344


EQUINE VETERINARY EDUCATION / AE / july 2022


Based on the cases in the current literature, prognosis for


elbow luxation in equids should be considered good, even in cases with Monteggia fractures. Cases in the current body of literature include animals either not used for high levels of athleticism or animals too young to be exercised. However, case follow-up indicates that equids are likely able to be athletic following elbow luxation. Monteggia fractures may occur more frequently in horses >12 months of age, while luxation without fracture may occur more commonly in equids <12 months of age. Contrary to previous reports that lateral collateral ligament rupture is more common (Nelson & Goodrich, 2014), analysis of the literature found that medial collateral ligament rupture appears to be more common than lateral collateral ligament rupture in cases of elbow luxation. Biaxial collateral ligament rupture appears to occur more frequently in equids <12 months of age. It is likely that fracture of the ulna preserves the soft tissues, resulting in less severe collateral ligament damage when compared to luxation without fracture, as evidenced by the fact that all Monteggia fractures were stable on palpation after ulna repair only. Based on the anatomy of the equid elbow joint, case


reports on equid elbow luxation, and knowledge from elbow luxation in small animals and people, recommendations for treatment of equid elbow luxations can be made. An attempt at repair of equid elbow luxation and Monteggia fractures should be considered as the prognosis is good for soundness long term. Closed reduction can be challenging but successful, and may be accomplished through traction applied to the distal limb (Collar et al., 2021; Jones, 1995) or through the described methods for elbow luxation reduction in small animals (flexion of the joint past 90 degrees, with internal rotation and abduction of the antebrachium while applying pressure to the proximal lateral aspect of the radius) (Fridel et al., 2022; Slatter, 2003; Tobias & Johnston, 2013). Cases with medial collateral ligament rupture in equids that can be maintained with the elbow in extension, using splints, hobbles, cross ties, or a sling, likely do not need surgical intervention, even with medial instability. However, equids that cannot be maintained with the elbow kept in extension (foals) and/or those with dramatic instability post reduction (biaxial collateral ligament rupture) may benefit from surgical stabilisation of the joint. It is unknown if the use of screws with wires or suture, or the use of bone anchors and FiberTape, is superior for repair of collateral ligament rupture. Based on the literature, the joint does not appear to need support from implants for extended periods of time for the horse to heal and regain soundness post-operatively. Rehab and range of motion exercises are likely to increase the chances of maintaining range of motion and the ability to be athletic in the future (Collar et al., 2021; Tobias & Johnston, 2013). In summary, with treatment, elbow luxation in equids


carries a good prognosis with or without fracture or collateral ligament rupture. It is unknown if equids could attain a high level of athleticism after elbow luxation. Based on the limited number of cases, athletic performance is likely attainable, dependent on the level of joint and cartilage damage at the time of injury. Medial collateral ligament rupture with luxation is more common than lateral collateral ligament rupture, and biaxial collateral ligament rupture appears to be more common in foals. Surgical intervention is likely unnecessary in cases of uniaxial ligament rupture when the joint is


© 2021 EVJ Ltd


anatomically restored and the equid can be maintained with the limb in extension. Surgical stabilisation may be warranted in cases where the leg cannot be maintained in extension or in cases of biaxial collateral ligament rupture. Surgical stabilisation does not appear to need to be in place for long periods of time for cases to be successful. While stabilisation with screws and wires/suture can be successful, use of bone anchors and FiberTape appears to be a promising surgical approach.


Author’s declaration of interests No conflicts of interest have been declared.


References


Arnbjerg, J. (1969) Fracture of ulna in the horse with case reports on three ponies. Nordisk Veterinaermedicin 21, 389-397.


Barone, R. (1986) Anatomie comparee des mammiferes domestiques. Tome II. Arthrologie et Myologie, 4th edition, Paris: Vigot Fr


eres. Bottegaro, N.B., Jelena Goti c, H.C., Huber, D., Ku cko, A. and Vrbanac,


Z. (2017) Elbow joint luxation in a ten months old Arabian colt – A case report. Acta Veterinaria 67, 441-448. https://doi.org/10.1515/ acve-2017-0036


Collar, E.M., Watson, L.J., Whitmer, C. and Hansen, S. (2021) Successful closed reduction and conservative management with traumatic elbow luxation and medial collateral ligament rupture in an equid. Equine Veterinary Education 33, e25-e29. https://doi.org/10.1111/ eve.13171


Crawley, G.R. and Grant, B. (1986) Repair of elbow joint luxation without concomitant fracture in a horse. Equine Practice 8, 19-24.


Daradka, M., Alshehabat, M. and Almomany, A. (2020) An unusual case of type iv monteggia fracture and concurrent humoral fracture in an arabian foal. Veterinary Medicine and Public Health 1(1), 1-2. https://doi.org/10.31559/vmph2020.1.1.1


Dyce, K.M., Sack, W.O., Wensing, C.J.G. and Dyce, K.M. (2009) Textbook of veterinary anatomy, Philadelphia: Elsevier.


Dyson, S.J. (2011) Chapter 40 – the elbow, brachium, and shoulder. In: M.W. Ross and S.J. Dyson (Eds.) Diagnosis and management of lameness in the horse, 2nd edition. Saint Louis: W.B. Saunders, pp 456-474.


Fails, A.D. (2020) Functional anatomy of the equine musculoskeletal system. In: G.M. Baxter (Ed.) Adams and Stashak’s lameness in horses, 7th edition. pp 1-65. Ames, IA : Wiley-Blackwell.


Fridel, G., F€ urst, A.E., Pozzi, A., Del Chicca, F. and Jackson, M.A. (2022)


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. Equine Veterinary Education 34, 341, e274-e281.


Hu, A.J., Scheuch, B. and Cannon, J. (2007) Repair of a complete luxation of the humeroradial joint in a foal with Securos suture. Equine Veterinary Education 19, 424-428. https://doi.org/10.2746/ 095777307X220498


Jalim, S., McKinnon, A. and Russell, T. (2009) Repair of a type IV Monteggia fracture in a foal. Australian Veterinary Journal 87, 463- 466. https://doi.org/10.1111/j.1751-0813.2009.00508.x


Janicek, J.C. (2005) What is your diagnosis? Journal of the American Veterinary Medical Association 227, 1743-1744. https://doi.org/10. 2460/javma.2005.227.1743.


Jones, D. (1995) Closed reduction of a radiohumeral luxation in a mule. Equine Practice 17, 33-36.


Kidd, J.A., Lu, K.G. and Frazer, M.L. (2014) Atlas of equine ultrasonography, Hoboken: John Wiley & Sons Incorporated.


Levine, S.B. and Meagher, D.M. (1980) Repair of an ulnar fracture with radial luxation in a horse. Veterinary Surgery 9, 58-60. https://doi. org/10.1111/j.1532-950X.1980.tb01653.x


Nelson, B.B. and Goodrich, L.R. (2014) 18 - elbow and shoulder. In: K.W. Hinchcliff, A.J. Kaneps and R.J. Geor (Eds.), Equine sports


Continued on page 388


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88