Simini Surgery Review: Equine Edition

In this episode of the Simini Equine Surgery Podcast, we explore the orthopedic research from the November 2025 issue (Issue 8) of Veterinary Surgery, where two studies focus on a shared objective: identifying orthopedic injuries earlier and treating them more effectively to maximize athletic performance and long-term soundness. 

One study demonstrates how early arthroscopic intervention can prevent incomplete third carpal bone slab fractures from progressing into career-ending injuries, while the second presents the largest multicenter case series to date evaluating plate fixation for proximal splint bone fractures in horses.

In this episode:

✅ Garcia-Collao et al. evaluated arthroscopic debridement of incomplete third carpal bone slab fractures (ISFs) in Thoroughbred and Standardbred racehorses. Reviewing 33 horses, the authors reported that 66.7% successfully returned to racing following early surgical intervention, with a median rehabilitation period of 247 days. The study emphasizes the importance of recognizing these lesions before progression to complete slab fractures or advanced osteoarthritis. During arthroscopy, surgeons observed medial palmar intercarpal ligament (MPIL) injury in every horse, raising important questions about whether ligament pathology may contribute to the development of these fractures rather than simply occurring as a consequence of them. The findings strongly support early diagnosis using skyline radiographs followed by aggressive arthroscopic debridement to preserve athletic careers. 

✅ Melly et al. presented the largest published series evaluating plate fixation of proximal small metacarpal and metatarsal (splint bone) fractures in horses. Among 27 cases, 76% returned to their previous level of work or higher, while more than 90% of racehorses returned to racing following surgery. The study provides valuable technical guidance on implant selection, emphasizing the importance of maximizing screw purchase in relatively soft splint bone while avoiding penetration into the cortex of the third metacarpal or metatarsal, where stress risers may lead to catastrophic fractures during anesthetic recovery. The authors also discuss intraoperative screw stripping, postoperative complications, and practical considerations that can significantly influence surgical success. 

Together, these studies reinforce a central principle of equine orthopedic surgery: successful outcomes often depend on recognizing injuries before they become catastrophic and executing meticulous surgical technique that respects both anatomy and biomechanics.

🎓 Journal Articles Discussed

• Garcia-Collao et al. — Outcome of arthroscopic debridement for the treatment of incomplete third carpal bone slab fractures in racehorses
• Melly et al. — Plate fixation of small metacarpal and metatarsal bone fractures in 27 horses

📚 From the November 2025 Issue (Issue 8) of Veterinary Surgery

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In this episode of the Simini Equine Surgery Podcast, we explore the orthopedic research from the October 2025 issue (Issue 7) of Veterinary Surgery, where two complementary studies examine the future of equine cervical vertebral fusion. Together, they answer two fundamental questions: Which implant performs best mechanically? And how do horses actually perform after surgery? 

This episode follows the evolution of cervical fusion—from decades of clinical experience using the kerf cut cylinder (KCC) to emerging 3D-printed titanium plate-and-spacer technology designed to improve construct stability and long-term outcomes.

In this episode:

 ✅ Cormier et al. — Evaluated intra-articular injection of decellularized porcine amnion/chorion suspension in horses. Both low- and high-dose groups developed inflammatory responses, but the high-dose group had more clinically evident inflammation, including increased lameness, elevated synovial and systemic SAA, and persistent signs requiring lavage and flunixin in some horses. The study concluded that dPACLS at the tested doses is not recommended for intra-articular injection because of the inflammatory response. 

✅ Janicek et al. present the largest multicenter evaluation of C7–T1 ventral interbody fusion using the kerf cut cylinder implant. Reviewing 38 horses treated over a 20-year period, the authors reported an 89% hospital discharge rate, with 79% achieving successful long-term outcomes. Half of the horses returned to athletic work—including dressage, show jumping, barrel racing, hunters, and western pleasure—while many others regained comfortable pasture soundness. The study also provides valuable surgical pearls for one of the most anatomically challenging regions of the equine cervical spine and highlights laryngeal spasm as the most significant perioperative complication requiring careful airway management. 

