Results 2008

As with all results, the results of this year are displayed in bold (with the results of the previous year and % change after in italics). 1624 sets of x-rays were filed in 2008 (1874, -13%). 774 (987, -22%) of which were taken in the clinic and 850 (887, -4%) were acquired using the mobile x-ray unit. 77 horses underwent shockwave therapy (112, -31%), and 260 bone scans were acquired (226, +15%), 6 of which horses had repeat scans during the year. There were 186 standing MRI scans performed (116, +60%). 716 ultrasound examinations (649, +10%) were performed including 389 (489, -20%) tendon scans, 73 (83, -12%) repeat tendon scans and 65 pelvic scans.3079 (3571, -14%endoscopic examinations were performed, 2557 (2874, -11 %) of which also had tracheal washes performed. A further 74 (50, +48 %) horses had a gastroscopic examination performed

554 surgeries (538, +3%) were performed at Donnington Grove, with an additional 22 surgeries being performed off-site in referral practices. This gives a combined total of 576 surgeries. Of the 554 surgeries performed at the hospital, a similar number of total surgeries to 2006 were orthopaedic - 250 (254, -2%) but the number of airway surgeries continues to increase on an annual basis 162 (140, +16%).

56 Standing surgeries were performed, continuing the increase on numbers performed in 2006 (49, +14%). The breakdown of surgical cases was as follows: 7 horses required standing sinus trephination and endoscopy (6, +17%), 8 required sinus flaps, 7 laparoscopic castrations (4, +75%), 2 laparoscopic ovariectomies (2, 0%), 3 dorsal spinous process resections (1, 200%), 5 screw removals (5, 0%) and 3 septic joints were flushed standing (3, 0%).2 jaws were wired (8, -75%) standing but none were performed under general anaesthetic. In addition, a horse had a renal biopsy taken and later went on to have a standing laparoscopic hand assisted nephrectomy to remove a renal carcinoma. 2 horses each had an eye removed standing. A horse with a medial condylar fracture of the left fore cannon had the repair performed standing using a single 5.5mm AO screw.

For the third year in a row, the number of arthroscopic surgeries increased. 205 were performed (197, +4%), an increase on 2006 (153, +34%) and 2005 (192, +7%) figures. The arthroscopies can be divided up as follows: 1 biccipital bursoscopy; 4 calcaneal bursae (8, -50%); 32 knee arthroscopies (39, -20%); 1 carpal slab fracture repair under arthroscopic guidance; 2 Tenoscopies of the extensor tendon sheath; 16 coffin joints and navicular bursae,3 femoro-patellar joints (8, -63%), 2 femoro-tibial joints (16, -88%), 28 stifle arthroscopies and a further 3 stifle cysts injected under arthroscopic guidance, 35 fetlocks (29, +21%), 5 high check ligament desmotomies (5, 0%),15 hocks (5, 200%), 49 tenoscopies of the digital tendon sheath, 3 septic tarso-crural joints, 3 carpal sheath arthroscopies, 5 physeal spikes (3, +66%) and 2 shoulder arthroscopies.

30 fractures were repaired (38, -20%) over the course of the year. Sagittal fractures of the first phalanx and cannon bone made up the majority of the caseload. 7 split cannons involving the lateral condyle were repaired - 4 in the hind canon and 3 in the fore cannon. One medial condylar fracture in the forelimb was repaired in the standing horse with a single AO 5.5mm screw. 5 first phalanx fractures were repaired - 4 in the front limb and 1 in the hind limb. 2 sesamoid fractures were repaired, a mid body fracture using 2 AO 3.5mm screws, and a comminuted fore limb sesamoid fracture using a single AO 4.5mm screw. 3 olecrannon fractures were repaired, 2 in older horses using a narrow, contoured DCP plate and then for a foal, a figure of 8-tension band wire and one interfragmentary screw was used. One of the plated olecrannon repair was highly comminuted and broke down during recovery and the horse was promptly euthanased. 2 tibial tuberosity fractures were repaired, one with a curved DCP and another with a LCP plate. The third carpal bone was not without surgery in 2008. 2 sagittal fractures were repaired with a single AO 3.5mm cortical screw and 1 horse had a frontal fracture of the dorsal aspect repaired with a single AO 3.5mm screw, only to have removed 24 hours later due to incomplete fracture reduction.

