A retrospective multicenter study on the use of locking compression plates for scapulohumeral arthrodesis in small equids.

OBJECTIVE: To report on technical aspects and outcomes after scapulohumeral arthrodesis (SHA) with a locking compression plate (LCP) in small equids. STUDY DESIGN: Retrospective multicenter case series. ANIMALS: Client-owned Shetland Ponies, Miniature Shetlands, and American Miniature Horses (n = 15). METHODS: Inclusion criteria were completed SHA with an LCP to treat scapulohumeral osteoarthritis/subluxation and availability of postoperative radiographs. Contributing surgeons completed a questionnaire to collect data. All radiographs were reviewed for this study. Follow-up information was obtained via re-admission to the hospital or telephone interview of the referring veterinarian or owner. Outcome was subjectively scored as excellent, good, moderate, or poor based on lameness and function. RESULTS: Sixteen SHAs were performed in 15 equids (body weight 65-145 kg) by nine different surgeons. A narrow 4.5/5.0 mm LCP (7-16 holes) was used in 14 of the 16 SHAs. Follow-up was collected 2.5 years after surgery (median; range: 9 weeks to 10 years). Major complications related to the SHAs were noted in 4 of the 13 horses alive long term, consisting of implant failure (n = 1), surgical site infection (n = 2), and scapular fracture (n = 1). The outcome was graded as excellent in 4, good in 5, and moderate in 4 horses. Two ponies were euthanized because scapulohumeral osteoarthritis and subluxation developed in the contralateral limb. CONCLUSION: Although major complications occurred in about one-third of ponies, SHA with LCP led to long-term survival with good function in most ponies. CLINICAL SIGNIFICANCE: SHA with an LCP offers a high chance for good long-term outcome in small equids although contralateral disease may affect outcome.

Other Clinical Problems of the Equine Foot.

Many disorders affect the equine foot, and many hoof problems have multiple predisposing causes. Surgery may be necessary after conservative management has failed. Diseases of the hoof capsule may seem simple, but their effect on performance can be long-lasting and healing is often prolonged. Diagnosis of problems within the hoof capsule is enhanced with the use of computed tomography and MRI. The prognosis of fractures has improved with strategic placement of lag screws across fracture planes using aiming devices and advanced intraoperative imaging techniques. Collaboration between the clinician and a skilled farrier is important for successful management of hoof disorders.

Long-term clinical and radiographic results after lag screw ostheosynthesis of short incomplete proximal sagittal fractures of the proximal phalanx in horses not used for racing.

OBJECTIVE: To determine long term outcomes of nonracing equines athletes treated for short incomplete proximal sagittal fractures of the proximal phalanx (SIPSFP1) by lag screw fixation. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Thirty-one horses. METHODS: Medical records from horses with an SIPSFP1 (2008-2014) were reviewed. Long-term (≥12 months) outcomes were assessed with telephone interviews and clinical and radiographic examinations. RESULTS: Warmblood was the predominant breed in cases included in the study. Among horses with long-term interview information, 27 of 31 returned to previous athletic activity level. In total, 15 horses with 19 fractures had clinical and radiographic assessment after a minimum of 12 months. Among those, nine of 15 horses were sound at the trot, and six of 15 were mildly lame. Complete radiographic healing was confirmed in six limbs, and the facture line was evident in 13. The position of the proximal screw was not associated with radiographic fracture healing or return to soundness. CONCLUSION: Most horses treated for SIPSFP1 with lag screw fixation returned to previous activity levels, although radiographic fracture healing remained incomplete 12 months or more after surgery. CLINICAL SIGNIFICANCE: Lag screw fixation is a valid treatment for horses not used for racing that are experiencing an SIPSFP1 and results in a high rate of return to intended use, although complete radiographic fracture healing cannot be expected.

Use of an aiming device and computed tomography for assisted debridement of subchondral cystic lesions in the limbs of horses.

