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BACKGROUND: Desmitis of the accessory ligament of the deep digital flexor tendon (ALDDFT) is a commonly reported injury. Despite the commonality of this injury, the literature is limited to small case series, with the reported success following treatment varying from 18% to 75%. OBJECTIVES: To identify the prognosis and factors associated with a return to work following ALDDFT injury. STUDY DESIGN: Retrospective case series. METHODS: Medical records of horses from four equine hospitals (January 2000 and December 2018) with a diagnosis of desmitis of ALDDFT were reviewed. Data retrieved included case detail, use, history, lameness treatment and follow-up. Success was defined as returning to work. Backward stepwise logistic regression was used to identify variables significantly associated with return to work. RESULTS: Ninety-one horses were included. The mean age was 13.5 years (standard deviation 4.9 years). Thirty-four percent (28/91) of horses were sound at the initial presentation. Sixty-eight percent (62/91) of horses were managed using controlled exercise alone, 28% (29/91) were treated with intra-lesional injection, therapeutic ultrasound, extracorporeal shockwave therapy or desmectomy of the ALDDFT and 3% (3/91) were euthanased without treatment. Sixty-four percent (54/85) of horses returned to work. Horses that were lame at follow-up were less likely to return to work (odds ratio [OR] 107.93, 95% confidence interval [CI] 20.06-580.61, p < 0.001) than those that returned to soundness. Identification of adhesions on ultrasonography was also associated with having reduced odds for return to work when compared to horses without adhesions (OR 0.10, 95% CI 0.01-0.76, p = 0.03). MAIN LIMITATIONS: Retrospective nature of the study, the potential of selection bias with regards to follow-up. CONCLUSION: Sixty-four percent (54/85) of horses returned to work following injury of the ALDDFT. Persistence of lameness and adhesion formation were significantly associated with a poor outcome.
RESUMO
INTRODUCTION: Fracture configuration is often more complex than is radiographically appreciable. The objective of this study is to describe the influence of pre-operative computed tomography (CT) for surgical planning in a variety of fracture types. This has not been described in previous studies. MATERIALS AND METHODS: All cases with pre-operative radiographs, admitted for CT and surgical repair of a suspected limb fracture from January 2010-December 2020 were reviewed. CT was acquired under general anaesthesia in a multi-slice helical scanner; any surgery was then performed immediately. Three diplomates (two surgical; one diagnostic imaging) performed a blinded retrospective review of the radiographs and CT for each horse. A consensus decision was made on any change in surgical plan prior to and after CT review, and cases divided into three categories: CT of major, intermediate or minor relevance, as previously described by Genton et al, 2019. RESULTS: 55 cases were collated. Thoroughbred racehorses predominated. The median age was 3 years. A diverse range of fractures were presented: proximal phalanx (18/55), carpal (17/55), metacarpal/tarsal (11/55), sesamoid (5/55), tarsal (3/55), and middle phalanx (1/55). In 13 of 55 cases (23.6%, 95% CI[12%,35%]) CT was of major relevance. In 21 of 55 cases CT was of intermediate relevance (38.2%, 95% CI[25%,51%]). In 21 of 55 cases CT was of minor relevance (38.2%, 95% CI[25%,51%]). A Fisher's exact test demonstrated no statistical difference in CT relevance between fracture types (p<0.05). DISCUSSION/CONCLUSIONS: This study demonstrates that CT has a significant role in surgical planning, and in the majority (61.8%) of cases added additional information or significantly changed the surgical plan. In all cases CT ensured confidence in surgical planning.
