Use of electrocautery probes in arthroscopic removal of apical sesamoid fracture fragments in 18 standardbred horses

Objective-To develop a technique for arthroscopic excision of apical sesamo id fracture fragments using electrocautery probes. Animals or Sample Population-A total of 18 Standardbred horses. Methods-Arthroscopic removal of apical sesamoid fracture fragments using bo th hook and loop electrocautery probes was performed on 18 Standardbred hor ses. The fracture fragments were approached using either an ipsilateral (3) or contralateral (15) arthroscopic triangulation technique. Distension of the metacarpo- (metatarso)-phalangeal joints was achieved using a 1.5% glyc ine solution. Under arthroscopic guidance, both the suspensory and interses amoidean ligament attachments to the abaxial and the axial margins of the a pical fragment were transected using a hook electrocautery probe. Subsequen tly, the palmar (plantar) soft tissue attachments to the apical fragment we re transected with a loop electrocautery probe. Once freed of soft tissue a ttachments, the apical fragment was removed with Ferris-Smith intervertebra l disc rongeur. The arthroscopic portals were closed in a routine manner. Results-Horse ages ranged from 2 to 8 years (median, 2.5 years). Eighteen a pical sesamoid fracture fragments were removed from the left (8) and right (8) hind limbs and the left (1) and right (1) forelimbs. Apical fragments o ccurred in 15 lateral and 3 medial proximal sesamoid bones. No major compli cations occurred during or after surgery. The electrocautery probes permitt ed an easy and precise dissection of all soft tissue attachments to the api cal sesamoid fracture fragments in all horses. Follow-up time was 7 to 34 m onths (median, 26 months); 10 of 14 horses returned to racing. Seven of nin e horses that raced before surgery raced again and three of five that had n ot raced before surgery, raced afterwards. Conclusion-Arthroscopic excision of apical sesamoid fracture fragments can be accomplished arthroscopically using electrocautery probes. Clinical Relevance-Arthroscopic electrosurgery is an efficient and safe alt ernative for intra-articular dissection in horses. (C)Copyright 1999 by The American College of Veterinary Surgeons.