OBJECTIVE: To describe the use of an aiming device (AD) and computed tomography (CT) for preoperative planning and intraoperative guided debridement of subchondral cystic lesions (SCL) in the limbs of horses and to determine the outcome 12 months after surgery. STUDY DESIGN: Prospective case series. ANIMALS: Twelve horses referred because of lameness caused by 1 or 2 SCL (total of 14 SCL). METHODS: All horses underwent CT-guided debridement of the SCL. The entry point of the drill bit and direction of drilling were planned and controlled by using a series of CT images and the AD. The SCL were curetted and filled with recombinant human bone morphogenetic protein-2. Surgical times were calculated, and the outcome was determined 12 months after surgery. RESULTS: The use of an AD and CT allowed precise and straightforward drilling of the SCL. The entry point of the drill bit into the SCL was considered optimal in 11 SCL and satisfactory in 3 SCL, and the lesions could be precisely debrided with preservation of the adjacent subchondral bone in all cases. There were no complications. Mean (range) surgery time was 75 (45-115) minutes. The outcome 12 months postoperatively was favorable in 10 of 11 horses. One horse died due to unrelated reasons. CONCLUSION: The use of CT and an AD allowed precise debridement of all SCL in the limbs of 12 horses. CLINICAL SIGNIFICANCE: CT-guided surgical debridement of SCL of the equine digit appears to result in a favorable outcome.

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.

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.

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.

Differences of morphological attributes between 62 proximal and distal subchondral cystic lesions of the proximal phalanx as determined by radiography and computed tomography.

OBJECTIVE: To determine morphological characteristics of subchondral cystic lesions (SCLs) in the proximal phalanx (PP) of adult horses. SAMPLE: Radiographs and/or CT scans of PP from 46 horses. PROCEDURES: There were horses with a SCL in PP, which was diagnosed by radiography and/or computed tomography, included. Additional data (signalment, history, orthopedic examination) were collected retrospectively for each case. RESULTS: Forty-six horses met the required inclusion criteria, with a total of 62 SCLs. Forty-three SCLs (70.5%) were located in the proximal PP (group A). Forty-four percent of these were associated with short, incomplete fractures, while 30 of the proximal PP SCLs (69.7%) were found mid sagittal. Proximal SCLs mostly showed a blurred, irregular shape (62.8%) and long, as well as wide, but shallow shapes in CT. Eighteen SCLs (29.5%) were found in the distal PP, near the proximal interphalangeal joint (group B). In contrast to the described proximal SCLs, the distal SCLs were of circular or oval shape, well delineated (77.8%), and distinctly larger. Horses of group A were significantly older (mean age, 11.47 years) than horses of group B (mean age, 6.72 years). CLINICAL RELEVANCE: The distribution and morphological attributes of proximal PP SCLs as well as their association to subchondral bone lesions and short, incomplete proximal fractures indicate more recently developed lesions due to chronic stress factors, such as repetitive trauma to the cartilage and subchondral bone. In contrast, morphology and distribution of distal SCLs showed high accordance with developmental bone cysts originating from a failure of endochondral ossification.

Simulated Kick Injury to the Mandible in Horses: Study of Fracture Configurations and Physical Parameters of the Impact.

OBJECTIVE: The goal of this study was to generate mandibular fractures in three regions of the diastema using a metal impactor to simulate a kick from a horse and to determine the mean deceleration in the initial phase of the impact event, the maximum contact force, the impact energy necessary to create a fracture and the duration of the impact. STUDY DESIGN: Thirty heads of horses aged between 5 and 20 years and euthanatized for various reasons were used. The heads were attached to a steel bar at the occiput at an axial angle of 45 degrees so that the body of the mandible was positioned horizontally and directly under the trajectory of the impactor. A 2 kg solid impactor was dropped with velocities of 6 to 14 m/s to simulate a kick from a horse. The impact was recorded using a high-speed video camera with a frame rate of 30,000 frames per second. Radiographs of the heads were obtained before and after the simulated kick. RESULTS: Mandibular fractures with configurations similar to those seen in clinical practice were generated at all three locations. The mean deceleration increased with impact velocity and with more cranially located impact positions. Absorbed energy increased with increasing impact velocity when no fracture was generated. CONCLUSION: The susceptibility to experimental fracture of the diastema increased from rostral to caudal locations, which is most probably caused by decreasing mandibular bone strength and an increase in the curvature at the lateroventral aspect of the mandible in that region. Physical parameters depended on fracture occurrence and type.

