Immediate pre-operative computed tomography for surgical planning of equine fracture repair: A retrospective review of 55 cases

Abstract

Introduction Fracture configuration is often more complex than is radiographically appreciable. The objective of this study is to describe the influence of pre-operative computed tomography (CT) for surgical planning in a variety of fracture types. This has not been described in previous studies. Materials and methods All cases with pre-operative radiographs, admitted for CT and surgical repair of a suspected limb fracture from January 2010-December 2020 were reviewed. CT was acquired under general anaesthesia in a multi-slice helical scanner; any surgery was then performed immediately. Three diplomates (two surgical; one diagnostic imaging) performed a blinded retrospective review of the radiographs and CT for each horse. A consensus decision was made on any change in surgical plan prior to and after CT review, and cases divided into three categories: CT of major, intermediate or minor relevance, as previously described by Genton et al, 2019. Results 55 cases were collated. Thoroughbred racehorses predominated. The median age was 3 years. A diverse range of fractures were presented: proximal phalanx (18/55), carpal (17/55), metacarpal/tarsal (11/55), sesamoid (5/55), tarsal (3/55), and middle phalanx (1/55). In 13 of 55 cases (23.6%, 95% CI[12%,35%]) CT was of major relevance. In 21 of 55 cases CT was of intermediate relevance (38.2%, 95% CI[25%,51%]). In 21 of 55 cases CT was of minor relevance (38.2%, 95% CI[25%,51%]). A Fisher’s exact test demonstrated no statistical difference in CT relevance between fracture types (p<0.05). Discussion/Conclusions This study demonstrates that CT has a significant role in surgical planning, and in the majority (61.8%) of cases added additional information or significantly changed the surgical plan. In all cases CT ensured confidence in surgical planning.

Comparison of Radiography and Computed Tomography for Evaluation of Third Carpal Bone Fractures in Horses

“…For horses with C3 Fx, early and accurate diagnosis of Fx configuration, the extent of bone injury and the presence of concomitant lesions is important when developing a treatment plan [8]. We aimed to evaluate the diagnostic accuracy of conventional radiography by comparison with CT in horses with a range of C3 fracture configurations.…”

“…Radiography plays an important role in the diagnosis of carpal injury but has wellrecognized limitations. For some horses with third carpal bone (C3) fractures (Fx), the poor sensitivity of planar radiography to identify fracture configuration and the full extent of comminution and other injury has been reported [1][2][3][4][5][6][7][8]. Additional views to the standard radiographic series can be useful in some cases including those with suspected sagittal Fx of the radial facet of C3 (RaF) [9], but not all limitations can be overcome.…”

“…In comparison, computed tomography (CT) is a cross-sectional modality with increased contrast resolution and no superimposition and is becoming more widely available in equine referral practice. CT is extremely useful in the diagnosis of distal limb fractures in horses, and when other imaging techniques are inconclusive [7,8,[10][11][12][13] and can detect fractures, comminution, small osseous fragments (OF), periosteal new bone, osteoarthritis (OA), lucencies within the subchondral cortical plate and subchondral trabecular bone (collectively termed subchondral bone, SCB) or osseous cyst-like lesions (OCLL) at various sites not evident radiographically [7,8,12,[14][15][16][17][18][19][20][21][22]. Due to benefits over planar radiography, CT helps guide surgical approach in horses with a range of distal limb fractures [8,23] and determination of prognosis in horses with lateral condylar Fx [23].…”

“…CT is extremely useful in the diagnosis of distal limb fractures in horses, and when other imaging techniques are inconclusive [7,8,[10][11][12][13] and can detect fractures, comminution, small osseous fragments (OF), periosteal new bone, osteoarthritis (OA), lucencies within the subchondral cortical plate and subchondral trabecular bone (collectively termed subchondral bone, SCB) or osseous cyst-like lesions (OCLL) at various sites not evident radiographically [7,8,12,[14][15][16][17][18][19][20][21][22]. Due to benefits over planar radiography, CT helps guide surgical approach in horses with a range of distal limb fractures [8,23] and determination of prognosis in horses with lateral condylar Fx [23]. The value of pre-operative CT in evaluation of carpal fractures has been reported; yet, only a limited number of horses with third carpal fracture were included [8].…”

“…Due to benefits over planar radiography, CT helps guide surgical approach in horses with a range of distal limb fractures [8,23] and determination of prognosis in horses with lateral condylar Fx [23]. The value of pre-operative CT in evaluation of carpal fractures has been reported; yet, only a limited number of horses with third carpal fracture were included [8]. Assessment of the value and limitations of radiography in evaluation of C3 Fx and a better understanding of radiographic lesions compared to CT findings will aid practitioners in the interpretation of radiographic studies.…”