Page 235 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

210 CHAPTER 1

VetBooks.ir 1.400 1.401

Fig. 1.400 A non-displaced comminuted fracture Fig. 1.401 A deliberately underexposed lateral
of the upper part of the tibial tuberosity caused by radiograph of the femoropatellar joint to highlight a
a kick to the cranial stifle region. (Photo courtesy small chip fracture off the cranial aspect of the lateral
Graham Munroe) trochlear ridge due to a kick injury. (Photo courtesy
Graham Munroe)

1.402 Management/prognosis
Treatment for tibial tuberosity fractures is determined
by the size of the fragment, the degree of displacement
and involvement of the joint. Horses with minimally or
non-displaced fragments may be treated conservatively
with box rest. It is advisable to cross-tie these horses to
minimise the risk of proximal displacement of the frac-
tured fragment by the pull of the quadriceps muscles
via the patellar ligament. Small, displaced fragments are
best removed, and large fragments creating loss of func-
tion of the patellar ligaments should be fixed internally
using a bone plate and screws. Generally, the prognosis
for horses with tibial tuberosity fractures is good.
Intra-articular fractures should be assessed,
and possibly treated, arthroscopically. Fractures of
the intercondylar eminence are best treated with
arthroscopic removal of the fracture fragment where
the fragment is small and internal fixation where a
Fig. 1.402 Caudocranial radiograph of the stifle larger fragment is encountered. Small fracture frag-
reveals a healing 3-month-old fracture of the proximal ments of the trochlear ridges of the femur and femo-
fibula caused by a direct trauma. (Photo courtesy ral condyles, often traumatic in origin and sometimes
Graham Munroe) accompanied but other injuries such as fracture of
the patella, are best treated by arthroscopic removal.