Modified Proximal Interphalangeal Joint Arthrodesis in a Yearling Filly with an Osseous Cyst-Like Lesion in the Proximal Phalanx.
Authors: Kol'vek Filip, Krešáková Lenka, Vdoviaková Katarína, Medvecký Ľubomír, Žert Zdeněk
Journal: Animals : an open access journal from MDPI
Summary
Osseous cyst-like lesions (OCLLs) of the phalanges present a particular surgical challenge when located on the convex surface of the proximal phalanx, where conventional arthroscopic access and cyst curettage become difficult. This case report documents the management of a clinically significant OCLL in a yearling Czech warmblood filly that presented with chronic moderate-to-severe intermittent hindlimb lameness, using a modified approach combining proximal interphalangeal joint arthrodesis with three lag screws (two paraxial, one axial) alongside cyst curettage and calcium phosphate biocement packing. Rather than relying solely on drilling or screw fenestration to arrest lesion progression, the surgical team elected to eliminate motion across the affected joint whilst simultaneously promoting lesion fill with osteoconductive material, addressing both the biomechanical and biological aspects of the problem. For practitioners managing phalangeal OCLLs in young horses, this approach offers a definitive option where conservative management has failed or where lesion location precludes straightforward arthroscopic treatment; the case demonstrates that sacrificing proximal interphalangeal joint function may be an acceptable trade-off against the functional limitations imposed by progressive cyst expansion. Farriers and rehabilitation specialists should be aware that post-arthrodesis management requires careful consideration of loading patterns and shoeing modifications to distribute forces appropriately through the remaining distal interphalangeal joint.
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Practical Takeaways
- •When OCLLs occur on the convex surface of the proximal phalanx where conservative drilling/screw placement is technically difficult, joint arthrodesis combined with biocement filling may be a viable surgical option
- •This approach may be particularly suitable for young horses with significant lameness from large, clinically relevant phalangeal cysts
- •Three-screw arthrodesis technique (two paraxial, one axial crossed lag screw) provides stable fixation for this procedure
Key Findings
- •A yearling filly with a large clinically significant OCLL on the distal joint surface of the proximal phalanx was successfully treated with surgical arthrodesis of the proximal interphalangeal joint using three lag screws
- •Calcium phosphate biocement was used to pack the cyst cavity after curetting to encourage lesion filling
- •Surgical arthrodesis combined with biocement packing provided a treatment option for phalangeal cysts on the convex surface where conservative treatment presents technical challenges