A number of individual fracture repairs were also performed. A supraglenoid fracture in a thoroughbred yearling was repaired using a combination of 3 interfragmentary screws and a tension band wire with a concurrent biceps tenotomy. An avulsion fracture of the insertion of the lateral collateral ligament of the left hind fetlock was repaired with a single screw. A lateral maleolar fracture was debrided arthroscopically and a depressed facial fracture of the frontal bone was elevated. An attempt was made to reduce and repair a coxofemoral luxation in a small pony. The repair was insufficient and the pony was later euthanased 12 hours later.

ENT surgeries continue to remain a strong component of the surgical caseload at the hospital, 162, from 2007 (140, +16%) and 2006 (112, +45%). Cautery of the soft palate was again the most commonly performed surgery at52 (40, +30%). Tie forward in combination with cautery of the soft palate made up another 42 surgeries (32, +31%). Hobday and cautery of the soft palate made up a further 14 cases (6, +130 %). The Hobday procedure was performed alone in 10 horses (34, -71%). Tie back and hobday procedure in combination made up a further 8surgeries (11, -30%), Only 5 horses had a tie forward performed alone (2, +150%). 6 horses had a tie back procedure performed alone (1, +500%). 4 epiglottic entrapments were released via a transoral approach (4, 0%). 8lateral buccotomies (5, +60%) were performed and a further 3 (4, -25%) teeth were removed orally with grasping forceps.

93 colics were admitted to Donnington Grove Veterinary Surgery for colic assessment (83, +12%). Of these, 44horses (30, +47%) were taken to surgery. 2 horses had a second colic operation within 72 hours of the first operation. These can be categorised as follows: 5 strangulating lipomas (5, 0%); 12 large colon torsions (4, +200%); 2 small intestinal impactions (5, -60%); 4 small intestinal volvulus (2, 100%); 6 epiploic foramen entrapments, one of which had an associated haemoperitoneum; 2 small intestinal strangulations through mesenteric rents, 1 scrotal hernia, 2 cases of anterior enteritis and 1 nephrosplenic entrapment.

One of the strangulating lipomas was removed from the mesentery of the small colon, which involved a resection and anastomoses. One horse, which had a large colon torsion died in recovery from an overwhelming endotoxaemia, and a second horse with a 720° torsion was found to have minimal ligamentous attachment between the caecum, large colon and body wall. The condition was assumed to be congenital and the horse was euthanased due to a poor prognosis. Finally, a horse that had surgery for a caeco-colic intussusceptions later died with post anaesthetic myopathy. Overall 5 horses had a fatal pre-operative disease, the short term survival rate of the remainder was 32 of 43 (74%).

Other frequently performed operations included 18 plantar fasciotomies and neurectomies (18, 0%), 2 bilateral medial patellar ligament desmotomies (4, -50%), 2 lateral palmar neurectomies and 7 digital neurectomies (3, +130%),

There were 9 perioperative deaths (12, -25%), of which 7 (7, 0%) were euthanased intra-operatively. 3 of the colic surgeries were euthanased during the operation for gastric rupture. Another of the colic operations also had peritoneal contamination with intestinal content from a perforated ulcer of the small intestine and was euthanased. One horse went into cardiac arrest and died in recovery after a surgery to correct a large colon torsion. A horse with a strangulating lipoma was euthanased during surgery at the owner's request. A three-year old thoroughbred that had a 720° large colon torsion was found to have minimal ligamentous attachment between the caecum, large colon and body wall. This rudimentary ligament arrangement has only been recently reported and is assumed to be congenital. The horse was euthanased. A horse with a left hind septic digital tendon sheath was euthanased during tenoscopic surgery on discovering the extent of the established infection and tendon pathology. Finally, a horse that had surgery for a caeco-colic intussusception later went on to develop an uncontrollable post-operative myopathy and was euthanased within 24 hours.

A total of 4 horses developed a post anaesthetic myopathy or neuropathy in recovery. 3 occurred during procedures with the horse in dorsal recumbancy but supported by an old 'bean bag' style support. A further 1 horse developed myopathy on the newly installed table mattress after a long procedure in lateral recumbancy.

No anaesthetic deaths were incurred (1, -100%). Therefore, the total number of unanticipated and unexpected deaths in horses undergoing general anaesthesia was 1 (olecranon fracture which broke again in recovery) from 498 procedures (0.2%) (5 of 489, 1.02%).