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首页> 外文会议>American College of Veterinary SurgeonsACVS Surgery Summit >SPIRAL CONDYLAR FRACTURES
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SPIRAL CONDYLAR FRACTURES

机译：螺旋髁骨折

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Medial condylar fractures and spiraling lateral condylar fractures, like all articular fractures in the horse, are clearly best managed with internal fixation (lag screw or lag screw and plate fixation). There are two fracture configurations for thesefractures. The less common fracture configuration spirals from the fetlock to the tarsus/carpus and the spiraling fracture line can be followed along it's entire length. The more common fracture configuration spirals about halfway up the metatarsus/carpus and then either disappears or "Y's" off medially and laterally. The first less common fracture type is best managed with the standing application of lag screws. The fracture of interest for this presentation is the spiraling fracture that gets lost inthe middle of fhe bone. The primary challenge in these cases is not the repair itself but how to safely recover these horses from anesthesia. Early attempts at repair with distal lag screws alone had a high incidence of catastrophic fracture of the cannon bone during or shortly after recovery from anesthesia. Short limb cast coaptation was of no value in protecting these repairs from failure and possibly even made failure in the mid cannon bone more likely. Swimming pool recovery! systems were a big improvement in safely transitioning these horses from general anesthesia to standing but failures in the middle of the bone were still occurring with just lag screw repair. Approximately 20 years ago surgeons began applying plates, either laterally or medially to these fractures to protect the bone from castastrophic failure during recovery and the early postoperative period. Initially these plates were applied through open incisions. In those days, it wasJ not possible to follow the fracture line any further looking directly at the bone than you could follow it on radiographs so there was no real advantage to the open approach and subsequently these fractures have been repaired through a minimally invasive approach with the bottom two lag screw's placed through stabs and the plate placed in a sub-periosteal pocket made through a small incision. The screw holes in the plate are then palpated through the skin and the plate screws are placed through stab incisions over each hole in the plate. The horses are then recovered either in a pool recovery system if available or with head and tail rope assistance if no pool is available. In the absence of a pool some surgeons will apply a full limb cast for recovery from anesthesia and, while this method will protect the fracture, there are clearly risks associated with recovering horses in full hind limb casts. The current trend for repairing these fractures standing with distal lag screws is, in my opinion, risky. It does nothing to protect the middle of the bone from catastrophic failure. While the incidence of catastrophic failure in untreated fractures and fractures repaired with distal lag screws only is unknown, estimates have ranged as high as 50%. Clearly, in my opinion, the incidence of failure is no where near that high. Based on the number of horses that arrive for surgery with the "Y" component of the fracture visible radiographically or horses in which the "Y" component of the fracture opens up under the plate after repair my best guess is that somewhere between 10 -20% of horses would suffer castastrophic failure if the middle of the bone is not protected.
机译：内侧髁突骨骨折和螺旋形侧髁骨折，如马的所有关节骨折，清楚地用内固定（滞后螺丝或滞后螺钉和板固定）。这些折衷有两个骨折配置。从Fetlock到Tarsus / Carpus的较小的常见骨折构型螺旋和螺旋形骨折线可以沿着它的整个长度遵循。大约中途的骨折构造螺旋越常见，然后在内侧和横向消失或“y”。第一种较少的常见骨折类型最好与滞后螺钉的站立施用。这种介绍的骨折是螺旋形骨折，骨骼中间丧生。这些情况下的主要挑战不是修复本身，而是如何安全地从麻醉中恢复这些马。在麻醉后，单独使用远端滞后螺钉修复的早期尝试在麻醉后或短暂的麻醉后不久的灾难性骨折发生率。短肢铸造拟合在保护这些维修的情况下没有任何价值，并且可能更有可能在中间炮骨中进行失败。游泳池恢复！系统是安全过渡从全身麻醉到站立的那种马的巨大改善，但骨骼中间的失败仍然发生在滞后螺钉修复。大约20年前外科医生开始横向或后侧向这些骨折施加平板，以保护骨骼在复苏期间和术后早期的术后。最初通过打开切口施加这些板。在那些日子里，它不可能遵循任何进一步看骨骼的骨折线，而不是在射线照相上遵循它，因此对开放方法没有真正的优势，随后通过微创的方法修复了这些裂缝。底部两根滞后螺钉通过刺刺和板置于透过小切口的骨膜口袋中。然后通过皮肤触发板中的螺纹孔，并且板螺钉通过板上的每个孔上的刺入切口放置。如果没有可用的池，则在池恢复系统中恢复，然后在池恢复系统中恢复。在没有一个游泳池的情况下，一些外科医生将应用一个全肢铸造，以便从麻醉中恢复，而这种方法将保护骨折，显然是与全后肢铸造的马匹相关的风险。在我看来，我认为伴随着远端滞后螺钉的这些骨折的当前趋势是风险的。它没有任何东西可以保护骨骼中间免受灾难性的失败。虽然未经治疗的裂缝和骨折的灾难性失败的发生率仅为未知，但估计值高达50％。显然，在我看来，失败的发生率是没有近高的地方。基于与骨折的“Y”组分到达手术的马匹数量可见射线照相或马匹，其中骨折的“Y”成分在修复后在板上在板上开放，我最好的猜测是10-20之间的某个地方如果骨骼的中间没有保护，那么马匹的百分比将遭受castactrophic失效。

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