Newmarket Equine Hospital, Newmarket, UK.
Equine Vet J. 2021 Jul;53(4):746-751. doi: 10.1111/evj.13343. Epub 2020 Sep 24.
Fractures of the proximal phalanx are one of the most common long bone fractures of Thoroughbred racehorses. Although the degree of disruption and damage to the articular surface is generally considered a major prognostic determinant, associated arthroscopic findings have not previously been reported.
To describe the metacarpo/metatarsophalangeal (MCP/MTP) joint lesions associated with parasagittal fractures of the proximal phalanx arthroscopically identified at the time of fracture repair and compare radiographic and arthroscopic appearance of complete fractures.
Retrospective case series.
Case records and arthroscopic images of horses with parasagittal fractures of the proximal phalanx admitted to Newmarket Equine Hospital from 2007 to 2017 were analysed.
81 MCP/MTP joints in 78 horses underwent arthroscopic evaluation concurrent to parasagittal fracture repair. Tears of the joint capsule and dorsal synovial plica were noted in 43 cases. Arthroscopy identified articular incongruity in three horses where fracture displacement was not predicted at all on pre-operative radiographs, and incongruity in additional plane(s) to the radiographic displacement in 14 horses. Concurrent osteochondral fragmentation and disruption of cartilage were present in some cases.
As a retrospective study, the arthroscopic data available for review were variable. Arthroscopic assessment of fracture reduction and joint congruency was evaluated in all cases but there was variation in the completeness of evaluation of the entire dorsal joint space of the fetlock joint. This may have led to the underestimation of soft tissue lesions in these cases.
Some horses suffering from parasagittal proximal phalanx fractures have concurrent tearing of the joint capsule and/or dorsal plica, which may have relevance in the acute course of events resulting in the development of fractures. Fracture displacement and incongruency at the articular surface cannot confidently be excluded pre-operatively by radiographs alone.
近节指骨骨折是纯种赛马最常见的长骨骨折之一。尽管关节面的破坏和损伤程度通常被认为是主要的预后决定因素，但尚未有报道过相关的关节镜检查结果。
描述在骨折修复时经关节镜检查发现的与近节指骨矢状骨折相关的掌指/跖趾（MCP/MTP）关节病变，并比较完全骨折的影像学和关节镜表现。
回顾性病例系列。
对 2007 年至 2017 年期间因近节指骨矢状骨折到纽马克特马医院就诊的马的病历和关节镜图像进行分析。
78 匹马的 81 个 MCP/MTP 关节在进行矢状骨折修复的同时进行了关节镜评估。43 例关节囊和背侧滑膜襞撕裂。在 3 例病例中，关节镜检查发现了骨折移位在术前 X 线片上完全无法预测的关节不平整，在 14 例病例中发现了与 X 线片上的移位不平行的额外平面的不平整。在一些病例中，存在骨软骨碎片和软骨破坏。
由于这是一项回顾性研究，可用于审查的关节镜数据存在差异。所有病例均评估了骨折复位和关节吻合度的关节镜检查，但评估跗关节整个背侧关节间隙的完整性存在差异。这可能导致这些病例中软组织病变被低估。
一些患有近节指骨矢状骨折的马同时存在关节囊和/或背侧襞撕裂，这可能与骨折发生的急性过程有关。仅通过 X 线片不能有把握地排除关节表面的骨折移位和不吻合。
