STANDING FRACTURES ISSUE 26_Jerkins feature.qxd 18/10/2012 01:02 Page 1
STANDING FRACTURES
STAND AND DELIVER
An important step forwards in equine fracture repair In the past, surgical repair of equine limb fractures has always been performed under general anesthesia. Anesthesia in horses is an inherently risky procedure, and the surgeon’s careful work can be destroyed in a moment as the horse wakes and rises unsteady on his feet only to break the limb for a second time. A second break at this stage is usually beyond repair. A new study, published in Equine Veterinary Journal (EVJ), has shown that a new approach has excellent results. WORDS: Celia M MaRR, POlly COMPStOn PHOtOS: ROSSDaleS anD PaRtneRS
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TANDING surgery in the horse is growing in popularity across soft tissue and orthopedic disciplines, as it is often quicker and avoids the inherent risks of general anesthesia. At Rossdales Equine Hospital in Newmarket, U.K., some racehorses with specific fracture configurations now have surgery ‘standing’ – that is, under standing sedation and local anesthetic. As increasing numbers of racehorses have had fractures repaired in this way, it has developed into a routine procedure for certain patients. General anesthesia is known to be of particularly high risk in the horse, and this is especially true for horses that are having a fracture repaired. Racehorses are extremely high performance athletes and therefore injuries that require surgery are inevitable. Two very common fracture sites in racehorses involve the fetlock joint: condylar fractures of
Polly Compston, clinical researcher at Rossdales
the cannon bone and midline ‘split pastern’ fractures. Both can be repaired with bone screws, which has been traditionally performed under a general anesthetic. However, in 2006 two scientific studies advocated a novel approach so that these fractures could be repaired using local anesthetic to desensitize the leg in a sedated patient. Shortly thereafter, Richard Payne at Rossdales started to perform this operation on standing horses. Horses are sedated heavily, in an area with padded floors and walls. The reasons for this are three-fold: firstly it is a clean and quiet environment; secondly it means that if the horse should need the procedure to be completed under a general anesthetic for some reason (it has not happened yet!) then everything is set up and the horse is in the right place for this; and thirdly, it is thought that the padded floor helps disperse the vibrations from the drill that is used to place the screws in the bone,
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