Kraus Beth M, Richardson Dean W, Nunamaker David M, Ross Michael W
Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA 19348, USA.
J Am Vet Med Assoc. 2004 Jan 15;224(2):254-63. doi: 10.2460/javma.2004.224.254.
To report the outcome of surgical treatment of comminuted fractures of the proximal phalanx in horses.
Retrospective study.
64 horses.
Medical records and radiographs were reviewed to obtain information regarding signalment, fracture classification, and treatment. Follow-up information was obtained by telephone conversation or evaluation of production records.
Thirty-eight horses had moderately comminuted fractures of the proximal phalanx. Two horses were euthanatized immediately. Fractures of the proximal phalanx in 36 horses were repaired with open reduction and internal fixation with a successful outcome in 33 (92%) horses. Reconstruction of the fracture was performed in most horses by use of a long curved incision, transection of the collateral ligament of the metacarpophalangeal or metatarsophalangeal joint, and open exposure of the proximal articular surface of the proximal phalanx. Twenty-six horses had severely comminuted fractures of the proximal phalanx. Six horses were euthanatized immediately. One horse was euthanatized after 9 days of treatment with a cast alone. Severely comminuted fractures of the proximal phalanx in 13 horses were treated with an external skeletal fixation device, and fractures healed in 8 of those horses. Six horses with severely comminuted fractures of the proximal phalanx were treated with transfixation pins incorporated into a fiberglass cast, and fractures healed in 4 horses.
Moderately comminuted fractures of the proximal phalanx can be successfully repaired; however, fractures that are too severe to permit accurate reconstruction of the fragments remain difficult to treat and horses have only a fair prognosis for survival.
报告马近端指骨粉碎性骨折的手术治疗结果。
回顾性研究。
64匹马。
查阅病历和X光片以获取有关特征、骨折分类和治疗的信息。通过电话交谈或生产记录评估获得随访信息。
38匹马患有近端指骨中度粉碎性骨折。2匹马立即实施安乐死。36匹马的近端指骨骨折采用切开复位内固定治疗，33匹（92%）马治疗成功。大多数马通过长弧形切口、切断掌指关节或跖趾关节侧副韧带以及暴露近端指骨近端关节面来进行骨折重建。26匹马患有近端指骨严重粉碎性骨折。6匹马立即实施安乐死。1匹马仅用石膏治疗9天后实施安乐死。13匹马的近端指骨严重粉碎性骨折采用外固定架治疗，其中8匹马骨折愈合。6匹马的近端指骨严重粉碎性骨折采用贯穿钢针结合玻璃纤维石膏治疗，其中4匹马骨折愈合。
近端指骨中度粉碎性骨折可以成功修复；然而，过于严重以至于无法准确重建骨折碎片的骨折仍然难以治疗，马的存活预后仅为一般。
