the injury. If the damage is restricted to bruising, local ice therapy, laser
therapy and NSAID administration usually bring about rapid improvement.
Occasionally a severe haematoma may require drainage.
II Fractures of the Tibial Tuberosity or Crest
Most fractures involve the most proximal aspect of the tibial crest, the tibial
tuberosity, but are non articular. Some fractures extend distally to the insertion
of the middle patellar ligament and exit through the tibial crest. The proximal
pull of the insertion of the quadriceps and biceps femoris muscles may result
in proximal or cranioproximal displacement and incapacitate the stay
apparatus of the injured limb. Non or minimally displaced fractures may be
treated successfully with prolonged rest (3 – 6 months). If the fracture has
become displaced surgical treatment is recommended either by removal or
internal fixation.
III-IV Patellar Fractures
Fractures of the base of the patella may occur alone or in association with a
fracture of the medial pole of the patella. Most fractures are small and
minimally displaced although some are intra-articular. In spite of this, most
basilar fractures are managed conservatively and horses are generally able to
resume work 6 to 8 weeks after the initial injury with a good prognosis for
sustained soundness. Displaced intra-articular fractures may be removed
through an arthroscopic approach to the suprapatellar pouch. Fractures of the
medial pole of the patella are articular and if left untreated usually result in
chronic lameness. These fractures are often only detectable on a
cranioproximal-craniodistal oblique (skyline) projection of the patella. Surgical
removal of the fracture fragment(s) with or without the medial patellar cartilage
is the treatment of choice and offers a good prognosis for full return to athletic
function (Dyson et al. 1992).
V Fractures of the Femoral Trochlea
Fractures of the femoral trochlear ridges may occur alone or in association
with patellar fractures. Treatment is by arthroscopic removal and prognosis is
favorable.
VI Cruciate ligament injury
Cruciate ligament injuries are much rarer than in small animals and are
difficult to diagnose with confidence without arthroscopy. The cruciate
ligaments lie under a thin layer of synovial membrane (subsynovially).
Damage is usually manifest by visual recognition of fibre rupture or
haemorrhage.
In addition, avulsion fragments of bone can be seen
radiographically at the origin and insertion sites of the ligaments. Walmsley
(1996) graded cranial cruciate tears based on their arthroscopic appearance:
(I) superficial haemorrhage and fibrin deposition (cruciate sprain); (II)
superficial separation of ligament fibers; (III) deep sparation of fibers or
rupture. Most cranial cruciate injuries seem to occur in its body or towards the
tibial insertion. New bone on the cranial edge of the medi al intercondylar
eminence of the tibia is believed to be more indicative of meniscal ligament
15-‐18
February
2016
East
London
Convention
Centre,
East
London,
South
Africa
65