Metatarsophalangeal Arthrodesis through the Modified Steel Basket Technique in Foal

Jackson Shade, Flávia do Prado Augusto Amaro, João Batista Poncio da Silva, Eric Danilo Pauls Sotelo, Luiza Costa Barcellos, Rogerio Luizari Guedes, Luiz Fagner da Silva Machado, Peterson Triches Dornbusch

Abstract


Background: The metacarpophalangeal and metatarsophalangeal joints are very demanded during high intensity exercises, and may be affected by osteoarthritis, fractures, luxations and rupture of the suspensory apparatus. Thus, arthrodesis may be indicated to restore joint stability and accelerate the ankylosis process. The most commonly used surgical techniques have been associated with postoperative complications, including infection and failure of the implants, so it is important to develop procedures that are less invasive procedures and promoting stable fixation. Therefore, the aim of this work is to report the use of the modified steel basket technique for metatarsophalangeal arthrodesis in a foal with hyperextension of the joint due to rupture of the digital flexor muscles. 

Case: A 2-day-old male foal was admitted to clinical care, presenting multiple cutaneous wounds caused by dogs bites, located in the tarsus and thigh of the hindlimb. The animal presented in standing position and had no difficulty of movement, being initially treated through daily cleaning of the cutaneous wounds and systemic antibiotic therapy. Hyperextension of the metatarsophalangeal joint was evidenced after 20 days, being approached through tenotomy and tendon shortening, followed by tenorrhaphy and immobilization for 30 days. Due to the failure of the treatment, it was opted for metatarsophalangeal arthrodesis by modified steel basket technique. The procedure involved the implantation of a steel basket of 25.0 mm in diameter x 25.0 mm long in a 24.0 mm hole created on the dorsal surface between the third metacarpal and the proximal phalanx. The basket was filled with bone extracted from drilling and fixed with two cortical screws at an angle of 25° toward proximoplantar and distoplantar direction. Immobilization of the limb was performed postoperatively with synthetic plaster cast for 45 days and, due to the persistence of lameness, maintained with Robert Jones banding and plantar splint for another 15 days. At 90 days after surgery, radiographic control showed signs of degeneration and joint fusion, and grade 2 claudication (1-5) was observed during locomotion. At six months after surgery, discrete claudication (grade 1/1-5) was evident. The aesthetic and functional result was considered satisfactory and the animal was then ridden and used for leisure. 

Discussion: In this report, arthrodesis was indicated due to hyperextension of the metatarsophalangeal joint caused by the rupture of the digital flexor muscles, since these structures, together with the suspensory apparatus, assist in the support of the joint. Several techniques have been descrited for arthrodesis of metacarpal/metatarsophalangeal joints in horses, being the technique described by Bramlage the most employed and successful one. However, complications related to the techniques such as infection and implant failure were evidenced in one study. The technique of the modified steel basket is characterized by the promotional of effective intervertebral arthrodesis in cases of cervical instability in horses. In this report, the technique was effective in promoting metatarsophalangeal arthrodesis, as well as easy and quick to perform. Therefore, it is suggested that the technique may be used as an alternative for metacarpal/metatarsophalangeal arthrodesis in horses with osteoarthritis or hyperextension of the joint due to suspensory apparatus failure.  However, studies are needed to evaluate the effectiveness of the technique in metacarpophalangeal arthrodesis in adult horses. 



Full Text:

PDF

References


Araújo F.F., Castro M.L., Laskoski L.M., Pavelski M., Deconto I. & Dornbusch P.T. 2015. Modified steel basket technique for the treatment of equine cervical vertebral stenotic myelopathy – a case report. Semina: Ciências Agrárias. 36(4): 2685-2692.

Bowman K.F., Leitch M., Nunamaker D.M., Feckelman G.E., Tate Jr. L.P., Park M.I., Boles C.L. & Raker C.W. 1984. Complications during treatment of traumatic disruption of the suspensory apparatus in Thoroughbred horses. Journal of the American Veterinary Medical Association. 184(6): 706-715.

