Standing MRI for surgical planning of equine fracture repair

Abstract

Objective To report the feasibility of standing MRI (sMRI) and document the value of sMRI in surgical planning for surgical repair of limb fractures in the horse. Study design Retrospective case series. Animals Thirty‐one horses with preoperative sMRI. Methods Medical records were reviewed for fracture type, application of a polyester cast, sMRI sequences performed, technical variables, and image quality. Fracture geometry and concomitant lesions were compared between sMRI and radiography. The relative value of sMRI with regard to surgical planning was classified as minor (sMRI did not provide additional findings), intermediate (additional lesions found or slight modification to surgical plan), or major (sMRI led to significant alternations in surgical plan). Results Standing MRI provided good studies in all horses. Standing MRI was classified as having major relevance in 12 of 31 horses, intermediate relevance in 14 of 31 horses, and minor relevance in 5 of 31 horses. Conclusion Preoperative sMRI produced good studies in all horses and influenced the surgical planning in the majority of fractures in this study. Application of a polyester cast seemed to improve comfort without appreciable loss of image quality. Clinical significance Standing MRI can be considered as an adjunct to plan the repair of equine fractures, and a polyester cast does not impair image quality.

Immediate pre-operative computed tomography for surgical planning of equine fracture repair: A retrospective review of 55 cases

“…Previous studies have reported complications such as further propagation or displacement of fractures [ 2 ] following induction of anaesthesia. This is mitigated against by providing external coaptation of the limb but complications can still occur.…”

“…The two surgical plans were then compared and finally each case was classified in to three categories on the basis of the relevance of the CT study to surgical planning. These groups were defined by previously published parameters by Genton et al, 2019 [ 2 ]. These are as follows;…”

“…Fractures of the distal limb are relatively common in the equine athlete and poor fracture healing can lead to persistent lameness which often leads to significant economic, welfare or functional losses [ 1 ]. Surgical repair of limb fractures aims to maximise return to function by minimising complications relating to fracture healing such as excessive callus formation, osteoarthritis or persistent lameness [ 2 ]. In order to achieve this, implant placement must be accurate and well planned to ensure complete reduction of the fracture.…”

“…There are several studies describing the use of CT in a small cohort of single fracture types [ 3 , 6 – 9 ]. There are also studies describing the use of intra-operative CT for a variety of fracture types [ 4 , 10 , 11 ] however, intra-operative CT is not widely available and poses a different set of benefits and challenges in comparison to pre-operative CT. A previous study described the use of pre-operative standing magnetic resonance imaging (MRI) for surgical planning of fracture repair [ 2 ]. This suggested that the use of pre-operative MRI significantly influenced surgical planning in most cases in the study and that standing pre-operative MRI was a safe and effective way to perform 3D imaging on a distal limb fracture [ 2 ].…”

Comparison of Radiography and Computed Tomography for Evaluation of Third Carpal Bone Fractures in Horses

“…Neither imaging technique we used is able to detect cartilage lesions; however the addition of positive contrast arthrography can assist with identification of cartilage loss on CT examination [35]. Pre-operative standing MRI may be useful in determining Fx morphology and guiding surgical planning [6,36] yet movement can be an issue with standing MRI of the carpus. Arthroscopy is limited to diagnosis of injuries involving the joint surface.…”