✅ Zedler et al. evaluated a 3D-printed titanium plate and spacer construct against the traditional 4.5-mm locking compression plate (LCP) in an ex vivo biomechanical model of C4–C5 fusion. Although both constructs demonstrated similar stiffness and failure loads, the 3D implant was significantly less likely to fail through displaced vertebral fracture or screw pullout during extension loading. The findings suggest that modern patient-specific implant design may improve mechanical reliability while providing a scaffold for future osseous integration. 

Together, these studies illustrate how clinical experience and engineering innovation are converging to improve treatment options for horses with cervical vertebral stenotic myelopathy (CVSM). Long-term outcomes demonstrate that cervical fusion is no longer simply a salvage procedure—it is increasingly becoming a realistic path back to athletic performance for appropriately selected horses. 

🎓 Journal Articles Discussed

• Cormier et al. — Inflammatory Response Following Intra-Articular Injection of Decellularized Porcine Amnion/Chorion in Horses
  Janicek et al. — Multicenter Results for C7–T1 Ventral Interbody Fusion in Horses Using the Kerf Cut Cylinder
  Zedler et al. — Ex Vivo Biomechanical Testing of a Three-Dimensional Printed Titanium Plate and Spacer Construct and 4.5 mm Locking Compression Plate for Ventral Cervical Fusion of C4–C5 in the Horse

📚 From the October 2025 Issue (Issue 7) of Veterinary Surgery

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In this Simini Equine Surgery Podcast episode, we explore two impactful studies from the August 2025 issue of Veterinary Surgery, offering data-driven refinement for both orthopedic and soft tissue equine procedures.

We cover:

✅ Ruspi et al. — A 20-year retrospective on medial condylar fractures in 150 racehorses. Despite historical concern, survival to discharge was 98.7%, long-term survival 93.3%, and 71% returned to racing. However, plating came with 7× higher complication risk (28% vs. 4%) than lag screws alone—shaping a critical discussion on fixation choice.

✅ Barnett et al. — A prospective study of laryngeal tie-forward (LTF) outcomes in 56 horses with IDDSP, assessed using post-op overground endoscopy (OGE). While 75% had resolution of displacement, 71% still had palatal instability, and owner/trainer concern post-op predicted 11× higher odds of persistent dysfunction—proving that vigilant follow-up is just as important as the surgery itself.

🎓 Journal Articles Discussed:

• Ruspi et al. — Short- and long-term survival, complications, return to
  racing, and racing performance of 150 racehorses with
  medial condylar fractures of the third metacarpal/
  metatarsal bone treated by internal fixation
• Barnett et al. — Overground endoscopic examination following laryngeal
  tie-forward in horses with dorsal displacement of the
  soft palate
  📚 From the August 2025 issue of Veterinary Surgery

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In this Simini Equine Surgery Podcast episode, we unpack two orthopedic studies from the August 2025 issue of Veterinary Surgery. These papers tackle both surgical mapping and cartilage regeneration—bringing fresh insights for accessing difficult anatomy and improving outcomes in mature horses.

We cover:

✅ Kerber et al. — A cadaveric study mapping the medial digital flexor tendon sheath (MDFTS) and evaluating the feasibility of needle endoscopy. Using a 2.4 mm needle scope and a two-portal technique, they successfully navigated this complex space and revealed multiple internal synovial folds that trap debris and resist clearance. Standard arthroscopy was not feasible, often causing iatrogenic damage, and conventional saline lavage left up to 42% of bacteria behind, underscoring the need for targeted lavage solutions like Simini Protect.

✅ Paul et al. — A 25-year retrospective on mosaic arthroplasty for treating subchondral bone cysts (SBCs) in the equine stifle and fetlock. With 68% return to work and 90% lameness improvement, the study breaks the age barrier—showing strong outcomes even in horses over 3 years old. Fewer, larger grafts led to better outcomes (90% success with 2 or fewer vs. 50% with 3+), and overdrilling proud grafts was emphasized to prevent damage.

🎓 Journal Articles Discussed:

• Kerber et al. — Gross anatomy, computed tomographic contrast
  tenography, and needle endoscopy of the equine
  medial digital flexor tendon sheath
• Paul et al. — Mosaic arthroplasty in equine stifle and fetlock joints:
  A retrospective study of 31 cases between 1998 and 2023
  📚 From the August 2025 issue of Veterinary Surgery

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In this Simini Equine Surgery Podcast episode, we break down two clinical studies from the August 2025 issue of Veterinary Surgery, both centered on smarter, more effective approaches to fetlock joint management—from first-line lavage to deep-pocket fragment removal.

