A technique for laser-facilitated equine pastern arthrodesis using parallel screws inserted in lag fashion.
Authors: Watts Ashlee E, Fortier Lisa A, Nixon Alan J, Ducharme Norm G
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Laser-Facilitated Pastern Joint Arthrodesis Proximal interphalangeal joint (PIJ) osteoarthritis represents a challenging end-stage condition in horses, and surgical fusion remains a definitive treatment option when conservative management fails. Watts and colleagues evaluated a minimally invasive technique combining diode laser application (2000 J energy) with parallel screw fixation (three 5.5 mm screws in lag fashion) inserted through small stab incisions rather than open surgical exposure, comparing outcomes across six horses (seven affected limbs) with radiographically confirmed PIJ OA. By six months post-operatively, five of six horses were sound and had returned to work, with four demonstrating radiographic evidence of solid joint fusion; however, one horse developed persistent low-grade lameness with delayed union at 12 months, and post-operative care involved either simple bandaging or bandage-casting for three weeks followed by progressive exercise. The laser-facilitated approach offers potential advantages over conventional open arthrodesis through reduced surgical trauma, lower operative costs, and reportedly decreased post-operative pain, though the authors appropriately emphasise that further investigation is needed to characterise laser dosimetry, determine optimal case selection criteria, and establish whether this technique should become standard practice. For practitioners considering fusion as a treatment option in chronic PIJ disease, this technique warrants consideration as a less invasive alternative, particularly in cases where minimising tissue damage and expediting return to function are priorities.
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Practical Takeaways
- •Laser-facilitated pastern arthrodesis offers a minimally invasive alternative to open surgery for PIJ osteoarthritis, with lower postoperative pain and faster return to function for suitable candidates
- •Most horses (5/6) were sound and back in work within 6 months, but case selection and patient counselling on the 3-4 week immobilization period are critical
- •This technique requires further investigation into optimal laser dosing and case selection criteria before becoming standard practice in your clinic
Key Findings
- •5 of 6 horses (83%) became sound within 6 months post-operatively
- •4 of 6 horses (67%) achieved radiographic evidence of successful joint fusion within 6 months
- •Laser-facilitated technique associated with less postoperative pain compared to standard open arthrodesis
- •5 of 6 horses (83%) returned to intended use during 6-18 month follow-up period