Fractures in the Horse. Группа авторов
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Table 3.1 Predictable sites of stress fractures and stress remodelling.
Bone/joint | Anatomical region | References |
---|---|---|
Scapula | Distal aspect of the spine | [140] [145] |
Humerus | Caudoproximal Craniodistal Medial diaphyseal Caudodistal | [146] [144, 147] [148, 149] |
Carpus | Dorsomedial third carpal bone Radial carpal bone Intermediate carpal bone | [150] [151] [89] |
Third metacarpal | Mid‐diaphyseal and supracondylar Parasagittal groove Proximal palmar Dorsal cortex Distal condyle | [152] [60] [153] [154] [69] [155] |
Proximal sesamoid | Palmar flexor region Medial sesamoid abaxial mid‐body subchondral bone | [38] [156] |
Proximal phalanx | Sagittal groove | [157] [158] |
Pelvis | Ilial wing Pubis | [159] [137] [160] [161] [162] |
Tibia | Distomedial Caudoproximal Caudal diaphyseal Proximolateral under the head of the fibula | [163] [164] [148] |
Tarsus | Dorsolateral third tarsal bone | [165] [166] |
Lumbar spine | L5–L6 vertebral junction | [136] |
The most common physeal fracture in horses is a Salter–Harris type II [175]. These have been reported in the third metacarpal and metatarsal distal physes, distal femoral physis and proximal tibial physis [175–177]. Physeal fractures of the proximal tibia have a typical pattern of type II with a lateral metaphyseal corner [179]. Type IV injuries tend to be unstable and many require internal fixation [180]. Bridging of the physis during internal fixation of physeal fractures should be avoided if possible as it may result in premature closure and subsequent development of angular limb deformity [180]. Type V injuries are rare, and are often not initially radiographically detectable, but manifest as a progressive angular limb deformity [176].
Table 3.2 Features and qualifiers of features applicable to fracture description.
Source: Stover [170]. Reproduced with permission of Sage Publication.
Feature | Qualifier | Description |
---|---|---|
Location | Epiphysis | Fracture involves the end of a long bone |
Physis | Fracture involves an open physisa | |
Metaphysis | Fracture involves a region of the bone adjacent to the physis on the side closest to the diaphysis | |
Diaphysis | Fracture involves the central region of a long bone | |
Direction | For example, proximodorsal to distopalmar | Direction(s) of the fracture line(s) is (are) described from proximal to distal unless the direction of propagation is known (e.g. MCIII/MTIII condylar fractures progress from distal to proximal) |
Plane | For example, transverse, oblique, longitudinal, sagittal and dorsal | Orientation of the predominant fracture line |
Configuration | Transverse | Fracture courses perpendicular to the longitudinal axis of the bone |
Longitudinal | Fracture courses parallel to the longitudinal axis of the bone | |
Oblique | Fracture courses along a flat plane obliquely through the bone (i.e. not parallel to a transverse or longitudinal plane) | |
Spiral | Fracture has a spiral component | |
Butterfly | Fracture has transverse and oblique components | |
Extent | Complete | Fracture courses completely through the bone, dividing it into two or more separate fragments |
Incomplete | Fracture does not course completely through the bone | |
Displacement | Nondisplaced | Fracture fragments remain in anatomic apposition |
Displaced | Fracture fragments separated, angulated or overriding, and no longer in anatomic apposition | |
Complexity | Simple | One fracture line dividing the bone into two separate fragmentsb |
Intermediate | May have one or two sizeable bony fragments (e.g. complete mid‐diaphyseal metacarpal/metatarsal fracture with a butterfly component) | |
Complex | Multiple fracture lines and ≥3 bony fragments or greater comminution | |
Joint involvement | Non‐articular | The fracture does not extend through an articular surface |
Articular | The fracture courses through an articular surface | |
Contamination | Closed | The skin overlying the fractured bone is intact and not penetrated by the injury |
Open | The skin has a wound over the fracture that introduces contamination and increases the risk of infectionc | |
Other | Avulsion |
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