Biomedical subjects
L R Bramlage
Publications and source records attributed to L R Bramlage.
Internal fixation of a tibial fracture in an adult horse.
A 3-year-old Thoroughbred mare was examined because of hindlimb lameness from incomplete fracture of the tibia, which became a complete diaphyseal fracture during the examination. The fracture was repaired by open reduction and internal fixation with lag screws and 2 neutralization plates. A cranial approach was used and the plates were placed craniolateral and medial on the tibia. At 18 months after surgery, there was no evidence of complications resulting from the fracture or its repair. It was concluded that a cranial approach with craniolateral and medial plate placement allows easier insertion and gives increased stability over previously described methods.
Multidirectional in vivo strain analysis of the equine radius and tibia during dynamic loading with and without a cast.
Rosette strain gauges were applied to the equine radius and tibia. Three sites were examined on each bone on separate occasions (proximal metaphysis, middiaphysis, and distal metaphysis). At each site, 4 rosette gauges were applied around the bone (ie, cranial, caudal, medial, and lateral). Strain recordings were made while walking the horse with and without a full-limb plaster cast. The principal axis of tensile strain was on the craniolateral aspect of the radius. Distally, on the radius, the largest strains were torsional. The cast changed the principal axis of tensile strain on the radius from the craniolateral surface to the caudal surface. The principal tensile strain of the tibia was just to the lateral side of cranial in the proximal and diaphyseal regions. Distally, the principal axis of tensile strain was craniolateral; however, the largest strains measured here were torsional. The cast changed the principal axis of tensile strain on the distal metaphysis of the tibia, but it did not reduce the magnitude of the strains measured. Casts may not aid stabilization of radial or tibial fractures repaired with internal fixation and may in fact place additional stress on the fracture site.
Avulsion fractures of the origin of the suspensory ligament of the horse.
Five horses with avulsion fractures of the proximal origin of the suspensory ligament were examined for lameness. The horses in the series each had lameness of acute onset; four were severely lame, and one was moderately lame. The condition was difficult to diagnose because commonly used local anesthetic blocks did not result in improvement during the routine examination. Local infiltration of the area with local anesthetic returned the horses to soundness. After a period of rest, varying from a few weeks in the acute injury to 6 months in the chronic injuries, the horses were returned to racing without lameness.
In vitro strength of the suspensory apparatus in training and resting horses.
Forty-eight limbs of 12 freshly euthanized horses were used to generate data on the strength of the equine suspensory apparatus. The point of failure of the suspensory apparatus of each limb was determined. Immediately before euthanasia, 6 of the 12 horses (thoroughbreds and standardbreds) had been engaged in active training or racing, and six horses in stall and/or pasture activity. In the actively training or racing horses, the point of acute failure of the suspensory apparatus was within the proximal sesamoid bones in 20 (83%) limbs (resulting in 17 apical fractures, 2 basilar fractures, and 1 midbody fracture). In the pasture exercised or stalled horses, the point of failure of the suspensory apparatus was either acutely within the suspensory ligament (10 horses, 42%) or, if no acute failure occurred, insidiously within the suspensory ligament (12 horses, 50%). Active training appeared to have a strengthening effect on the suspensory ligament, causing the weakest point in the suspensory apparatus to become the sesamoid bones rather than the suspensory ligament. An average force of 1338 kg (between 1082 and 1673 kg) was needed to fail the suspensory apparatus in this group of horses. In nontraining horses, the site of failure was most often the suspensory ligament. An average force of 1100 kg (between 918 and 1241 kg) used to fail the suspensory apparatus in this group of horses was significantly (p less than 0.5) less than in the first group.
Arthrodesis of the distal interphalangeal joint in two horses using three parallel 5.5-mm cortical screws.
The distal interphalangeal joint was successfully arthrodesed in two horses using three parallel 5.5-mm cortical screws and an autogenous cancellous bone graft. The screws were directed from the palmar proximal border of the second phalanx dorso-distally across the joint space and into the third phalanx. The technique was first developed on a normal horse. The second horse, a clinical case, ruptured its deep digital flexor tendon with complete luxation of the distal interphalangeal joint. Bony fusion of the distal interphalangeal joint occurred in both horses, but both also had residual lameness at a walk. Twenty-one months after the arthrodesis procedure, the clinical patient died from complications related to a subsolar abscess in the operated limb.
Application of a hook plate for management of equine ulnar fractures.
Closed fractures of the proximal aspect of the ulna were repaired in 10 horses younger than or equal to 6 months of age by application of a hook plate using a tension band principle. Ulnar fractures were classified as type 1A (2 horses), type 1B (4 horses), type 2 (1 horse), type 3 (1 horse), and type 4 (2 horses); all fractures had displacement of a proximal fragment. Complications were implant deformation (4 horses), screw pullout (1 horse), osseous sequestration (1 horse), ulnar fracture through a hole used to apply a tension device (1 horse), and metacarpophalangeal deformity associated with a displaced anconeal fragment (1 horse). Hook deformation was likely associated with failure to insert screws in all of the proximal holes of the plate and also in two horses, possibly with difficult recovery from anesthesia. Seven horses were discharged from the hospital and were being used for athletic activities. Insertion of the hook through the tendon of the triceps muscle and incorporation of the fragment within the hook can be used to effectively reduce and stabilize a fragment that might otherwise not hold screws.