Ex vivo comparison of standing and recumbent repair of incomplete parasagittal fractures of the first phalanx in horses

Abstract

Objective: To assess suspensory ligament extensor branch location and fracture gap reduction with simulation of standing and recumbent cortical bone screw repair of experimental incomplete parasagittal proximal phalanx (P1) fractures.Study design: Controlled laboratory study. Sample population: Twenty equine cadaver forelimbs.Methods: Simulated fractures were repaired twice in random order. A proximal cortical bone screw was placed in lag fashion with the limb unloaded (simulated recumbent repair) and loaded to 38% of body weight (range, 375-568 kg; simulated standing repair). Changes in fracture gap width were assessed on computed tomography (CT) images and with intraplanar forcesensitive resistors measuring voltage ratios (V 4 ) between loaded recumbent (R-1) and standing repair simulations (R-2). Extensor branch borders were determined relative to implant position and sagittal P1 width on transverse CT images. P ≤ .05 was considered significant.Results: Standing repair simulation-associated fracture gaps were not wider than in R-1 while controlling for confounding factors (loading weight, implant position, or animal age; P > .7, repeated-measures analysis of variance). Voltage ratio data associated with R-2 were not smaller than with R-1 (mean difference, 0.002 ± 0.052; one-sided Wilcoxon signed-rank test, P = .27). More of P1 width was approachable palmar to extensor branches when limbs were loaded (0.804 ± 0.314 cm) vs unloaded (0.651 ± 0.31 cm; paired Student's t test, P < .001). Conclusion:Simulated standing repair was not associated with inferior fracture reduction compared with loaded simulations of recumbent repairs. Limb loading affected extensor branch location relevant to implant positioning.

Standing surgery among equine board certified surgeons: Survey regarding current use and trends

“…This high number of procedures being performed standing in the last 10 years could also be directly related to the increasing number of publications describing standing surgical procedures in recent years, to the favourable outcomes reported and/or to the latest anaesthetic and technological advancements (standing CT, laser and advanced laparoscopic equipment) that facilitate diagnosis and performance of many of these procedures. 10,11,[25][26][27] We found that for most procedures performed standing (28/36, 78%), surgeons reported to perform them always or commonly that way when an eligible case was presented. Thus, familiarity with a standing procedure is likely one of the most decisive factors to routinely perform a procedure with the horse standing.…”

“…Relevant clinical data was also mentioned as an important factor to switch from GA to standing. As mentioned, we believe that results from recent literature has fostered new trends identified in this survey; however, there are just a few reports directly comparing outcomes and complications between procedures under GA and standing 25–27 . Thus, studies where the same surgical team randomly performs the procedure with the horse standing or under GA are required to truly highlight benefits and limitations of specific standing procedures.…”

“…However, it is also possible to include the 3/36 additional procedures that had always been performed standing by respondents board certified >10 years as we did not specifically ask at what point in their careers they started to perform the procedures standing. This high number of procedures being performed standing in the last 10 years could also be directly related to the increasing number of publications describing standing surgical procedures in recent years, to the favourable outcomes reported and/or to the latest anaesthetic and technological advancements (standing CT, laser and advanced laparoscopic equipment) that facilitate diagnosis and performance of many of these procedures 10,11,25–27 …”

“…There is also limited information regarding the use and prevalence of standing surgical techniques among equine surgeons and literature directly comparing outcomes between procedures performed standing versus under GA is scarce 25–27 . Thus, knowledge regarding the current use, recent trends and benefits and limitations of standing surgery among board certified surgeons would be of interest.…”

“…There is also limited information regarding the use and prevalence of standing surgical techniques among equine surgeons and literature directly comparing outcomes between procedures performed standing versus under GA is scarce. [25][26][27] Thus, knowledge regarding the current use, recent trends and benefits and limitations of standing surgery among board certified surgeons would be of interest. Our objectives were to determine the current use and recent trends for equine standing surgery among board certified surgeons and to identify the main reasons for and limitations with performing a procedure standing.…”