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PET imaging of metacarpal/metatarsal condylar fractures following repair

Vet Surgery 2023

Background: Condylar fracture of the third metacarpal and metatarsal bones is a common and serious injury in Thoroughbred racehorses. Advanced imaging techniques such as positron emission tomography (PET) may help to detect early lesions and monitor healing.

Study: A prospective descriptive study of 14 Thoroughbred racehorses with metacarpal/metatarsal condylar fractures that underwent surgical repair and PET imaging within 4 days of surgery and at 3 and 5 months postoperatively.

Methods: PET images were acquired using a scanner designed for standing horses and a radiotracer (18F-sodium fluoride) that reflects bone remodeling. Areas of abnormal uptake were graded using a previously validated system. Fracture location, associated pathology, and outcome were recorded.

Results: Eight fractures were located in the parasagittal groove (PSG) and six fractures were located abaxial to the PSG. All horses with non-PSG fractures had uptake in the same condyle of the contralateral limb, suggesting pre-existing stress remodeling. Horses with PSG fractures had minimal or mild uptake in the medial condyle of the fractured limb, which is atypical for horses in full training. Increased uptake at the fracture site resolved in most horses over time, but four horses developed periarticular uptake indicative of degenerative joint disease. These findings were associated with poor outcome.

Limitations: The study had a small sample size, inconsistent follow-up intervals, and lacked associated structural imaging such as computed tomography for detailed assessment of fracture location and healing.

Conclusions: PET has a potential role in the prevention, diagnosis, and postoperative monitoring of metacarpal/metatarsal condylar fractures in racehorses. PET can reveal pre-existing lesions, specific uptake patterns, and postoperative changes that may affect prognosis.

Images of a Thoroughbred racehorse with an incomplete nondisplaced lateral condylar fracture of the right front limb located in the parasagittal groove (case 5). 18F-sodium fluoride positron emission tomography (18F-NaF PET) dorsal maximal intensity projection (MIP) (A), preoperative dorsopalmar radiographic projection (C) and overlay of both images (B). Lateral is to the left. There is marked increased 18F-NaF uptake through the distal aspect of the fracture line. The increased uptake follows a narrow line as it approaches the articular surface (long arrow), whereas the maximal uptake is located further proximal (short arrow). The focal increased uptake in the medial metacarpal cortex (arrowhead) corresponds to the tip of the screw based on postoperative radiographs (not shown here). Mild increased uptake is present in the soft tissue adjacent to the screw heads, attributed to bone debris (thick arrows).

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