Surgical repair of mid-body proximal sesamoid bone fractures in 25 horses.
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.


METHODS
Retrospective case series.


METHODS
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.


CONCLUSIONS
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.
Busschers
Evita
E
Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA 19348-1692, USA. busscher@vet.upenn.edu
Richardson
Dean W
DW
Hogan
Patricia M
PM
Leitch
Midge
M
D000818:Animals; D001182:Arthroscopy / Q000379:methods / Q000662:veterinary*; D001696:Biomechanical Phenomena; D001863:Bone Screws / Q000662:veterinary; D001864:Bone Wires / Q000662:veterinary; D005260:Female; D005552:Forelimb; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods / Q000662:veterinary*; D006736:Horses / Q000293:injuries / Q000601:surgery; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D012716:Sesamoid Bones / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D013177:Sports; D016896:Treatment Outcome