Fractures of the Distal Phalanx

Nixon, Alan J.; Ducharme, Norm G.; Bertone, Alicia L.

doi:10.1002/9781119108757.ch14

Cited by 3 publications

(16 citation statements)

References 32 publications

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“…In this study, racehorses most commonly presented with type II P3 fractures after racing or race training. Standardbreds were over‐represented in the study population, consistent with previous reports 1,2,5,13 . As these horses race on a hard surface in a counter‐clockwise direction, the lateral aspect of the left forelimb and medial aspect of the right forelimb are most common 1,2,4,13 .…”

Section: Discussionsupporting

confidence: 82%

“…Because the countersunk screw head might not be completely on a dense cortex, it is the senior author's experience that care should be taken to tighten the screw gradually and repeatedly to assure compression of bone under the screw head. It has been suggested that countersinking is not necessary for fixation of P3 fractures as the screw head sinks into the outer cortex of P3 when tightened 5 but intraoperative CT imaging has clearly shown that this does not occur. In the present study, 9/13 horses with delayed implant infection have surgery prior to January 2014 when the cannulated countersink tool was acquired, with an infection rate of 65%.…”

Section: Discussionmentioning

confidence: 99%

“…All cases were mild compared with other horses in our hospital population with DIPJ degeneration. Osteoarthritis following an articular P3 fracture is more likely to occur with incomplete healing or irregularity of the articular surface, or if infection and delayed union have occurred 5 . This was supported by our findings with incomplete radiographic union and/or infection present in 6/9 horses (infection [n = 1]; incomplete union [n = 2] and both [n = 3]); however, no significant association between radiographic union and the occurrence of osteoarthritis was detected.…”

Section: Discussionmentioning

confidence: 99%

“…Because anatomic reduction cannot be achieved with conservative management, healing of type II fractures can be poor and/or prolonged as a result of the motion between fracture fragments during weightbearing 8 . This motion is exacerbated by the abaxial position of the fragment and the size discrepancy between the fragment and parent bone, resulting in incongruity of the articular surface and increased risk for the development of osteoarthritis 5,8,9 . It has been proposed that in older horses (>3 years old) with articular P3 fractures, internal fixation using a standard lag screw technique might allow more rapid fracture healing and shorter convalescence time through improved fracture stability and articular congruency 3,9,10 .…”

Section: Introductionmentioning

confidence: 99%

“…Fractures of the distal phalanx (P3) are an uncommon but welldescribed cause of lameness in both racing and nonracing horses, [1][2][3][4][5][6] with a prevalence of 0.38%-1.1% reported in two hospital populations. 2,4 Seven types of distal phalangeal fractures have been described based on the radiographic configuration.…”

Section: Introductionmentioning

confidence: 99%

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Computed tomographic guidance for internal fixation of type II distal phalangeal fractures in 51 horses

Smanik

Stefanovski

Reilly

et al. 2021

Equine Veterinary Journal

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Background: Type II distal phalanx (P3) fractures are a well-described cause of lameness in horses. Reports on outcome following internal fixation of type II P3 fractures are lacking, and with little emphasis on complications.Objective: To describe a technique for internal fixation of type II P3 fractures, and evaluate whether specific variables influenced post-operative complications or a horse's ability to return to work. Study design: Retrospective case series.Methods: Medical records of 51 horses with CT-guided internal fixation of type II P3 fractures were reviewed. Outcome data were acquired from race records and telephone interviews. Associations between independent variables and outcome were analysed using multivariable logistic regression.Results: Eighty-six per cent (95% CI 74%-94%; n = 44) successfully returned to work.Implant infection (n = 15) and distal interphalangeal joint osteoarthritis (n = 9) were the most common complications, with the latter reducing the likelihood of success (OR = 0.09, 95% CI 0.01-0.7, P = .02). Implant infection increased the time to return to work (HR = 0.5, 95% CI 0.2-0.9, P = .03). The odds of delayed infection decreased by filling the hoof defect with acrylic hoof adhesive rather than poly(methyl methacrylate) and deeply countersinking the screw head (OR = 0.08, 95% CI 0.02-0.38, P = .001); the individual effect of each treatment is unknown. Radiographic healing was not associated with likelihood of success.Main limitations: Study limitations included variation in follow-up methods, lack of control population for comparison and lack of randomisation of treatment protocols.Conclusions: Internal fixation of type II P3 fractures is an effective treatment that allows horses to return to athletic use, with similar improved success rates as those reported for conservative management. Infection rates were reduced by deeply countersinking the screw head and filling the hoof defect with an acrylic that mimics hoof wall flexibility and provides a secure seal. Recommencement of training should be based on clinical rather than strictly radiographic findings.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Computed tomographic guidance for internal fixation of type II distal phalangeal fractures in 51 horses

