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Arthroscopy for Chip Fractures and Other Acute Joint Injuries
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Starting from the mid-eighties, arthroscopy has become the technique of choice for the treatment of many conditions affecting equine joints. The main indications include removal of osteochondral fragments resulting from OCD or traumatic lesions, debridement or intra-lesional injections for bone cysts, arthroscopic assisted internal fixation of fractures, treatment of septic arthritis and, more recently, cartilage repair.
The treatment of chip fractures and acute joint injuries represents an important field of application of the technique. The most common sites for acute joint injuries and chip fractures in the horse are the fetlock and carpal joints, whereas less common locations are the coffin, tarsocrural, femoropatellar and femorotibial joints. In order to be more specific, this paper will focus on non septic traumatic lesions of cartilage and bone, excluding lesions affecting other articular structures like synovial membrane, ligaments and menisci.
Metacarpophalangeal and metatarsophalangeal joints
Traumatic lesions affecting the fetlock can be located both in the dorsal and palmar/plantar compartments of the joint. The most common type of chip fractures are located in the dorsomedial aspect of the proximal border of the proximal phalanx. The fragment may have sharp of rounded margins, and the latter normally refer to more chronic lesions. The fragment is normally more or less loosely attached with fibrous tissue or can be deeply embedded in the joint capsule, which may show some degree of synovitis. More rarely, the fragment may be free within the joint. In order to properly plan the surgery, it is important to have a complete set of radiographic images, including oblique views.
The prognosis for athletic return after removal of proximodorsal fragments of the proximal phalanx is good (Kawcak and McIlwraith, 1994; Colon et al. 2000). Removal of fragments with a more abaxial (usually lateral) location is more difficult and normally their presence is associated with some degree of DJD. In cases of proximal dorsal fractures with large fragments, where the fracture line extends deeply under the capsular attachment, removal is not indicated and the injury may be repaired using small lag screws.
When treating this conditions, the surgeon must evaluate any cartilage damage, usually involving the dorsal aspect of the distal metacarpus/metatarsus, which may vary from one or more wearlines to significant full thickness defects. [...]
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