Introduction

• Arthrodesis of the metacarpo- or metatarsophalangeal joints is primarily a salvage procedure that can lead to comfortable survival of a patient, but not a return to athletic function.

Uses

• To reduce pain and suffering in severe osteoarthritis   Musculoskeletal: osteoarthritis (joint disease)  of the metacarpo- or metatarsophalangeal joint.
• To allow comfortable weight-bearing on the affected limb following traumatic disruption of the palmar/plantar support structures of the fetlock, eg biaxial fracture and distraction of the proximal sesamoid bones   Proximal sesamoid: fracture  , complete disruption of the suspensory ligament or distal sesamoidean ligaments.
• To stabilize the fetlock joint and allow comfortable weight-bearing in severe luxations of the fetlock joint or compound articular fractures.
• To correct flexural deformity of metacarpophalangeal joint secondary to radial nerve palsy.

Advantages

• Reduce suffering in severe osteoarthritis.
• Allow comfortable survival following traumatic disruption of the fetlock support apparatus.
• Prevent contralateral limb breakdown in severe osteoarthritis or disruption of the suspensory apparatus.
• May salvage horse for breeding purposes, but not return to athletic function.

Disadvantages

• Cannot return horse to athletic function.
• Risk of general anesthesia and recovery.
• Risks of surgical procedure: sepsis - greater risk if open disruption of palmar/plantar support apparatus.
• Damage to vascular structures associated with traumatic disruption of suspensory apparatus can limit repair or lead to complete avascular necrosis of distal limb.
• Any factor leading to pain in the affected limb may result in overload of the contralateral limb, and contralateral limb laminitis.
• Graft collection may prolong the procedure.

Requirements

Preparation

Procedure

Aftercare

Outcomes

Prognosis

• Fair: one study showed an overall 65% success rate for survival, pain-free weight-bearing and unrestricted activity.
• Better for horses treated for osteoarthritis than for rupture of the suspensory apparatus.
• For treatment of osteoarthritis, the prognosis is largely dependent on the integrity of the contralateral foot. With no evidence of laminitis, the success rate is high.
• For treatment of suspensory apparatus disruption, the prognosis is largely dependent on the severity of injury.

Further Reading

Publications

Refereed papers

• Recent references from PubMed and VetMedResource.
• Whitfield-Cargile C & Watkins J P (2011) Bilateral distal radial epiphysectomy and pancarpal arthrodesis for correction of complex carpal deformities in an Americal Miniature horse. Equine Vet Educ 23 (8), 381-385 VetMedResource.
• Kelmer G & Wilson D A (2007) Bilateral metatarsophalangeal arthrodesis for severe congenital flexor tendon laxity and metatarsophalangeal luxation in a miniature horse. Equine Vet Educ 19 (10), 547-550 VetMedResource.
• Levine D G & Richardson D W (2007) Clinical use of the locking compression plate (LCP) in horses: a retrospective study of 31 cases (2004-2006). Equine Vet J 39 (5), 401-406 PubMed.
• Sod G A & Martin G S (2004) An invitro biomechanical comparison of a prototype intramedullary pin-lnate with a dynamic compression plate for equine metacarpophalangeal arthrodesis. Vet Surg 33 (1), 83-91 PubMed.
• Auer J A et al (1993) Metacarpophalangeal arthrodesis in conjunction with a disrupted suspensory apparatus- part II of an in vitro study. Vet Surg 22 (3), 253 VetMedResource.
• Zamos D T & Honnas C M (1993) Principles and applications of arthrodesis in horses. Comp Contin Ed 15 (11), 1533-1541 VetMedResource.
• Whitehair K J et al (1992) Arthrodesis for congenital flexural deformity of the metacarpophalangeal and metatarsophalangeal joints. Vet Surg 21 (3), 228-233 PubMed.
• Blater G & Weber B G (1990) Wave plate osteosynthesis as a salvage procedure. Arch Orthop Trauma Surg 109 (6), 330-333 PubMed.
• Auer J A (1988) Application of the dynamic condylar screw (DCS) and dynamic hip screws (DHS) implant systems in the horse. Vet Comp Orthop Trauma 1 (1), 18-25 VetMedResource.
• Crawley G R, Grant B D, White K K, Barbee D B, Gallina A M & Ratzlaff M H (1988) A modified Cloward's technique for arthrodesis of the normal metacarpophalangeal joint in the horse. Vet Surg 17, 117-127 PubMed.
• Richardson D W, Nunamaker D M & Sigafoos R D (1987) Use of an external skeletal fixation device and bone graft for arthrodesis of the metacarpophalangeal joint in horses. JAVMA 191, 316-321 PubMed.
• Snyder J R et al (1986) Conservative management of metacarpophalangeal joint instability. Proc Am Assoc Equine Pract 32, 357-364 VetMedResource.
• Bramlage L R (1985) Arthrodesis of the metacarpophalangeal joint - results in 43 horses. Vet Surg 14, 49.
• Bowman K F et al (1984) Complications during treatment of traumatic disruption of the suspensory apparatus in thoroughbred horses. JAVMA 184, 706 PubMed.
• Bramlage L R (1982) An initial report on a surgical technique for arthrodesis of the metacarpophalangeal joint in the horse. Proc Am Assoc Equine Pract 27, 257-261 VetMedResource.

Other sources of information

• Bramlage L R (1996) Fetlock arthrodesis. In: Equine Fracture Repair. Ed: A J Nixon. W B Saunders, USA. pp 172-178.
• Auer J A (1992) Arthrodesis techniques. In: Equine Surgery. Ed. J A Auer. W B Saunders, USA. pp 902.
• Auer J A (1991) Arthrodesis techniques. In: Equine Medicicine and Surgery. 4th Edn. Eds: P Colahan, I G Mayhew, A Merrit et al. Santa Barbara-American Veterinary Publications. pp 1253.
• Fackelman G E and Nunamaker D M (1982) Metacarpophalangeal joint arthrodesis.In:Manual of Internal Fixation in the horse. Springer-Verlag, USA. pp 80-85.
• Bramlage L R (1982) Arthrodesis of the fetlock joint. In: Equine Medicine and Surgery. 3rd Edn. Eds: R A Mansman and G S McAllister. Santa Barbara-American Veterinary Publications, pp 1064.