Development and Characterization of a Subcutaneous Implant-Related Infection Model in Mice to Test Novel Antimicrobial Treatment Strategies.

Orthopedic-device-related infection is one of the most severe complications in orthopedic surgery. To reduce the associated morbidity and healthcare costs, new prevention and treatment modalities are continuously under development. Preclinical in vivo models serve as a control point prior to clinical implementation. This study presents a mouse model of subcutaneously implanted titanium discs, infected with Staphylococcus aureus, to fill a gap in the early-stage testing of antimicrobial biomaterials. Firstly, three different inocula were administered either pre-adhered to the implant or pipetted on top of it following implantation to test their ability to reliably create an infection. Secondly, the efficacy of low-dose (25 mg/kg) and high-dose (250 mg/kg) cefazolin administered systemically in infection prevention was assessed. Lastly, titanium implants were replaced by antibiotic-loaded bone cement (ALBC) discs to investigate the efficacy of local antibiotics in infection prevention. The efficacy in infection prevention of the low-dose perioperative antibiotic prophylaxis (PAP) depended on both the inoculum and inoculation method. Bacterial counts were significantly lower in animals receiving the high dose of PAP. ALBC discs with or without the additional PAP proved highly effective in infection prevention and provide a suitable positive control to test other prevention strategies.

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.

Plate Removal after Internal Fixation of Limb Fractures: A Retrospective Study of Indications and Complications in 48 Horses.

OBJECTIVE: The aim of this study was to determine the indications for, and complications of, plate removal surgery in horses that underwent internal fixation of limb fractures. STUDY DESIGN: Medical records of horses presented to our hospital between 1990 and 2015 for the removal of plates after treatment of limb fractures were reviewed. Data collected at the time of initial presentation, including signalment, history, fracture features and treatment and information about the indications, timing and complications of implant removal were reviewed. RESULTS: The most common bones involved were the ulna (n = 19) and third metacarpal and metatarsal bones (n = 14). A total of 63 plates were removed from 48 horses during 53 separate surgeries, and the complication rate was 6/48; six horses had complications related to implant removal, which included persistent infection (n = 1) and refracture (n = 5). Complications related to implant removal were associated with comminuted fractures (p = 0.002), age > 3 years (p = 0.016) and the presence of surgical site infection (p = 0.001). CONCLUSION: Plate removal after fracture healing is necessary in patients with implant-associated clinical signs. There is a strong relationship between the complication rate and the degree of comminution of the original fracture, increasing age and the presence of surgical site infection. The surgeon must be aware of these risk factors when planning plate removal.

The Effect of Reducing the Bone to Cast Distance in an Equine Transfixation Pin Cast: An Ex Vivo Biomechanical Study.

OBJECTIVE: The aim of this study was to evaluate the effect of reducing the bone to cast distance on the resistance of the pin to cyclic loading in equine transfixation pin casts. STUDY DESIGN: Eleven pairs of cadaveric equine third metacarpal bones were prepared and one 6.3/8.0 mm transfixation pin was placed in standard fashion 10 mm proximal to the distal physeal scar into each bone. One metacarpus of each pair was tested with a distance of 10 mm (10 mm group) and the contralateral metacarpus with a distance of 20 mm (20 mm group) between the outer cortex of the bone and the fixation of the pin. Eight pairs were tested using a simplified test set-up in which the pins were fastened at both ends to polyoxymethylene-copolymer sleeves. The pins of the remaining three pairs of bones were incorporated into a fibreglass cast. All specimens were tested under cyclic loading until failure of the pin in axial compression. RESULTS: All pins failed uni- or bilaterally at clinically relevant load levels. Pins of the 10 mm group endured significantly (p < 0.05) higher load levels and total number of cycles until failure compared with the pins of the 20 mm group. CONCLUSION: The distance between the bone surface and the cast at the location of pin insertion has a significant effect on resistance of the pins to cyclic loading. Therefore, the amount of padding applied underneath an equine transfixation pin cast can have an influence on the overall stability and durability of the construct.

