Proximal interphalangeal locking compression plate for pastern arthrodesis in horses

Abstract

Background: Outcomes following proximal interphalangeal joint (PIPJ) arthrodesis by a variety of surgical methods are available. Reports detailing clinical outcomes following PIPJ arthrodesis utilising the proximal interphalangeal joint locking compression plate (PIP-LCP) and abaxial transarticular lag screws technique are limited. Objectives: To report survival, radiographic and clinical outcomes following PIPJ arthrodesis with PIP-LCP and abaxial transarticular lag screw fixation. Study design: Retrospective case series. Methods: Medical records of all horses undergoing pastern arthrodesis from 2009 to 2018 were reviewed. Arthrodeses performed using a 3-hole, 4.5 mm narrow LCP, specifically designed for the proximal interphalangeal joint, were included. Patient details, presentation, radiographic findings, intraoperative and post-operative data, and complications were documented. Short-and long-term follow-up was available for 23 horses.Results: Thirty PIPJ arthrodeses were performed in 29 horses meeting the criteria for inclusion. Twenty-eight horses (97%, 95% CI 83-100) survived to discharge.Twenty-three horses (79%, 95% CI 60%-92%) had successful outcomes including 12 of the 15 forelimb cases and 11 of the 13 hindlimb cases with available follow-up. Fifteen of 19 performance horses returned to athletic activity. Soundness in performance horses was recognised at less than 3 months in one case, 3 to 6 months in six cases, 6 to 12 months in five cases, and greater than 12 months in six cases. Complications included three implant infections, support limb laminitis (two horses), and fragmentation of the extensor process of the distal phalanx (one horse). Main limitations:A retrospectively reviewed, small study population with a variety of breeds and disciplines. Conclusions:The PIP-LCP construct provides a very good prognosis for performance and an excellent prognosis for pasture soundness.

Evaluation of factors associated with surgical site infection in equine proximal interphalangeal joint arthrodesis: 54 cases (2010–2019)

“…This study described the rate of SSI in equine PIPJ arthrodesis and the relative risk for development of infection with various systemic and local antibiotic protocols. The prevalence of SSI in this population (3.7%) was lower than previous reports in equine orthopaedic internal fixation (10-28%; Ahern et al, 2010;Curtiss et al, 2019;Macdonald et al, 1994) or PIPJ arthrodesis specifically (6.6-17.2%; Hicks et al, 2021;Knox & Watkins, 2006;McCormick and Watkins, 2017;Sakai et al, 2018). There was no difference in SSI rate in cases administered systemic antibiotics for 1-3 days or > 3 days, or for those horses that did or did not receive regional antibiotic perfusion in this population, although Bayesian odds ratios indicate that a shorter course (< 3 days) of antibiotics may be associated with a decrease in the odds of a postoperative SSI.…”

“…In one study describing the use of LCPs in PIPJ arthrodesis, 5 days of parenteral antibiotics followed by oral doxycycline until cast removal was reported (Hicks et al. 2021). Ahern et al.…”

“…2018) associated with infections following orthopaedic implant placement, as well as Enterobacter (Ahern et al. 2010; Knox & Watkins, 2006), Streptococcus (Knox & Watkins, 2006), Pseudomonas (Ahern et al., 2010; Hicks et al., 2021; Knox and & Watkins, 2006) and Corynebacterium (Sakai et al., 2018). Ahern et al.…”

“…The articular cartilage was removed from the PIPJ in all cases using a curette, and osteostixis was performed with a 2.5‐mm drill bit. Either a DCP, LC‐DCP or locking compression plate (LCP) plate with two trans‐articular screws placed in lag fashion, two LCP plates or two trans‐articular screws were used as previously described (Herthel et al., 2016; Hicks et al., 2021; Sakai et al., 2018). All plates were contoured to provide plate‐to‐bone contact as needed.…”

“…Retrospective evaluations of equine patients undergoing PIPJ with orthopaedic implant placement have reported SSI rates in 2/30 (6.6%) (McCormick & Watkins, 2017), 3/30 (10%) (Hicks et al. 2021), 6/53 (11.3%) (Knox & Watkins, 2006), and 5/29 (17.2%) (Sakai et al., 2018) cases. The outcome for athletic performance following PIPJ arthrodesis was reduced in horses operated on for osteoarthritis vs. other causes (Herthel et al.…”