We cover:

✅ Beggan et al. — An ex vivo study comparing needle-through-and-through lavage (NTA) to endoscopic lavage (EL) for equine joints. In both the fetlock and DFTS, NTA cleared debris just as well—especially in the first 2 liters, and even outperformed EL in early-stage flushing. But remember: EL remains essential for established sepsis and foreign body removal, and saline alone may leave up to 42% of bacteria behind.

✅ Foucaud et al. — A study introducing a direct dorsal arthroscopic approach to the distal palmar/plantar fetlock pouch, used in 25 horses. It yielded 100% successful fragment removal with zero complications—and was especially useful in horses over 4 years, where 100% had cartilage damage, 73% of which was full-thickness. Flexed radiographs and ultrasound are key to identifying these hidden lesions.

🎓 Journal Articles Discussed:

• Beggan et al. — Efficacy of needle and endoscopic lavage on the
  recuperation of microspheres from the adult equine
  metacarpo/metatarsophalangeal joint and digital
  flexor tendon sheath
• Foucaud et al. — Direct arthroscopic approach to the distal pouch of
  the palmar/plantar recess of the metacarpophalangeal/
  metatarsophalangeal joint in horses
  📚 From the August 2025 issue of Veterinary Surgery

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In this Simini Equine Surgery Podcast episode, we explore three practice-changing studies from the July 2025 issue of Veterinary Surgery. These investigations revisit long-standing protocols around anesthesia recovery, antibiotic use, and colic prevention—each bringing new clarity to what works, what doesn’t, and why it matters.

We cover:

✅ Lindqvist et al. — A prospective crossover study evaluating an adjustable ceiling during anesthesia recovery in horses. Recovery quality scores improved dramatically, but with modest physiologic stress trade-offs.

✅ Sjöberg et al. — A large retrospective review of over 200 hospital-managed suture castrations in stallions. The study found no statistical benefit from surgical antimicrobial prophylaxis (SAP)—supporting reduced antibiotic use in clean, aseptic procedures.

✅ Warren et al. — A retrospective cohort study in 188 Thoroughbred broodmares showing that ventral midline cecopexy significantly reduced both general colic and large colon volvulus (LCV) recurrence—without compromising breeding outcomes.

Whether you’re focused on reducing complications, refining post-op care, or strengthening antimicrobial stewardship, this episode brings data-driven recommendations to equine soft tissue protocols.

🎓 Journal Articles Discussed:

• Lindqvist et al. — Effect of an adjustable ceiling to prevent premature rising attempts after general anesthesia in healthy ponies and horses: A pilot study
• Sjöberg et al. — Influence of antimicrobial prophylaxis in horses undergoing sutured castrations
• Warren et al. — Effect of a ventral midline colopexy on large colon volvulus recurrence and days to next live foal in Thoroughbred broodmares  
• 📚 From the July 2025 issue of Veterinary Surgery

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In this Simini Equine Surgery Podcast episode, we examine three orthopedic-focused studies from the July 2025 issue of Veterinary Surgery. From novel standing repair techniques to computer-assisted spinal fixation, this episode delivers fresh insights into return-to-work outcomes and high-stakes vertebral surgery.

We cover:

✅ Drahonovska et al. — Standing lag screw fixation for short, non-displaced frontal plane fractures of the dorsal P1. Six Thoroughbreds returned to racing with a 100% healing rate—highlighting a fast, effective alternative to GA for distal limb repair.

✅ Esselman et al. — Return-to-performance outcomes in 34 Western performance horses with stifle chondromalacia. Surprisingly, severity of cartilage lesions and post-op biologics didn’t predict return—but 74% returned to some work.

✅ Käfer-Karrer et al. — A case report detailing the use of computer-assisted surgery (CAS) for lag screw fixation of a C6 cranial articular process fracture. With no exuberant callus and return to full work, this could redefine surgical options for mid-cervical spinal trauma.

Three studies, one message: refined technique and realistic expectations are key to optimizing outcomes in equine ortho.

