Arthroscopically assisted arthrodesis of the distal interphalangeal joint with transarticular screws inserted through a dorsal hoof wall approach in a horse

Evita Busschers Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA 19348-1692.

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Dean W. Richardson Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA 19348-1692.

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Abstract

Case Description—A 16-year-old Thoroughbred gelding was examined because of chronic right forelimb lameness.

Clinical Findings—On radiographs of the right front foot, the distal interphalangeal (DIP) joint space was narrow, and osteophytes and periarticular bony proliferation indicative of severe osteoarthritis were seen. Arthrodesis of the right DIP joint was recommended to improve the horse's comfort on the limb.

Treatment and Outcome—The horse was anesthetized, and palmar and dorsal arthroscopic approaches were used to remove as much of the articular cartilage as was accessible. Holes were then drilled through the dorsal aspect of the hoof wall, and 3 transarticular, 5.5-mm cortical screws were placed in lag fashion through these holes across the distal phalanx and into the middle phalanx. Defects in the hoof wall were filled with gentamicin-impregnated polymethyl methacrylate plugs and sealed with cyanoacrylate. Eight months after surgery, fusion of the DIP joint was evident radiographically and the horse was sound at a walk.

Clinical Relevance—Transarticular placement of cortical screws through a dorsal hoof wall approach combined with arthroscopically guided cartilage removal can result in fusion of the DIP joint in horses.

Abstract

Case Description—A 16-year-old Thoroughbred gelding was examined because of chronic right forelimb lameness.

Clinical Findings—On radiographs of the right front foot, the distal interphalangeal (DIP) joint space was narrow, and osteophytes and periarticular bony proliferation indicative of severe osteoarthritis were seen. Arthrodesis of the right DIP joint was recommended to improve the horse's comfort on the limb.

Treatment and Outcome—The horse was anesthetized, and palmar and dorsal arthroscopic approaches were used to remove as much of the articular cartilage as was accessible. Holes were then drilled through the dorsal aspect of the hoof wall, and 3 transarticular, 5.5-mm cortical screws were placed in lag fashion through these holes across the distal phalanx and into the middle phalanx. Defects in the hoof wall were filled with gentamicin-impregnated polymethyl methacrylate plugs and sealed with cyanoacrylate. Eight months after surgery, fusion of the DIP joint was evident radiographically and the horse was sound at a walk.

Clinical Relevance—Transarticular placement of cortical screws through a dorsal hoof wall approach combined with arthroscopically guided cartilage removal can result in fusion of the DIP joint in horses.

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