Smanik

Stefanovski

Reilly

et al. 2021

Equine Veterinary Journal

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A novel transcoronal surgical technique for the treatment of cystic lesions of the distal phalanx: A cadaveric study

Frietman,

van Proosdij,

Rijkenhuizen

et al. 2024

Veterinary Surgery

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ObjectiveTo assess the feasibility of a novel transcoronal approach for the treatment of axial type 3 cysts of the palmar/plantar aspect of the distal phalanx (P3).Study designEx vivo, experimental study.Sample populationTen cadaveric specimens, four forelimbs and six hindlimbs.MethodsAll cadaveric specimens underwent radiographically guided drilling, followed by cortical screw placement. The cartilage was macroscopically assessed after disarticulation of the distal interphalangeal joint. The entry point and trajectory were evaluated with computed tomography. Results were categorized as: axial, near‐axial and abaxial. The minimal distance from the outer margin of the drill hole and the proximal border of the subchondral bone plate was measured using frontal computed tomographic slices.ResultsEight of the 10 screws were in an axial to near‐axial position and nine followed the desired axial to near‐axial trajectory. One screw was inserted axially but continued in an abaxial trajectory. Iatrogenic damage to the joint cartilage, flexor cortex and solar canal of P3 was not observed. All cortical screws were placed close to the proximal subchondral bone‐plate of P3.ConclusionThe desired axial/near‐axial drilling and screw placement, under radiographic guidance, was achieved in nine out of 10 specimens.Clinical significanceThis novel technique seems promising for the treatment of inaccessible P3 cysts. Additional studies are required to investigate its feasibility in clinical cases, and the long‐term outcome following transcystic screw placement of type 3 P3 cysts.

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Experimental evaluation of cortical screw placement in lag fashion into the distal phalanx in standing horses

Izing

Béni

Molnár

et al. 2021

Acta Veterinaria Hungarica

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The objectives of this in vivo experimental study were to evaluate the feasibility of cortical screw insertion into the intact distal phalanx in standing sedated horses and to document potential postoperative complications. One cortical screw was randomly inserted in lag fashion into each distal phalanx in 9 horses. The second surgery on the contralateral limbs was performed 2–3 weeks after the first operation, when a 4.5-mm cortical screw was inserted in lag fashion into the distal phalanx of sedated horses following perineural analgesia. Following surgery, the drill hole was filled with an antibiotic-soaked swab, which was changed every 48 h. The horses were euthanised 8 weeks after the second surgery. The hooves were disarticulated and evaluated macroscopically and by computed tomography. The surgery time was 13.9 ± 4.8 min (mean ± SD). Pain scores and lameness gradually decreased after 7 days. Solar canal penetration (SCP) was detected in 10 out of the 18 distal phalanges (55.5%). In 7 out of the 10 penetrations intraoperative bleeding was obvious. No postoperative infection was observed. Screw insertion into the distal phalanx was easily and quickly accomplished in standing horses, but its advantages in horses with sagittal fractures should be investigated further. SCP had no impact on postoperative lameness.

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Fractures of the Distal Phalanx

Cited by 3 publications

References 32 publications

Computed tomographic guidance for internal fixation of type II distal phalangeal fractures in 51 horses

Computed tomographic guidance for internal fixation of type II distal phalangeal fractures in 51 horses

A novel transcoronal surgical technique for the treatment of cystic lesions of the distal phalanx: A cadaveric study

Experimental evaluation of cortical screw placement in lag fashion into the distal phalanx in standing horses

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