Problem of Pin Breakage in Equine Transfixation Pin Casting: Biomechanical Ex Vivo Testing of Four Different Pins.

OBJECTIVE: The aim of this study was to evaluate cyclic fatigue behaviour of a new pin with a thread run-out design in comparison with three other types of pins commonly used for equine transfixation pin casting. MATERIALS AND METHODS: Twenty-four pairs of equine cadaveric third metacarpal bones (MC3) equipped with one transfixation pin placed horizontally in the distal metaphysis were tested using a simplified model, mimicking the biomechanical situation of equine transfixation pin casting. A 6.3/8.0-mm Imex Duraface pin with thread run-out design (ITROP) was compared with a 6.1-mm smooth Steinmann pin (SSP), a Securos 6.2-mm, positive-profile pin (SPPP) and an Imex 6.3-mm, positive-profile pin (IPPP) under cyclic loading until failure in axial compression of MC3. RESULTS: All pins broke at clinically relevant load levels and cycle numbers. The SSP endured significantly (p = 0.0025) more cycles before failure (mean: 48685) than the ITROP (mean 25889). No significant differences in cycles to failure were observed comparing the SPPP versus ITROP, and the IPPP versus ITROP, respectively. CLINICAL SIGNIFICANCE: A thread run-out design does not necessarily lead to higher resistance against pin breakage under cyclic loading conditions. The SSP was most resistant against cyclic failure in these testing conditions, even though it was associated with more lateromedial displacement and cortical wear-out. This could outweigh reported disadvantages of the SSP such as reduced resistance to axial extraction and pin loosening.

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.

Use of a 3-Telsa magnet to perform delayed gadolinium-enhanced magnetic resonance imaging of the distal interphalangeal joint of horses with and without naturally occurring osteoarthritis.

OBJECTIVE To characterize delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) features of healthy hyaline cartilage of the distal interphalangeal joint (DIPJ) of horses, to determine whether dGEMRIC can be used to differentiate various stages of naturally occurring osteoarthritis of the DIPJ, and to correlate relaxation times determined by dGEMRIC with the glycosaminoglycan concentration, water content, and macroscopic and histologic findings of hyaline cartilage of DIPJs with and without osteoarthritis. SAMPLE 1 cadaveric forelimb DIPJ from each of 12 adult warmblood horses. PROCEDURES T1-weighted cartilage relaxation times were obtained for predetermined sites of the DIPJ before (T1preGd) and after (T1postGd) intra-articular gadolinium administration. Corresponding cartilage sites underwent macroscopic, histologic, and immunohistochemical evaluation, and cartilage glycosaminoglycan concentration and water content were determined. Median T1preGd and T1postGd were correlated with macroscopic, histologic, and biochemical data. Mixed generalized linear models were created to evaluate the effects of cartilage site, articular surface, and macroscopic and histologic scores on relaxation times. RESULTS 122 cartilage specimens were analyzed. Median T1postGd was lower than the median T1preGd for normal and diseased cartilage. Both T1preGd and T1postGd were correlated with macroscopic and histologic scores, whereby T1preGd increased and T1postGd decreased as osteoarthritis progressed. There was topographic variation of T1preGd and T1postGd within the DIPJ. Cartilage glycosaminoglycan concentration and water content were significantly correlated with T1preGd and macroscopic and histologic scores but were not correlated with T1postGd. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that dGEMRIC relaxation times varied for DIPJs with various degrees of osteoarthritis. These findings may help facilitate early detection of osteoarthritis.

