Short-term cast immobilisation is effective in reducing lesion propagation in a surgical model of equine superficial digital flexor tendon injury
ABSTRACT Larger superficial digital flexor tendon (SDFT) injuries have a poorer prognosis than smaller lesions. During the inflammatory phase enlargement of the initial lesion is frequently noted, with biomechanical loading being recently proposed to play an important role.
To evaluate the effect of lower limb cast immobilisation on tendon lesion propagation in an equine model of surgically induced SDFT injury.
Core lesions were surgically induced in both front SDFTs of 6 young mature horses. At the end of surgery, one leg was randomly placed in a lower limb cast and the other leg (control) was bandaged for 10 days. Computerised ultrasonographic tissue characterisation performed at Days 10, 15, 21, 28, 35 and 42 allowed measurement of lesion length (cm) and width (expressed as a percentage of whole tendon cross-section). On Day 42 horses were subjected to euthanasia and both SDFTs were sectioned every centimetre to assess the lesion length macroscopically. Statistics were performed to compare cast vs. control legs with significance set at P<0.05.
When all time points were combined, lesion length was 19% shorter (P<0.0001) and lesion width 57% smaller (P = 0.0002) in the cast legs (6.13 ± 0.12 cm; 6.90 ± 0.64%) than in the control legs (7.30 ± 0.21 cm; 10.85 ± 1.22%). On Day 42 the lesion length on macroscopic evaluation was 19% shorter (P = 0.04) in the cast (7.00 ± 0.36 cm) than in the control legs (8.33 ± 0.33 cm).
Cast immobilisation for 10 days effectively reduced lesion propagation (length and width) compared to bandaging in an in vivo model of artificially-induced tendon lesions.
A short period of cast immobilisation during the early phase of tendon healing may be an easy and cost-effective way to reduce the initial enlargement of lesion size and hence to improve prognosis.
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ABSTRACT: Background: Evidence for a standard x-ray study and cast immobilization in emergency department (ED) management and follow-up of children with bicycle spoke injury (BSI) is absent. Objective: To describe the injury pattern and outpatient follow-up and care of ED patients with BSI. In addition, patient characteristics predicting the presence of a fracture and long-term follow-up were assessed. Methods: This was a retrospective study including BSI patients < 9 years of age. Kruskal-Wallis test was used to compare groups with a fracture, soft tissue injury, and mild skin abrasion. Multivariable logistic regression analysis was used to identify independent predictors of a fracture and long-term outpatient follow-up. Results: Twenty-three percent of 141 included patients had a fracture, with a median (interquartile range) follow-up of 27 (23-40) days. For soft tissue injury and mild abrasions this was 9 (6-14) and 7 (5-9) days, respectively (p < 0.001). No clinical variables could predict a fracture. Fifty-six (40%) patients required no further care after the first outpatient visit at similar to 1 week. Triage category yellow and swelling were independent predictors for more than one outpatient visit, besides presence of fracture. Corrected odds ratios (95% confidence interval) were 2.42 (0.99-5.88) and 4.76 (1.38-16.39), respectively. Only 12% of 141 patients had none of these predictors at ED presentation. Conclusions: A quarter of ED patients with BSI have a fracture with no clinical signs that could predict the presence of a fracture, justifying a standard x-ray study in ED management. Only 12% of ED patients with BSI have no fracture and no signs that predict long-term follow-up. In this group, further studies are warranted to investigate the benefit of cast immobilization for fractures and soft tissue injury. (C) 2014 Elsevier Inc.Journal of Emergency Medicine 06/2014; 47(3). DOI:10.1016/j.jemermed.2014.04.028 · 1.18 Impact Factor
Equine Veterinary Journal 01/2014; 46(1):4-9. DOI:10.1111/evj.12128 · 2.37 Impact Factor
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ABSTRACT: Objective: Even though equine multi-limb tendinopathy models have been reported, it is unknown if fore- and hindlimb tendon healing behave similarly. The aim of this study was to compare the healing process of surgically induced superficial digital flexor tendon (SDFT) core lesions of fore- and hindlimbs in horses. Methods: Tendon core lesions were surgically induced in the SDFT of both fore- and hindlimbs in eight horses. One randomly assigned forelimb and one randomly assigned hindlimb were injected with saline one and two weeks post-surgery. The healing process was monitored clinically and ultrasonographically. After 24 weeks, the tendons were harvested and biochemical, biomechanical and histological parameters were evaluated. Results: Twenty-four weeks post-surgery, the forelimb SDFT lesions had a significantly higher colour Doppler ultrasound vascularization score (p = 0.02) and glycosaminoglycan concentration (p = 0.04) and a significantly lower hydroxylysylpyridinoline content (p = 0.03). Clinical relevance: Our results indicate that fore- and hindlimb SDFT surgically induced lesions exhibit significant differences in several important parameters of tendon healing 24 weeks post-surgery. These differences create significant challenges in using all four limbs and accurately interpreting the results that one might generate. Therefore these findings do not support the use of four-limb models for study of tendon injury until the reasons for these differences are much better understood.Veterinary and Comparative Orthopaedics and Traumatology 07/2014; 27(5). DOI:10.3415/VCOT-13-11-0136 · 1.03 Impact Factor