Circumferential Wiring of Mid‐body and Large Basilar Fractures of the Proximal Sesamoid Bone in 15 Horses

Abstract

Circumferential wiring was used to repair 12 mid-body fractures and four large basilar fractures of proximal sesamoid bones in 15 horses. Eighteen-gauge stainless steel wire was placed around both fragments in five horses, and through the proximal fragment and around the distal fragment in 10 horses. The horses were returned to work when they were clinically sound and fracture healing was evident radiographically. Eleven horses resumed athletic performance, three horses were used as breeding animals, and one horse was retired. Five horses performed at an athletic level equal to or better than their previous levels, and six horses performed at a lower level.

AnIn VitroBiomechanical Comparison of Two Fixation Methods for Transverse Osteotomies of the Medial Proximal Forelimb Sesamoid Bones in Horses

“…Placement of the transfixation wire was relatively easy in this cadaver model. Although we showed the initial strength of the 18‐gauge stainless steel wire was significantly greater than LS‐repair, others reporting on the use of the TW‐repair method suggested using heavier gauge wire for the repair, because 6 of 15 wires broke after surgery 8 . However, because of the reported success of the procedure, the wires in that report most likely broke from cyclic loading well into the postoperative period after the sesamoid bones were sufficiently healed.…”

“…In a report of fixation by screws placed in lag fashion for repair of midbody and basilar proximal sesamoid bone fractures, 14 of 20 horses returned to training but only 1 horse met or exceeded its previous level of performance 9 . Circumferential or transfixation wiring of midbody and basilar proximal sesamoid bone fractures, using 18‐gauge stainless steel wire, has been reported in 15 horses, with 11 returning to training and 5 meeting or exceeding their previous level of performance 8 . In that report, six wires broke at some time after the initial repair, leading the authors to speculate that heavier gauge wire may be needed for optimal fracture repair.…”

“…Surgical options for repair of midbody proximal sesamoid bone fractures include internal fixation with screws placed in lag fashion, and circumferential or transfixation wiring 6–9 . In a report of fixation by screws placed in lag fashion for repair of midbody and basilar proximal sesamoid bone fractures, 14 of 20 horses returned to training but only 1 horse met or exceeded its previous level of performance 9 .…”

“…In that report, six wires broke at some time after the initial repair, leading the authors to speculate that heavier gauge wire may be needed for optimal fracture repair. Advantages of wiring over lag screw fixation have been reported to include less soft tissue trauma, easier implantation, and lack of need for specialized equipment 8 . Disadvantages include the necessity for incisions into both the fetlock joint and flexor tendon sheath and the possibility of wire breakage resulting in postconvalescent lameness 8 …”

Surgical Approach for Removal of Nonarticular Base Sesamoid Fragments of the Proximal Sesamoid Bones in Horses

“…Midbody sesamoid fractures occur in relatively equal frequency in the Standardbred and Thoroughbred horses 1 . Prognosis for return to soundness with screw fixation in lag fashion or transfixation wiring has been reported as 75% and 73%, respectively 9,10 . Abaxial sesamoid fractures are less common and may be articular or nonarticular 4 .…”