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Arthroscopic surgery on chip fractures in standing horses
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Fractures of the proximal phalanx are commonly seen, especially in racehorses and often as dorsoproximal chip fractures. This article describes not only a new technique and the results of an arthroscopic removal of the chip fractures, it also informs about the later `use` of the patients: 91 percent of the racehorses returned to race, more than 75 percent of them to the at least same level!
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In this retrospective study, a total of 104 horses were included, 1 to 13 years of age, with a dorsoproximal chip fracture of a proximal phalanx.
Horses were restrained in standing stocks and sedated with intravenous xylazine, detomidine, or a combination of both drugs. Local analgesia was achieved with 2% mepivacaine administered intra-articularly and by subcutaneous infiltration in a crescent-shaped block dorsal to the fetlock.
Sterile drapes were placed on the surgical field, and impervious drapes were used on the hoof and floor. Arthroscopic portals were created in the dorsal pouch of the metacarpophalangeal or metatarsophalangeal joints to remove chip fractures.
Statistical analysis was performed on race records for all Thoroughbred racehorses and compared with previously published studies. Operative and hospitalization times were compared with those of the general hospital population, and risks associated with general anesthesia were examined.
No major operative or postoperative complications occurred. Ninety-one percent of racehorses raced after surgery with 78% returning to race at the same or higher level.
Standing arthroscopic surgery can be performed successfully to remove dorsoproximal chip fractures of the proximal phalanx. It offers a valid alternative treatment for experienced surgeons to avoid the expense and potential risks associated with general anesthesia.
Source: Elce, Yvonne A. & Richardson, Dean W. (2002): Arthroscopic Removal of Dorsoproximal Chip Fractures of the Proximal Phalanx in Standing Horses. In: Veterinary Surgery 31 (3), 195-200.
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