Frequency of Penetration of the Digital Flexor Tendon Sheath and Distal Interphalangeal Joint Using a Direct Endoscopic Approach to the Navicular Bursa in Horses.
Authors: Kane-Smyth Justine, Taylor Sarah Elizabeth, García Eugenio Cillán, Reardon Richard J M
Journal: Veterinary surgery : VS
Summary
This cadaveric investigation examined the safety profile of direct endoscopic access to the navicular bursa in horses, comparing a conventional angled approach with an alternative parasagittal technique across four experienced surgeons operating on 40 limbs. The conventional direct approach resulted in inadvertent penetration of adjacent synovial structures in 45% of cases (37.5% digital flexor tendon sheath, 17.5% distal interphalangeal joint, with 10% involving both), alongside iatrogenic damage to navicular fibrocartilage or the deep digital flexor tendon in 55% of limbs—notably, surgeon experience made a substantial difference, with penetration rates ranging from 10% to 80%. The alternate parasagittal approach eliminated inadvertent synovial penetration entirely and prevented iatrogenic damage in all 12 cadaver limbs examined. For practitioners managing navicular bursa sepsis via direct endoscopic approach, these findings underscore the critical importance of systematically investigating for unintended penetration of the flexor tendon sheath or joint, and warrant serious consideration of adopting the straighter parasagittal trajectory, provided the trade-off between improved safety and potentially restricted visualisation within the bursa is deemed acceptable for individual cases.
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Practical Takeaways
- •If using direct endoscopic approach to navicular bursa, always probe/investigate for inadvertent penetration of DFTS or DIPJ, as nearly half of attempts risk compromising these structures
- •Surgeon experience and technique significantly influence complication rates—seek practitioners with documented low complication frequencies for this procedure
- •Consider advocating for the alternate parasagittal approach if available, as it eliminates penetration risk, though endoscopic visualization may be more limited
Key Findings
- •Direct endoscopic approach to navicular bursa resulted in inadvertent synovial penetration in 45% of cadaver limbs (DFTS 37.5%, DIPJ 17.5%, both 10%)
- •Surgeon variation was substantial, with penetration rates ranging from 10-80% between operators
- •Iatrogenic damage to navicular fibrocartilage and/or deep digital flexor tendon occurred in 55% of limbs using direct endoscopic approach
- •Alternate parasagittal direct technique achieved 0% inadvertent penetration and 0% iatrogenic damage in 12 cadaver limbs tested