🎓 Journal Articles Discussed:

• Drahonovska et al. — Standing repair of short frontal plane fractures involving the dorsoproximal articular surface of the proximal phalanx in six Thoroughbred racehorses
• Esselman et al. — Severity, distribution and postoperative therapy are not predictors of return to work in western performance horses with stifle chondromalacia
• Käfer-Karrer et al. — Internal fixation of a fractured cranial articular process of the sixth cervical vertebra by means of computer-assisted surgery in a Warmblood gelding
  📚 From the July 2025 issue of Veterinary Surgery

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In this Simini Equine Surgery Podcast episode, we explore two diagnostic turning points from the May 2025 issue of Veterinary Surgery. One challenges how we interpret synovial fluid after fracture. The other examines new intraoperative tools for evaluating bowel viability in colic surgery. Both studies offer critical precision in moments that matter.

We cover:

✅ Mason et al. — A retrospective review of synovial samples from 54 horses with acute intra-articular fractures. The study shows that nucleated cell counts, protein levels, and neutrophil percentages often mimic septic arthritis within hours of trauma—risking misdiagnosis and overtreatment.

✅ Verhaar et al. — A narrative review on real-time intraoperative diagnostics in colic surgery. From laser Doppler flow to ICG fluorescence angiography and tissue oximetry, this paper highlights objective tools that may finally demystify viability calls in the OR.

Whether you're interpreting bloody joint taps or choosing a resection margin mid-surgery, this episode sharpens your clinical decision-making.

🎓 Journal Articles Discussed:

• Mason et al. — Synovial fluid parameters following acute articular fracture
  in the horse
• Verhaar et al. — Real-time ancillary diagnostics for intraoperative
  assessment of intestinal viability in horses–looking for
  answers across species
  📚 From the May 2025 issue of Veterinary Surgery

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In this episode of the Simini Equine Surgery Podcast, we shift from bone to soft tissue as we unpack three standout studies from the April 2025 issue of Veterinary Surgery. This episode focuses on improving tendon health through evidence-based strategies—from how we cool, to how we scope, to how we cut.

We cover three tendon-focused studies:

✅ McCarthy et al. — Compression cooling systems vs. ice boots in flexor tendon care. If you use standing bandages or cold therapy post-op, this one’s for you.

✅ Breen et al. — Needle endoscopy for digital flexor tendon sheath diagnostics and desmotomy. Safer, faster, and feasible—no general anesthesia needed.

✅ Barton et al. — RF energy for manica flexor resection. Complete transection, minimal bleeding, and better visibility in both cadavers and live horses.

Whether you’re wrapping limbs, scoping sheaths, or resecting tears, this episode arms you with practical improvements for safer, more effective tendon surgery.

🎓 Journal Articles Discussed:

• McCarthy et al. — In vivo effects of cold therapy and bandaging on core temperatures of equine
• Breen et al. — Standing Needle Endoscopy for the Digital Flexor Tendon Sheath
• Barton et al. — Tenoscopic‐guided resection of the manica flexoria utilizing radiofrequency energy
  📚 From the April 2025 issue of Veterinary Surgery

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In this episode of the Simini Equine Surgery Podcast, we dive into the April 2025 issue of Veterinary Surgery and explore two high-stakes orthopedic studies that redefine stabilization—one at the fetlock and pastern, and the other at the thoracolumbar spine.

You’ll hear takeaways from two groundbreaking investigations:

✅ Orozco Lopez et al. — Dual joint arthrodesis in racehorses with catastrophic suspensory failure. Discover how a human distal femur plate eliminated PIPJ subluxation—but didn’t eliminate infection risk.

✅ Pezzanite et al. — A biomechanical comparison of pedicle screw rod constructs with and without interbody fusion devices. When it comes to stabilization, this study questions whether more hardware really equals more safety.

Whether you manage racehorse injuries or contemplate spine stabilization in any species, this episode delivers actionable, data-driven surgical insights.

🎓 Journal Articles Discussed:

• Orozco Lopez et al. — Treatment of traumatic disruption of the suspensory apparatus in Thoroughbred
• Piezzanite et al. — Ex vivo biomechanical comparison of pedicle screw and rod constructs with and
  📚 From the April 2025 issue of Veterinary Surgery

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