Total removal of the fourth metacarpal bone in an Icelandic horse.

Fractures of the splint bones are the most common fractures in horses. Various treatment options for splint bone fractures (MC/MT II and IV), including conservative and surgical management, have been described. This report describes an acute splint bone fracture due to external trauma in a 17-year-old Icelandic mare. The fracture was diagnosed as an open multifragment fracture of the proximal third of the fourth metacarpal bone (MCIV) in the right front limb. Surgery was performed with the horse under general anaesthesia. The distal fragments were removed, and the distal part of the proximal remnant splint bone was cut with an osteotome. During the postoperative period, a routine x-ray-control two days after surgery showed a dislocated fracture of the remaining proximal part of the fourth metacarpal bone. In a second surgery, the proximal part of MCIV was entirely removed. After a reconvalescence period of 5 month, the horse reached her previous level of performance as a leisure horse. The mare is still free of lameness 6 years after the incident.

[Unilateral mandibular fracture in horse - Treatment with fixateur externe, a complication during implant removal and procedure for removal of implant fragments]. / Unilaterale Mandibulafraktur bei einem Pferd.

The first part of this case report describes the surgical treatment of a unilateral mandibular fracture in the standing horse by using a fixateur type I. By the time of implant removal, the fracture had completely healed. However, during implant removal, an implant failure of 2 of the 4 implants occurred with fragments remaining in the bone. The second part of the report focuses on the development of a special surgical instrument that was designed for removal of the implant fragments. Furthermore, the surgical method allowing the entire extirpation of the fragments within a second surgery is described.According to the authors' knowledge, this is the first case report showing the use of the presented surgical technique for the treatment of a mandibular fracture in the standing horse. Additionally, this report also provides an approach for removing implant fragments from the depth of the bone which may occur in case of implant breakage as a potential complication of the described surgery.

Arthrodesis of the equine proximal interphalangeal joint: a biomechanical comparison of 2 different LCP systems.

OBJECTIVE: This study compares the mechanical stability and surgical usability of 2 locking plate systems (Kyon ALPS-20 and Synthes PIP-LCP system) for arthrodesis of the equine proximal interphalangeal joint (PIJ). MATERIAL AND METHODS: The experimental ex vivo study included 6 pairs of cadaver distal limbs (n = 12). All specimens were derived from Warmblood horses of various ages that were euthanized for non-orthopedic reasons. Of the 12 limbs collected, 3 left and 3 right distal limb specimens were randomly assigned to each system for implantation. Two abaxial 4.5-mm cortical screws were inserted transarticularly in all cases. Both systems were implanted according to the manufacturer's instructions with the plates placed centrally between the 2 transarticular screws. The ALPS-20 systems were implanted using Kyon B-6.4-mm monocortical locking screws in all positions. The LCP systems were implanted axially using 2 Synthes 5-mm locking screws in the proximal and distal positions, with a standard 4.5-mm cortical screw inserted in the middle position. All constructs underwent CT-scans after implantation and biomechanical testing to detect implant deformation. Uniaxial mechanical loading was applied via a servo-hydraulic test system at a test speed of 50 mm/s, up to a maximum displacement of 80 mm. The resulting load-displacement curves were used to calculate yield point, stiffness, and maximum force for each construct. The measured values were evaluated for statistical significance (p < 0.05) between the 2 plate systems via one-factor ANOVA (Tukey test). The statistical power was verified for yield force, stiffness, and maximum load. RESULTS: No statistically significant differences between the 2 preparation groups were calculated across all of the measured parameters (p > 0.05). The ALPS system implants showed no signs of deformation, either in the plates or the screws. In contrast, the LCP demonstrated visible deformation, which had already occurred at the time of implantation from the tightening of the middle screw, as well as during the subsequent testing of the implants. After biomechanical testing, deformations ranging between 3.1° and 7.0° were measured in 4 LCPs. A total implant failure was observed for 2 LCPs. CONCLUSION AND CLINICAL RELEVANCE: Both systems demonstrated comparable mechanical properties in the present study's ex vivo test model for equine PIJ arthrodesis. As such, the Kyon ALPS-20 may be a good alternative to the Synthes LCP for equine PIJ arthrodesis.

[Intramural jejunal lipoma in the small intestine of a young Arabian horse causing invagination of the jejunum]. / Intramurales Lipom im Jejunum als Ursache für eine Invagination bei einer jungen Araberstute.

A 2-year-old Arabian horse was presented with severe colic symptoms. During explorative laparotomy, a jejuno-jejunal invagination secondary to a submucosal intestinal mass was detected. The involved jejunal segment was surgically removed and an end-to-end anastomosis was created. Opening the specimen demonstrated the presence of a nodular mass on the head of the intussusceptum, measuring 10 cm in diameter, and almost completely obliterating the intestinal lumen. Additionally, a severe hyperemia of the jejunal mucosa was visible. Histological examination, which revealed a well-demarcated mass in the submucosa of the jejunum consisting of well-differentiated adipocytes, led to the diagnosis of an intramural lipoma. The small intestinal mucosa displayed mild to moderate signs of congestion. Pedunculated lipomas in the mesentery of horses causing intestinal volvulus and obstruction are a frequent cause of small-intestine strangulation in aged horses. To the authors' knowledge, intramural intestinal lipomas to date have not been described in the horse. The mare recovered without complications and was free of colic symptoms after 6 months.

Aryepiglottic fold augmentation as treatment for late-onset dysphagia following surgical treatment of recurrent laryngeal neuropathy.

OBJECTIVE: Coughing and dysphagia have been described following prosthetic laryngoplasty (LP) with or without ventriculectomy/ventriculocordectomy (VE/VCE) for the treatment of recurrent laryngeal neuropathy. All previous case descriptions include patients with acute onset of clinical signs after surgery that persisted. The authors observed a late-onset of dysphagia and coughing months to years after LP ± VE/VCE. The condition was always associated with an abnormality of the aryepiglottic fold (AEF). Treatment options for those patients are limited. We suggest augmentation of the AEF as treatment for affected horses. The goal of the study was two-fold: Firstly, to describe a new condition of late-onset dysphagia in horses following LP ± VE/VCE associated with an abnormal appearance of the AEF, and secondly, to offer a minimally invasive and successful treatment for those patients. MATERIAL AND METHODS: Six horses were presented because of dysphagia and coughing with an onset of months to years after LP ± VE/VCE. Endoscopically, the AEF always appeared thinner and more flaccid to a varying degree. The food path was traceable along the AEF into the trachea using dyed molasses. An initial injection of hyaluronic acid (HA) into the AEF led to immediate improvement of the dysphagia. The procedure was performed in the standing sedated horse. The needle was placed through the cricothyroid ligament and the injection performed under endoscopic guidance. RESULTS: All horses tolerated the injection well. Injection of HA was successful only in the short term in all cases and repeated injections were needed for permanent resolution using either cross-linked HA, polyacrylamide hydrogel or platelet rich plasma. CONCLUSION AND CLINICAL RELEVANCE: Horses may develop dysphagia and coughing months to years after LP ± VE/VCE as a late-onset complication. The condition seems to be associated with an abnormal appearance and function of the AEF. Successful treatment is possible by augmenting the AEF. However, careful patient selection is mandatory.