despite antimicrobial therapy. All horses developed neurologic signs, eventually unresponsive to treatment. Suppurative meningoencephalitis was diagnosed macro- and/or microscopically on necropsy in all horses. Conclusion Meningitis is a rare but fatal complication after sinus surgery in horses.