Bramlage L.R. 1981. An initial report on a surgical technique for arthrodesis of the metacarpophalangeal joint in the horse. Proceedings of the American Association of Equine Practitioners. 27: 257-261.

Bramlage L.R. 1996. Fetlock arthrodesis. In: Nixon A.J. (Ed). Equine Fracture Repair. Philadelphia: Saunders, pp.172-178.

Butler J.A., Colles C.M., Dyson S.J., Kold S.E. & Poulos P.W.2017. Clinical Radiology of the horse. 4th edn. Ames: Wiley Blackwell, 798p.

Cantley C.E.L., Firth E.C., Delahunt J.W., Pfeiffer D.U. & Thompson K.G. 1999. Naturally occurring osteoarthritis in the metacarpophalangeal joints of wild horses. Equine Veterinary Journal. 31(1): 73-81.

Carpenter R.S., Galuppo L.D., Simpson E.L. & Dowd J.P. 2008. Clinical evaluation of the locking compression plate for fetlock arthrodesis in six Thoroughbred Racehorses. Veterinary Surgery. 37(3): 263-268.

Crawley G.R., Grant B.D., White K.K., Barbee D.D., Gallina A.M. & Ratzlaff M.H. 1988.A Modified Cloward’s Technique for Arthrodesis of the Normal Metacarpophalangeal Joint in the Horse. Veterinary Surgery. 17(3): 117-127.

DeBowes R.M., Grant B.D., Bagby G.W., Gallina A.M., Sande R.D. & Ratzlaff M.H. 1984. Cervical vertebral interbody fusion in the horse: a comparative study of bovine xenografts and autografts supported by stainless steel basket. American Journalof Veterinary Research. 45(1): 191-199.

Denoix J.M. 1994. Functional anatomy of tendon and ligaments in the distal limbs (manus and pes). The Veterinary Clinics of North America: Equine Practice. 10(2): 273-322.

James F.M. & Richardson D.W. 2006. Minimally invasive plate fixation of lower limb injury in horses: 32 cases (1999-2003). Equine Veterinary Education. 38(3): 246-251.

Lischer C.J. & Auer J.A. 2012. Arthrodesis techniques. In: Auer J.A. & Stick J.A. (Eds). Equine Surgery. 4th edn. Saint Louis: Elsevier, pp.1130-1147.

Moore B.R., Reed S.M. & Robertson J.T. 1993. Surgical treatment of cervical stenotic myelopathy in horses: 73 cases (1983-1992). Journal of the American Veterinary Medical Association. 203(1): 108-112.

Richardson D.W., Nunamaker D.M. & Sigafoos R.D. 1987. Use of an external skeletal fixation device and bone graft for arthrodesis of the metacarpophalangeal joint in horses. Journal of the AmericanVeterinary Medical Association. 191(3): 316-321.

Sod G.A. & Martin G.S. 2004. An in vitro biomechanical comparison of a prototype intramedullary pin-plate with a dynamic compression plate for equine metacarpophalangeal arthrodesis. Veterinary Surgery. 33(1): 83-91.

Stein M.I., Nayak A.N., Gaskins R.B., Cabezas A.F., Santoni B.G. & Castellvi A.E. 2014. Biomechanics of an integrated interbody device versus ACDF anterior locking plate in a single-level cervical spine fusion construct. The Spine Journal. 14(1): 128-136.

Zubrod C.J. & Schneider R.K. 2005. Arthrodesis techniques in horses. The Veterinary Clinics of North America: Equine Practice. 21(3): 691-711.




DOI: https://doi.org/10.22456/1679-9216.97973

Copyright (c) 2019 Jackson Shade, Flávia do Prado Augusto Amaro, João Batista Poncio da Silva, Eric Danilo Pauls Sotelo, Luiza Costa Barcellos, Rogerio Luizari Guedes, Luiz Fagner da Silva Machado, Peterson Triches Dornbusch

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.