A new EVJ collection available for free online highlights researchers’ breakthroughs in diagnostic imaging and equine fracture management.
Fractures are common in horses of all ages and breeds, but the development of various imaging modalities over the past 10 years is helping significantly to advance equine fracture management techniques.
The Equine Veterinary Journal’s (EVJ) new online collection, with an introduction from imaging expert Renate Weller, DrMedVet, PhD, MRCVS, MScVetEd, FHEA, the new president of the British Equine Veterinary Association, showcases the diagnostic imaging breakthroughs that are helping to identify causes, support prevention, and improve fracture outcomes.
Some research highlights include:
- Fractures are often associated with complications and a poor outcome. In “Epidemiology of fractures: the role of kick injuries in equine fractures,” the authors conclude that kicks are the most common cause, most often seen in ponies and with mares being at higher risk.
- Medial intercondylar eminence of the tibia (MIECT) fractures are also usually associated with a traumatic event, researchers concluded in “Fractures of the media intercondylar eminence of the tibia in horses treated by arthroscopic fragment removal.” Rarely reported in horses, these fractures need prompt diagnosis and arthroscopic fragment removal for the best prognosis.
- Stress fractures are the leading cause of lost training days and a common cause of euthanasia in racehorses. The results of “Analysis of stress fractures associated with lameness in Thoroughbred flat racehorses training on different track surfaces undergoing nuclear scintigraphic examination” showed a higher incidence of stress fractures in horses training on synthetic surfaces, but other factors such as training philosophy are also likely to be influential.
- The researchers behind “A longitudinal study of fractures in 1488 Thoroughbred racehorses receiving intrasynovial medication” have addressed the shortfall of knowledge on the association between intrasynovial medication and fracture risk. The study concluded that 3% of horses suffered serious injury following medication and that greater use of premedication diagnostic imaging could reduce injury rates.
- Condylar fractures of the distal (lower) metacarpus (forelimb cannon bone) are an important cause of fatality in Thoroughbred racehorses. The results of “Unicortical condylar fracture of the Thoroughbred fetlock” suggest that veterinary vigilance and timely intervention could considerably reduce the risk of catastrophic injury during racing.
- Increased subchrondral bone (which is found below the cartilage and supports the cartilage of the joint surface) plate thickness at the parasagittal groove can be a useful indicator of lateral condylar fracture, researchers concluded in “Can we use subchondral bone thickness on high-field magnetic resonance images to identify Thoroughbred racehorses at risk of catastrophic lateral condylar fracture?”
- Micro CT can also demonstrate fatigue damage in the distal metacarpal subchondral bone. The results from “Subchrondral bone microdamage accumulation in distal metacarpus of Thoroughbred racehorses” suggest that reduced intensity of training and increased rest periods could limit microdamage accumulation.
- However, high-resolution peripheral quantitative CT does not specifically predict condylar fracture, researchers concluded in “Can high resolution peripheral quantitative computed tomography imaging of subchrondral and cortical bone predict condylar fracture in Thoroughbred racehorses?” This could be because there is a lack of clear distinction between the subchrondral plate and the trabecular bone and because measurement of the subchrondral bone thickness is complicated by adjacent palmar osteochrondral disease lesions, they say.
- In terms of fracture configuration, diagnosis, method of repair, and outcome, results from the study “Short frontal plane fractures involving the dorsoproximal articular surface of the proximal phalanx: description of the injury and a technique for repair,” revealed that these were more common in hind limbs. Fractures exiting the bone distal to (below) the metacarpophalangeal and metatarsophalangeal joint (front and hind fetlocks, respectively) capsule can often be repaired minimally invasively and carry a good prognosis for a return to work.
- Results from the study “Central tarsal bone fractures in horses not used for racing: computed tomographic configuration and long-term outcome of lag screw fixation” suggest that fractures in nonracehorses had a distinct configuration, but that subtle additional fractures lines can occur, likely a result of chronic stress. Accurate diagnosis of the fracture configuration resulted in successful internal fixation and a very good prognosis.
- Researchers described a successful technique for repairing slab fractures in the study “Slab fractures of the third tarsal bone: minimally invasive repair using a single 3.5 mm cortex screw placed in lag fashion in 17 Thoroughbred racehorses.” They concluded that surgical repair is a viable alternative to conservative management.
- Post-operative imaging is essential for repair and potential complication assessment, and in human medicine MRI is the preferred modality. Results from “Magnetic resonance imaging of an equine fracture model containing stainless steel metal implants” indicate that multiacquistion variable resonance image combination (or MAVRIC) significantly reduced the artefacts created by metallic implants and improved anatomic delineation.
“The advancement of imaging modalities over the past ten years has significantly improved the management of equine fractures,” said Celia Marr, BVMS, MVM, PhD, Dipl. EIM, ECEIM, MRCVS, editor of the EVJ. “The articles included in this fascinating collection not only highlight the current scope of diagnostic imaging for a range of equine musculoskletal conditions but also clearly indicate its potential in continuing to improve clinical assessments, treatment and outcomes.”
Find the research collection, available for free, at onlinelibrary.wiley.com/page/journal/20423306/advances_in_diagnostic_imaging_fractures.htm.