Standing Surgical Management of Splint Bone Fractures in 13 Horses: A Comparison to Management Under General Anaesthesia

Abstract

Objective The aim of this article was to describe the technique and outcomes of standing surgical management of splint bone fractures and to compare outcome variables and hospitalization cost to a group with similar fractures treated under general anaesthesia. Study Design It is a single-institution retrospective study. Surgical technique, surgical time, hospitalization cost and complications were retrieved from the medical records of horses treated surgically for splint bone fractures (2008–2020). Owner telephone follow-up provided data about athletic outcome, client satisfaction and cosmetic appearance. Results Forty-nine horses (13 standing, 36 under general anaesthesia) with 57 fractures (18 contaminated and 39 non-contaminated) were included. Seven fractures were in the proximal third (4 standing, 3 under general anaesthesia), 18 in the middle third (5 standing, 13 under general anaesthesia) and 30 were distal (4 standing, 26 under general anaesthesia). No significant difference between groups in surgical time was found (p= 0.8). Average total cost was 522 CAN$ lower for the standing group for non-contaminated fractures (p= 0.02). Three horses of the general anaesthesia group demonstrated postoperative colic signs and one case of the standing group was re-operated due to sequestration. Based on follow-up information (range: 3.8-151.2 months), no significant differences in cosmetic and athletic outcomes were found between groups. Conclusion Surgical management of splint bone fractures in the standing horse is a valuable alternative for horses selected based on behaviour. When compared to general anaesthesia, standing management of splint bone fractures did not alter the surgical time or outcome variables and avoided general anaesthesia-associated risks.

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.…”