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Arthroscopy in fracture repair: A step too far?
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A rhetorical question? Perhaps, and then again perhaps not. Is it necessity or an optional extra? Given that the definition of necessity is “the fact of being necessary or indispensable”, one could argue that arthroscopy is not required for anatomically correct fracture reduction and repair in the horse. Prior to the routine use of this minimally invasive tool radiographically guided implants were sufficient, with or without the concomitant use of an arthrotomy. Have our success rates increased with the addition of the arthroscope in fracture repair? This question should not be interpreted as a suggestion that the author believes that an arthrotomy is better than performing arthroscopy. It is merely a philosophical question asking for evidence that the improved visualization and joint exploration has resulted in more horses returning to previous levels of performance after fracture repair.
It has been fairly well established that arthroscopy delivers benefits that arthrotomy cannot, despite which side-by-side comparisons of the technique are not common in the horse. Bertone et al. (1992) published a comparison between arthrotomy and arthroscopy with partial synovectomy for treatment of experimentally induced infectious arthritis in horses and found that while both treatments eliminated infection (in all but one horse), other outcome measures such as degree of lameness, joint circumference and elimination of infection were improved significantly faster with arthroscopy than with arthrotomy. Vatistas et al. (1995) compared arthroscopy and arthrotomy for the treatment of osteochondrosis in the femoropatellar joint and found compelling evidence for the use of arthroscopy. Horses undergoing arthroscopy had substantially shorter hospital stays and a significantly greater proportion entered athletic performance than those that had an arthrotomy performed. Interestingly, as the severity of the lesion increased, the success rate with arthroscopy remained the same, whereas that of arthrotomy declined. Raidal and Wright (1996) also found that arthroscopy was associated with a significantly shorter convalescent period than arthrotomy (however only 18% of horses had an arthrotomy performed and no discussion as to case selection or differential post-operative management is given. Fubini et al. (1999) describe factors affecting the survival of 507 horses with joint disease and concluded that the odds of being alive at 3 months post-surgery included arthroscopic surgery. [...]
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