Outcome of Ventral Fusion of Two or Three Cervical Vertebrae with a Locking Compression Plate for the Treatment of Cervical Stenotic Myelopathy in Eight Horses.

OBJECTIVES: It was recently shown that biomechanical stability achieved with a locking compression plate (LCP) for ventral cervical fusion in horses is similar to the commonly used Kerf cut cylinder. The advantages of the LCP system render it an interesting implant for this indication. The goal of this report was to describe surgical technique, complications and outcome of horses that underwent ventral fusion of two or three cervical vertebrae with an LCP. METHODS: Medical records of eight horses were reviewed for patient data, history, preoperative grade of ataxia, diagnostic imaging, surgical technique and complications. Follow-up information was obtained including clinical re-examination and radiographs whenever possible. RESULTS: Two (n = 5) or 3 (n = 3) cervical vertebrae were fused in a mixed population with a median age of 9 months, median weight of 330 kg and median grade of ataxia of 3/5. A narrow 4.5/5.0 LCP (n = 6), a broad 4.5/5.0 LCP (n = 1) and a human femur 4.5/5.0 LCP (n = 1) were applied. Two horses were re-operated due to implant loosening. Six patients developed a seroma. Long-term complications included ventral screw migration in four, spinal cord injury in one and plate breakage in two horses at 720 to 1116 days after surgery. Outcome was excellent in three, good in four, poor in one patient. CLINICAL SIGNIFICANCE: The use of an LCP for ventral cervical vertebral fusion is associated with good clinical results. However, a careful surgical technique is required to further reduce the complication rate.

Fixation of supraglenoid tubercle fractures using distal femoral locking plates in three Warmblood horses.

Three horses that were presented with supraglenoid tubercle fractures were treated with open reduction and internal fixation using distal femoral locking plates (DFLP). Placing the DFLP caudal to the scapular spine in order to preserve the suprascapular nerve led to a stable fixation, however, it resulted in infraspinatus muscle atrophy and mild scapulohumeral joint instability (case 1). Placing the DFLP cranial to the scapular spine and under the suprascapular nerve resulted in a stable fixation, however, it resulted in severe atrophy of the supraspinatus and infraspinatus muscles and scapulohumeral joint instability (case 2). Placing the DFLP cranial to the scapular spine and slightly overbending it at the suprascapular nerve passage site resulted in the best outcome (case 3). Only a mild degree of supraspinatus and infraspinatus muscle atrophy was apparent, which resolved quickly and with no effect on scapulohumeral joint stability. In all cases, fixation of supraglenoid tubercle fractures using DFLP in slightly different techniques led to stable fixations with good long-term outcome. One case suffered from a mild incisional infection and plates were removed in two horses. Placement of the DFLP cranial to the scapular spine and slightly overbending it at the suprascapular nerve passage prevented major nerve damage. Further cases investigating the degree of muscle atrophy following the use of the DFLP placed in the above-described technique are justified to improve patient outcome.

Salter-Harris type II metacarpal and metatarsal fracture in three foals. Treatment by minimally-invasive lag screw osteosynthesis combined with external coaptation.

OBJECTIVES: To describe minimally-invasive lag screw osteosynthesis combined with external coaptation for the treatment of Salter-Harris type II third metacarpal and third metatarsal bone fractures. METHODS: Three foals aged two weeks to four months with a Salter-Harris type II third metacarpal or third metatarsal fracture. Surgery was carried out under general anaesthesia in lateral recumbency. After fracture reduction, the metaphyseal fragment was stabilized with two cortical screws placed in lag fashion under fluoroscopic control. A cast was applied for at least two weeks. RESULTS: All foals had a good outcome with complete fracture healing and return to complete soundness without any angular limb deformity. All foals had moderate transient digital hyperextension after cast removal. CLINICAL SIGNIFICANCE: Internal fixation of Salter-Harris type II third metacarpal or third metatarsal fractures with two cortical screws in lag fashion, combined with external coaptation provided good stabilization and preserved the longitudinal growth potential of the injured physis.