Equis ISSN 2398-2977

Carpus: growth acceleration - angular deformity

Synonym(s): Hemicircumferential periosteal transection, periosteal stripping

Contributor(s): Patrick Colahan, Graham Munroe, Chris Whitton

Introduction

  • To promote 'catch up' growth on the concave side of a joint with an angular limb deformity   Musculoskeletal: angular deformity    →   straightening of the limb.
  • The exact mechanism of hemicircumferential periosteal transection and elevations (HCPTE) affect on accelerating growth at the physis is unknown. One theory is that it results in physeal decompression by releasing tensile forces across the growth plate; the other is that the surgical insult results in an increased blood supply to the region: both resulting in an increased growth rate at the physis.
  • Correction of carpal valgus   Carpus: angular deformity 03 - valgus and toe out  is described here, with comments on adapting the technique to other regions.
  • Recent research has questioned effectiveness of HCPTE's, but the model used may be flawed.

Uses

  • Correction of selected angular limb deformities   Musculoskeletal: angular deformity  in foals:
    • Deformities of: the distal third metacarpal/metatarsal region; proximal phalanx; distal tibia; distal radius.
    • Where continued longitudinal skeletal growth is expected, eg foals >2 weeks but <3-6 months old; 0-6 weeks fetlock; 0-3 months carpus/tarsus.
    • For severe deformities in combination with growth retardation techniques   Carpus: growth retardation - angular deformity  .
    • For deformities where conservative management has failed.
  • For carpal, metacarpophalangeal/metatarsophalangeal and tarsal valgus and varus deviations.

Advantages

  • Simple, quick technique   →    less cost.
  • No implants    →   less reisk of infection. 
  • Mandatory implant removal not needed (cf transphyseal bridging techniques   Carpus: growth retardation - angular deformity  ).
  • Good cosmetic results.
  • No risk of overcorrection.
  • Can be combined with growth retardation techniques.
  • Can be repeated.
  • Can be undertaken as early as 2 weeks of age.

Disadvantages

  • May need to repeat 6-8 weeks later.
  • Efficacy of technique is being questioned and is currently under study - recent trials have indicated that HCPTE is no more effective than stall confinement and hoof trimming alone for correcting experimentally induced angular limb deformities.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Excellent - young foals <3 months of age the earlier the treatment the better the prognosis.
  • Good - for athletic career, depending on severity, time of treatment and concomitant abnormalities.
  • The range of cases that can be successfully treated with this technique alone or in combination has not yet been established.
  • Poorer - if has exercised for long time on deformed limb   →   cartilage damage and degenerative changes.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Read E K et al (2002) Effect of hemi-circumferential periosteal transection and elevation in foals with experimentally induced angular limb deformities. JAVMA 221 (4), 536-540 PubMed.
  • Bramlage R M (1999) The science and art of angular limb deformity correction. Equine Vet Educ 31 (3), 182-183 (Editorial comment) PubMed.
  • Caron J P (1988) Angular limb deformities in foals. Equine Vet J 20, 225-228 PubMed.
  • Auer J A & Martens R J (1982) Periosteal transection and periosteal stripping for correction of angular limb deformities in foals. Am J Vet Res 43, 1530-1534 PubMed.
  • Auer J A, Martens R J & Williams E H (1982) Periosteal transection for correction of angular limb deformities in foals. J Am Vet Assoc 181, 459-466 PubMed.

Other sources of information

  • Colles C M (2008)How to Aid the Correction of Angular Limb Deformities in Foals Using Physeal Stimulation.In: Proc AAEP Congress.pp 60.
  • Auer J A (2006)Angular Limb Deformities Growth Acceleration.In:Equine Surgery.3rd edn. Eds: Auer J A & Stick J A. Saunders Missouri, USA. pp 1138-1143.
  • Castelijns H (2006)Foal Development: Angular and Rotational Deformities Around the Fetlock.Website: www.farriery.eu/articles/008-2008.htm.


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