Surgical Repair of Mid-body Proximal Sesamoid Bone Fractures in 25 Horses

Authors: 
EVITA BUSSCHERS, DVM, DEAN W. RICHARDSON, DVM Diplomate ACVS, PATRICIA M. HOGAN, VMD, Diplomate ACVS and MIDGE LEITCH, VMD, Diplomate ACVS
Volume: 
37
Number: 
8
Pages: 
771 - 780
Journal: 
Veterinary Surgery
Date: 
December 2008

Objective—To describe the characteristics of unilateral mid-body proximal sesamoid bone (PSB) fractures, to determine factors associated with the outcome of horses after surgical repair, and to describe a technique for arthroscopically assisted screw fixation in lag fashion.

Study Design—Retrospective case series.

Animals—Horses (n=25) with unilateral mid-body PSB fracture.

Methods—Medical records (1996–2006), radiographs, and arthroscopic videos of horses with surgically repaired unilateral mid-body PSB fractures were reviewed. Retrieved data included signalment, affected limb and PSB, fracture characteristics, and surgical technique. Outcome was established by radiographic assessment of healing and race records; categorical data were analyzed using Fisher's Exact test.

Results—Medial forelimb PSBs were most commonly affected (80%). Surgical technique and degree of reduction were significantly associated with outcome; 44% of horses with screw repair and none of the horses with wire fixation raced (P=.047). Factors that may have influenced this outcome were differences in fracture reduction (improved reduction in 22% wire repairs and 88% screw repairs, P=.002) and use of external coaptation (22% wire repair and 88% lag screw repair, P=.002). None of the horses with unimproved reduction raced after surgery.

Conclusions—Only 28% of horses with mid-body PSB fractures raced after surgery. Compared with wire fixation, screw fixation in lag fashion resulted in good reduction and is seemingly a superior repair technique.

Clinical Relevance—For mid-body PSB fractures, arthroscopically assisted screw fixation in lag fashion and external coaptation for anesthesia recovery and initial support provides the best likelihood of return to athletic use.