Proximal interphalangeal joint arthrodesis in 34 horses using two parallel 5.5‐mm cortical bone screws

Abstract

Age, breed, and initial disease did not affect outcome. Arthrodesis of the proximal interphalangeal joint by use of two 5.5-mm ASIF cortical bone screws, in parallel orientation, placed in lag fashion by use of a combined aiming device, resulted in sound use of the limb in >85% of the joints with shortened postoperative coaptation.

The use of nonglycosylated recombinanthuman bone morphogenic protein 2 (rhBMP-2) released from a fibrin matrix to promote arthridesis in an equine pastern joint

“…A cast application for at least three (Stashak 2002) to six weeks (Watkins 1996, McIlwraith and Robertson 1998, Nixon 1999) is recommended. In this case decubital ulcers occurred as a complication relating to the cast as described previously (Caron et al 1990, MacLellan et al 2001, Schaer et al 2001, resulting in cast removal at the sixth postoperative day. Although the cast was removed so early, a successful outcome was reached, suggesting a sufficient stability of the internal fixation in combination with preservation of the collateral ligaments and surrounding proliferative tissues.…”

“…According to the case history, the latter pathogenesis seems most probable in this mare. Arthrodesis using the parallel lag-screw fixation technique with two or three 5.5. mm screws extending across the joint in a dorsoproximal to palmaro-/plantarodistal direction is advocated for joints with osteoarthritis, subluxations, luxations or uniaxial eminence fractures of the middle phalanx (Watkins 1996, Auer 2000, MacLellan et al 2001. Removal of all articular cartilage is considered important, since the remaining cartilage acts as a barrier to the bridging of the joint by osseous tissue (Watkins 1996).…”

“…This composite has been successfully used to treat clinical cases of dogs and cats with bone defects, replacing a necessary cancellous bone autograft by the ngly-rhBMP-2/fibrin composite (Schmoekel et al 2004b). In recent reports mean postoperative cast immobilisation averaged from four (Rick et al 1986, MacLellan et al 2001) to twelve-and-a-half weeks (Schaer et al 2001) with a minimum of five days (MacLellan et al 2001). A cast application for at least three (Stashak 2002) to six weeks (Watkins 1996, McIlwraith and Robertson 1998, Nixon 1999) is recommended.…”

“…In the present case, however, the mare became sound within ten months after surgery. Prognosis for complete return or intended athletic function following arthrodesis of the pastern joint in the forelimb is said to be between 46 and 85 % (Caron et al 1990, MacLellan et al 2001, which is significantly less than in the hindlimbs (Caron et al 1990) due to the difference in normal weight bearing between fore-and hindlimbs (Martin et al 1984). Steenhaut et al (1985) described two cases of arthrodesis using lag screw technique in which the collateral ligaments had not been cut and no complete removal of articular cartilage was achieved, but which resulted in considerable periosteal proliferation and persistance of a visible joint space five months postoperatively.…”

“…Arthrodesis of the proximal interphalangeal joint (PIPJ) has successfully been used for the treatment of advanced degenerative joint disease (DJD) (Martin et al 1984, Steenhaut et al 1985, Rick et al 1986, Caron et al 1990, MacLellan et al 2001, Schaer et al 2001, luxations (Steenhaut et al 1985, MacLellan et al 2001, subluxations (Martin et al 1984, Steenhaut et al 1985, Caron et al 1990, Schaer et al 2001, sepsis of the pastern joint (Groom et al 2000) and fractures involving the pastern joint (Colahan et al 1981, Martin et al 1984, Steenhaut et al 1985, Rick et al 1986, Doran et al 1987, Bukowiecki and Bramlage 1989, Caron et al 1990, Crabill et al 1995, MacLellan et al 2001, Schaer et al 2001). Various surgical techniques have been used, most of them refer to three principles as being important for the promotion of arthrodesis: removal of articular cartilage, internal fixation and external immobilisation (Stashak 2002).…”