Use of preoperative computed tomography (CT) to plan repair of comminuted fractures of the middle phalanx in six Warmblood horses: Configuration, treatment and long-term outcome.

Abstract

Objective: To describe the additional information provided by computed tomography (CT) in planning and assisting repair of comminuted fractures of the middle phalanx (MP) in Warmblood horses.

Study design: Case series.

Animals: Six adult Warmblood horses.

Methods: The case records of horses undergoing CT examination prior to internal fixation of comminuted MP fractures were reviewed. All horses underwent radiographic and preoperative CT examination. A standardized fast protocol (SFP) to assess CT images was used. Surgical repair consisted of fracture repair and proximal interphalangeal joint arthrodesis using two dorsally located plates under general anesthesia. Long-term follow-up was obtained from the clinical records and/or referring veterinary surgeons.

Results: In all cases, CT provided information that could not have been obtained from radiographic examination. Four horses were alive at >6 months follow up and presented with a mild 3/5 AAEP lameness.

Conclusion: The SFP provided additional information regarding fracture configuration that could not have been obtained during radiographic examination in all cases. In two cases it allowed identification of a small navicular bone fracture at the level of its dorsal cortex within the distal interphalangeal joint. In one case it allowed identification of deep digital flexor tendon (DDFT) rupture. Preoperative CT scans helped in planning the positioning of two or more independent 4.5/5.5 mm cortical lag screws to improve construct stability.

Clinical significance: The use of the CT SFP provides surgeons with precise fracture configuration, enables identification of concurrent pathology and optimizes surgical planning, thereby improving construct stability.