Comparison of 3D‐assisted surgery and conservative methods for treatment of type III fractures of the distal phalanx in horses. (6th December 2019) - Heer, C.
Summary: The aim of this retrospective study was to compare the outcome of conservative methods and 3D‐assisted surgery for treatment of type III fractures of the distal phalanx with regard to recovery time and the development of osteoarthritis (OA) in the distal interphalangeal joint (DIPJ). The medical records of all horses with type III fracture of the distal phalanx referred to the Equine Department, Vetsuisse Faculty, University of Zurich, between 1992 and 2016 were reviewed. The severity of lameness at initial examination, radiographic evaluation, treatment (conservative, group A; 3D‐assisted surgery, group B), complications, outcome and recovery time were determined. Follow‐up examinations included clinical and radiographic examinations. Of 33 horses, 15 received conservative treatment and 18 underwent surgery. Eleven of the 15 (73.3%) horses in group A returned to their intended use and four were subjected to euthanasia or remained chronically lame. The median recovery time was 240 days (95% CI, 180–374). Thirteen of 15 (86.7%) horses developed OA of the DIPJ within 5 months of the fracture. In group B, 16 of 17 (94.1%) horses returned to their intended use, one horse remained chronically lame, and one horse was subjected to euthanasia because of unrelated reasons. The median recovery time was 139 days (95% CI, 120–270), and seven horses (38.9%) developed OA of the DIPJ within 5 months of the fracture. Overall, the screws had to be removed in five fluoroscopic‐assisted surgery cases (three because of implant infection and two because of severe lameness), in one computer‐assisted surgery case due to severe lameness and in one computed tomography‐assisted surgery case because of implant infection. In conclusion, there was no significant difference in time for recovery of type III fractures of the distal phalanx between the two groups, but surgical treatment led to significantly fewer cases of OA in the DIPJ as determined by subjective radiographic evaluation (P = 0.015).