EQUINE VETERINARY EDUCATION Equine vet. Educ. (2022) 34 (2) 65 doi: 10.1111/eve.13540_1
Case Report
Successful treatment of a severely contaminated open metatarsophalangeal joint luxation by arthrodesis
M. Haspeslagh* , S. Schauvliege and A. Martens Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium *Corresponding author email:
maarten.haspeslagh@ugent.be
Keywords: horse; arthrodesis; fetlock; luxation; salvage Summary
A 1-year-old Warmblood mare with a bodyweight of approximately 400 kg was presented with a severe open medial luxation of the left hind metatarsophalangeal joint (Fig 1). There was erosive damage to the cartilage of the sagittal ridge, and the exposed bone, cartilage and soft tissues were heavily contaminated. Both the medial and the lateral collateral ligaments of the fetlock had ruptured, as well as the medial and lateral collateral ligaments of the proximal sesamoid bones. The joint capsule was mostly unidentifiable because of tissue damage and contamination. Neurovascular bundles, extensor and flexor tendons, flexor tendon sheath, suspensory ligament and distal sesamoidean ligaments were all intact. On radiographs, no fractures could be identified. The owners requested that every effort be made to save the horse for breeding purposes. Because normal joint function would be permanently impaired, an arthrodesis would ultimately be necessary, but the use of implant material in a heavily contaminated environment
would have resulted in infection and loss of stability. Therefore, a two-stage approach was used. In a first stage, all involved structures were debrided and rinsed, the luxation was reduced, and the skin defect was sutured. A plate shoe with silicone pad was applied to the contralateral hoof to prevent laminitis. The horse was recovered in a distal limb cast bandage, which was changed under general anaesthesia at 14 and 35 days after surgery, together with the contralateral plate shoe. Post-operative treatment consisted of sodium penicillin, gentamicin and phenylbutazone intravenously for 20 days. At 56 days after surgery, the cast and contralateral shoe were removed, and 7 days later, an arthrodesis of the metatarsophalangeal joint was carried out using a dorsally placed 13 hole broad 4.5 LCP plate along with 3 x 4.5 cortical screws placed transarticularly in lag fashion, and fixation of the proximal sesamoid bones to the metatarsal bone with 4.5 cortical screws in lag fashion. A distal limb cast bandage and a contralateral plate shoe with silicone pad were applied and changed under general anaesthesia at 14 and 35 days after the arthrodesis. The horse was treated with sodium penicillin, gentamicin and phenylbutazone intravenously during 14 days after surgery. The cast was taken off at 56 days after the arthrodesis, after which the horse was kept on box rest for one more month. The horse was then hand-walked for 3 weeks and then turned out in a small paddock. The horse remained comfortable during the entire treatment period, except for some days between cast removal and arthrodesis. No signs of contralateral laminitis developed, other than a palpable pulsation of the right plantar digital arteries. No complications developed, and at 213 days after the arthrodesis, the horse remains comfortably weight bearing.
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Key points
• A severe, contaminated, open luxation of the fetlock was managed by a two-stage approach.
• In the first stage, all tissue was debrided and rinsed, the luxation was reduced and the skin is sutured. When the infection was eliminated, an arthrodesis was carried out in a second stage.
• When owners refuse immediate euthanasia, horses with a severe open contaminated luxation of the fetlock can be salvaged using the two-stage approach, with a satisfactory outcome.
Fig 1: A severe, contaminated, open luxation of left metatarsophalangeal joint was present.
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