Closing wedge ostectomy and medial distal tibia plate application for treatment of severe bilateral angular limb deformities in the hindlimbs of an 8‐month‐old foal

Abstract

Summary This case report describes the evaluation, surgical approach and outcome of an 8‐month‐old foal with severe angular limb deformities of both metatarsophalangeal joints (MTPJ). Radiography and computed tomography (CT) were used to diagnose a windswept deformity of the hindlimbs with associated bilateral physitis. The orthopaedic surgery was planned and rehearsed using three‐dimensional (3D) bone models. A bilateral closing wedge ostectomy was performed on the distal MtIII, and 3.5 mm LCP® medial distal tibia plates were used bilaterally for osteosynthesis. Even though convalescence was prolonged and complicated by partial unilateral implant failure and osteoarthritis (OA), reduction of the deformities was successful and resulted in a sound foal.

Displacement osteotomies/ostectomies in the horse

“…Luckily, significant rotational deviations are rarely encountered because they would be difficult to correctly assess radiographically alone (Piras et al 2012). Every now and again a deformity in the sagittal plane is encountered, such as in the case described by Lindt et al (2022) in this issue. These deformities are thought to be part of the physitis complex and possibly associated with Salter-Harris type-1 fractures (Watkins and Auer 1984;Bramlage 1993;Jackson et al 2011).…”

“…In most instances, the internal fixation is insufficient, therefore requiring some type of post-operative external coaptation. The closing wedge ostectomy leads to shortening of the bone, which is a minor problem in horses, but could have led to marked weak angle in the MTPJ angle in the case described by Lindt et al (2022).…”

“…On these models, the exact displacement OE/OO can be practiced hands-on and is nowadays strongly recommended in human surgery (Franklin et al 2017;Kwun et al 2017;Winer et al 2017;Lau et al 2018). Recently, reports of using this technique in veterinary medicine have been published (Radtke et al 2017;Oaxley 2018;Lindt et al 2022;Schweinsberg et al 2021).…”

“…Being able to rehearse the actual correction results in a shorter surgery time and increased accuracy (Lindt et al 2022) and aids in the selection of the best implants, especially for more complex and multiplanar osteotomies (Lau et al 2018;Schweinsberg et al 2021).…”

“…Additionally, the term 'displacement osteotomy' is defined as: the surgical division of a bone and shifting of the divided ends to change the alignment of the bone or to alter weight-bearing stresses. Therefore, displacement ostectomy/osteotomy (OE/OO) are the correct terms for the type of technique discussed by Lindt et al (2022) and in this Clinical Commentary.…”