EQUINE VETERINARY EDUCATION Equine vet. Educ. (2022) 34 (7) 341 doi: 10.1111/eve.13541_1


Case Report


Closed reduction and surgical fixation of elbow joint luxation in an adult mare and in a 3-month-old foal using knotless bone anchors and FiberTape


G. Fridel†,A.E.F€ urst†, A. Pozzi‡, F. Del Chicca§ and M. A. Jackson†,*


†Clinic for Equine Surgery; ‡Clinic for Small Animal Surgery; and §Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland *Corresponding author email: mjackson@vetclinics.uzh.ch


Summary


This report describes the successful surgical stabilisation of elbow joint luxation using knotless bone anchors and FiberTape to repair the medial collateral ligament in an 11- year-old mare (Case 1) and both, medial and lateral, collateral ligaments in a 3-month-old foal (Case 2). Radiography (both cases) and computed tomography (Case 2) were used to diagnose subluxation (Case 1) and complete luxation (Case 2, Fig 1) with suspected rupture of both collateral ligaments. In Case 1, closed reduction was carried out. Manipulation of the limb showed marked instability of the medial aspect of the joint because of disruption of the medial collateral ligament. The first suture anchor (5.5 9 19.1 PEEK SwiveLock C) was therefore placed in the distal medial humeral metaphysis, and then, the second suture anchor was placed in the proximal medial radial metaphysis. A 2-mm braided composite suture tape (FiberTape) was inserted into the eyelet of the suture anchor, which was then implanted into the prepared pilot hole. In Case 2, closed reduction was completed similarly to Case 1. Fixation with prosthetic collateral ligaments was undertaken. The surgical procedure for replacement of the collateral ligaments was analogous to that used for Case 1 except that the medial collateral ligament was repaired at its avulsed origin and prostheses were inserted bi-axially to provide sufficient mechanical stabilisation of the elbow joint. The origin of the medial


collateral ligament at the humerus was disrupted, and it was fixed to the bone with a 26 mm 9 3.5 mm cortex screw and


341


Fig 2: Illustration showing implantation of the FiberTape prosthesis. The tape is being inserted into the eyelet of the second suture anchor located in the prepared drill hole in the distal lateral humeral metaphysis. The first suture anchor has already been placed in the proximal lateral radial metaphysis.


a washer. The first suture anchor (5.5 9 19.1 PEEK SwiveLock C) was then placed just cranial to the collateral ligament. The second suture anchor was placed in the proximal medial radial metaphysis. The suture tape (FiberTape) was inserted into the eyelet of both suture anchors and implanted into pilot hole as described for Case 1. Case 1 was sound at the walk at the time of discharge 8


weeks after surgery and 1 year later at the follow-up visit. Case 2 was discharged 3 weeks after surgery and was sound at the trot when re-evaluated 2 (Fig 2) and 6 months postoperatively.


Key points


• Although closed reduction in elbow joint luxation may be successful, damage to the collateral ligaments can lead to instability of the joint, necessitating a surgical reconstruction of the collateral ligaments


• Knotless bone anchors and FiberTape allowed full return to the intended use of the mare and normal locomotion of the foal 1 year after surgery


Fig 1: Mediolateral radiographic view of the left elbow joint of Case 2 before surgery. There is lateral, cranial and proximal displacement of the radius and ulna with complete loss of contact of the humeral- radio-ulnar articular surfaces, consistent with luxation.


• Additional studies are required to determine whether the presented technique is superior to previously described monofilament nylon or stainless-steel wire for tension band wiring


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