How Advances in Intraoperative Imaging Techniques Allowed Improvement in Fracture Fixation

There are numerous indications for performing orthopaedic procedures in standing, sedated horses. The avoidance of general anesthesia has an inherent appeal to those of us who recognize that even the best anesthetized patients can develop problems secondary to the general anesthetic. Examples include violent recoveries with catastrophic injury, facial nerve paresis, myopathy, neuropathy and postoperative pneumonia/ pleuropneumonia. None are common but each can be a devastating complication for that uncommonly afflicted patient. There is no question that the vast majority of orthopaedic surgeries cannot be accomplished well without a fully anesthetized patient but some procedures are simple enough and anatomically appropriate to perform in a standing patient. The most commonly performed standing orthopaedic procedures in my hands include dorsal fetlock arthroscopy, screw fixation/osteostixis of dorsal cortical (“stress”) fractures of MC3 and implant removal. Other indications include various desmotomies/tenotomies (fetlock annular ligament, DDF etc.),

Arthroscopy in the standing horse:
Standing arthroscopic surgery may seem a bit ridiculous considering the delicacy and expense of the instruments. However, some arthroscopic surgical procedures are so rapidly performed that the amount of time spent inducing, positioning and recovering a horse from general anesthesia seems disproportionate. In addition, there is, even under the best of circumstances, an element of risk to the patient for general anesthesia both during the procedure and during recovery from anesthesia. These risks include postoperative pneumonia and traumatic injuries during recovery, both of which may occur in young and healthy athletic horses. It is important to emphasize, however, that these risks are still quite low and certainly don’t demand an alternative approach to surgery. An alternative such as a standing approach should not be done unless the procedure can be done equally well or if the alternative approach affords some other specific advantage.  [...]