Fetlock arthrodesis boost survival rates - DVM
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Fetlock arthrodesis boost survival rates
Experts find procedure quick, effective for some traumatic injuries and degenerative damage


DVM360 MAGAZINE
Volume 39, Issue 8

"We use it in other types of horses, other than racetrack-injured Thoroughbreds," says Bob Schneider, DVM, MS, Dipl. ACVS, a professor at Washington State University's College of Veterinary Medicine. "In fact, (one of) the last two horses I've done it on ... was an Arabian performance horse, a mare with degenerative arthritis. She lost the cartilage, and had bone-on-bone contact in the joint. So we fused her, to save her as a broodmare. I also fused a rescue horse with a bad degenerative rear fetlock. It was in chronic, unrelenting pain from a degenerative fetlock joint and now, after the procedure, is much more comfortable."

Faster results

"Arthrodesis is an opportunity to circumvent many of the really bad problems of the fetlock joint, and the real benefit of it is (that) the horses are almost immediately pain-free," Bramlage explains. As soon as the pain of the incision and the surgical approach has passed, they begin bearing weight on the leg.

As aftercare improves, some horses do light exercise as soon as a month after surgery and are in the field as soon as three months.

"These horses post-surgery are very quickly pain-free," agrees Dean Richardson, Charles W. Raker professor of equine surgery and chief of large-animal surgery at the University of Pennsylvania School of Veterinary Medicine's New Bolton Center.

What Richardson usually tells his residents is that, right after the fusion, horses normally are sore for 24 to 48 hours. "But when a surgery is successful, most of those horses are sound within two days, comfortable, standing squarely," Richardson says.

"Contralateral laminitis probably is one of the most important problems that we have, as with any major orthopedic procedure. If they bear too much weight on the opposite limb, there is a chance of laminitis," he adds.

On the other hand, with fetlock fusions after the typical racetrack breakdown, if the surgery goes well and without complications, many horses become comfortable so quickly that laminitis in the opposite foot is not a major issue.

The goal is making sure the surgery allows the horse to stand squarely on the injured leg relatively quickly after the fusion.

"Even though laminitis is a big complication, the bigger complications usually are local infection, breakdown of the pastern region and other problems that aren't exactly associated with the surgical fusion," Richardson suggests. "If you have those problems, the horse doesn't become comfortable and laminitis in the opposite foot is more of a risk."

Tension band placement

The key to the procedure was the insertion of the tension band in the back of the joint. "You can't put the plate in the back of the joint where you would mechanically like to put it, because all of the injury that occurred there," Bramlage says. "The approach is difficult, and there's no real good place to attach it. And when the horse has a suspensory apparatus rupture, you're worried about blood supply. So if you do the surgery in the back of the joint, you add to that problem," he explains. "So we put the implant in the front and then go actually through the joint to insert a wire or, in the case of DA, you can use the horse's own ligaments by attaching his sesamoids, and that puts a support in the back of the joint, preventing the plate in front from cycling," Bramlage says.

"It's the same mechanical concept as extending a crane, where you see them put the joint at the end and another boom on the end of the crane and they run the cable up over this prop," Bramlage explains. "That's the exact analogy, mechanically, that we use to give stability in the back of the joint. It results in such a stable fixation that it's really pain-free."

A horse will have some pain to overcome from the original injury and some from the incision, but instead of taking weeks to get it back on the leg comfortably, it can be a matter of days, which protects the other foot from laminitis. "That's really what you need to have a chance at a successful recovery," says Bramlage.


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