Single-stage reconstruction of third-degree perineal lacerations in horses under general anesthesia: Utrecht repair method.

OBJECTIVE: To describe perioperative management, surgical procedure, and outcome in mares with third-degree perineal lacerations (TDPL) treated with a single-stage repair, the Utrecht repair method (URM). STUDY DESIGN: Retrospective study. ANIMALS: Twenty mares with TDPL. METHODS: Medical records of mares with TDPL reconstructed with a URM were reviewed for perioperative management; surgical outcome; and postoperative fertility, athletic performance, and complications. RESULTS: Mares ranged in age from 3.5 to 11 years. Long-term follow-up was available for 13 mares. Mean duration of follow-up was 9 years (median, 9.5; range, 2-215 months (17.9 years)). Standardized perioperative fasting and postoperative refeeding protocols were used. Only five mares received supportive gastric medication. Reconstruction of the rectovestibular shelf was successful in 18 of 20 mares. Two of 20 mares developed a small rectovestibular fistula after the initial repair, which was successfully repaired with a second surgery. Other postoperative complications were observed in 13 mares and consisted of mild postanesthetic myositis, facial nerve paralysis, esophageal obstruction, rectal obstipation, partial perineal dehiscence, and rectal or vestibular wind-sucking. Six of seven mares that were subsequently bred became pregnant. One mare was successfully used for embryo recovery, and five of six mares foaled without recurrence of a TDPL. Nine of 13 mares were used for riding at various levels. CONCLUSION: The alternative single-stage reconstruction for TDPL was successful in 18 of 20 mares after a single surgery. No major complications related directly to the technique were noted. CLINICAL SIGNIFICANCE: The URM is a valid alternative surgical technique for repairing TDPL in mares.

Arthroscopic Removal of Large Extensor Process Fragments in 18 Friesian Horses: Long-Term Clinical Outcome and Radiological Follow-Up of the Distal Interphalangeal Joint.

OBJECTIVE: Report long-term clinical and radiological follow-up in horses after removal of large extensor process fragments occupying >25% of the joint surface of the distal interphalangeal joint (DIJ). STUDY DESIGN: Retrospective case series. ANIMALS: Friesian horses (n=18) that underwent arthroscopic removal of a large extensor process fragment. METHODS: Arthroscopic examination of the DIJ was performed in dorsal recumbency with the affected foot in extension using routine portals. Visualization of the fragment was improved using motorized synovial resectors. A dissection plane between the common digital extensor tendon and the extensor process fragment was created using sharp lever instruments, in some cases aided by motorized burrs and radiofrequency ligament dissection. The fragment was removed piecemeal using Ferris-Smith rongeurs. Medical records, preoperative and postoperative radiographs, and owner surveys were reviewed for case details and outcome. RESULTS: The technique described allowed removal of the large fragment in all 18 horses. Of the 17 horses where long-term clinical follow-up was available, 14 were used as intended and 3 kept some degree of lameness. The angle between the remodeled extensor process and the dorsal surface of the distal phalanx was increased and subchondral bone remodeling at the fragment bed was noted on postoperative lateromedial radiographs. CONCLUSION: Arthroscopic removal is a good treatment option for horses with large extensor process fragmentation with a good long-term outcome. Remodeling of the remaining extensor process and the subchondral new bone formation in the fragment bed can occur with functional recovery.

An Alternative, Direct Approach for Arthroscopic Removal of Osteochondral Fragments in the Dorsal Pouch of the Proximal Intertarsal Joint of Horses.

OBJECTIVE: To describe an alternative technique and resulting outcomes for arthroscopic removal of osteochondral (OC) fragments from the proximal intertarsal joint (PIJ) using a direct approach without resection of the membrane between the tarsocrural joint (TCJ) and the PIJ. STUDY DESIGN: Retrospective case series. ANIMALS: Client owned horses (n = 11) with Category 1 OC fragments in the PIJ. METHODS: Arthroscopic examination of the dorsal pouch of the TCJ was performed with horses positioned in dorsal recumbency using routine portals. A hook probe placed through one of the standard portals was used to lift the edge of the communication between TCJ and PIJ to help pass the arthroscope into the PIJ from the opposite standard portal. A third direct portal into the PIJ was created under arthroscopic visualization, and loose OC fragments (Category 1) were removed using the direct portal. Medical records, race records, and owner surveys were reviewed for case details and outcome. RESULTS: The described technique allowed removal of all fragments in all 11 cases. No complications associated with the procedure were observed. Of the 9 horses with long term follow-up available, 7 were used as intended (4/4 riding horses, 3/5 racehorses). Two horses did not enter an athletic career because of reasons unrelated to fragment removal. CONCLUSION: A direct approach for arthroscopic removal of OC fragments of the PIJ using a third portal into this joint, without resection of the membrane between the TCJ and PIJ is a good alternative for removal of fragments at this site.

Management and outcome of fractures of the distal phalanx: a retrospective study of 285 horses with a long term outcome in 223 cases.

A multicentre study of 285 cases was performed to enhance the management of distal phalangeal fractures on the basis of clinical evidence. The outcome after treatment was available for 223 of the cases. Horses with a non-articular type I fracture had a better prognosis (91.7%) for return to original or expected level of use than horses with an articular type II or III fracture (69.6% and 74.1%, respectively). The prognosis for types IV and V fractures was fair (57.7% and 57.1%, respectively) and for type VI good (80%). Horses with a hindlimb fracture had a significantly greater chance of a successful outcome. No significant association between age or time to start treatment and success rate was noted. The best treatment option for types I-III fractures was a conservative approach (box rest). Type IV fractures were best treated by arthroscopic removal of the fragment. Immobilisation of the hoof did not seem to influence outcome. Radiological findings and clinical healing were not accurately correlated and the re-commencement of training should be based on clinical rather than radiological findings. Complete osseous union of the fracture was not essential for a successful return to athletic activity.

Osseous lesions in the metacarpo(tarso)phalangeal joint diagnosed using low-field magnetic resonance imaging in standing horses.

We report the use of low-field standing magnetic resonance imaging in the standing horse for the diagnosis of osseous lesions in the metacarpophalangeal (MCP) or metatarsophalangeal (MTP) joint that were not apparent using standard radiography. Thirteen horses were studied and all had thickening of the subchondral bone plate and abnormal signal intensity in the adjacent spongiosa in either the condyles of metacarpal/metatarsal III or the proximal phalanx or both. Abnormalities were characterized by diffuse decreased signal intensity on T1-weighting adjacent to the subchondral bone and within the spongiosa in at least two imaging planes; in the absence of increases in signal intensity in fat-suppressed images, this change was interpreted as bone sclerosis. Nine horses also had a diffuse decreased signal intensity on T2*-weighting in the same areas and five had a diffuse increase in signal intensity in fat-suppressed images in conjunction with a decrease in signal intensity on T1- and T2*-weighted images; the increase in signal intensity in fat-suppressed images was interpreted as fluid accumulation. Five horses had a focal area of change in signal intensity within the subchondral bone with apparent loss of definition between the subchondral bone and the articular cartilage. Eleven horses were available for follow up, of which eight were sound and three remained lame. We conclude that lameness originating from the MCP or MTP joint may be associated with osseous damage in horses of any signalment in the absence of radiographic changes.