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Objective The aim of this article was to describe the technique and outcomes of standing surgical management of splint bone fractures and to compare outcome variables and hospitalization cost to a group with similar fractures treated under general anaesthesia. Study Design It is a single-institution retrospective study. Surgical technique, surgical time, hospitalization cost and complications were retrieved from the medical records of horses treated surgically for splint bone fractures (2008–2020). Owner telephone follow-up provided data about athletic outcome, client satisfaction and cosmetic appearance. Results Forty-nine horses (13 standing, 36 under general anaesthesia) with 57 fractures (18 contaminated and 39 non-contaminated) were included. Seven fractures were in the proximal third (4 standing, 3 under general anaesthesia), 18 in the middle third (5 standing, 13 under general anaesthesia) and 30 were distal (4 standing, 26 under general anaesthesia). No significant difference between groups in surgical time was found (p= 0.8). Average total cost was 522 CAN$ lower for the standing group for non-contaminated fractures (p= 0.02). Three horses of the general anaesthesia group demonstrated postoperative colic signs and one case of the standing group was re-operated due to sequestration. Based on follow-up information (range: 3.8-151.2 months), no significant differences in cosmetic and athletic outcomes were found between groups. Conclusion Surgical management of splint bone fractures in the standing horse is a valuable alternative for horses selected based on behaviour. When compared to general anaesthesia, standing management of splint bone fractures did not alter the surgical time or outcome variables and avoided general anaesthesia-associated risks.

Despite decades of research, many aspects of coral reproductive biology, such as colony size and age at the onset of sexual maturity remain poorly studied. In this study, wild colonies of different...

espanolEl registro de lupus de la Sociedad Espanola de Reumatologia (RELESSER) es un registro multicentrico de pacientes con lupus eritematoso sistemico seguidos en servicios de reumatologia espanoles, que contiene cuantiosa informacion sobre 4.024 pacientes. Hasta la fecha han sido publicados 14 analisis sobre la fase transversal del registro. Se describen los resultados mas relevantes, a criterio de los autores, concernientes a las caracteristicas clinicas acumuladas, nivel de actividad, tratamientos, refractariedad, dano y mortalidad. Se revisan asimismo los resultados de analisis especificos sobre el lupus incompleto, la nefritis lupica, las manifestaciones respiratorias, los eventos cardiovasculares, las infecciones graves, las neoplasias, la fibromialgia, el lupus en varones, el lupus en latinoamericanos y el lupus de inicio juvenil, comparando los diferentes subgrupos con el total de la cohorte. RELESSER se ha constituido como uno de los registros clinicos de lupus eritematoso sistemico mas importantes del mundo, resultando altamente productivo en terminos de generacion de conocimiento de la enfermedad en pacientes espanoles, util tambien para toda la comunidad cientifica. EnglishThe lupus register of the Spanish Society of Rheumatology (RELESSER) is a multicentre register of patients with systemic lupus erythematosus (SLE) under follow-up by Spanish Rheumatology Services. It contains data on a total of 4024 patients with SLE. So far, 14 studies have been published from the transversal phase of RELESSER. Here we report the more relevant contributions of those studies, according to the authors’ perspective, concerning cumulative clinical characteristics, level of activity, treatments, refractory disease, damage and mortality. We also review the main results of the analysis regarding incomplete SLE, lupus nephritis, respiratory manifestations, cardiovascular disease, serious infection, malignancies, fibromyalgia, SLE in males, SLE in Hispanics and juvenile-onset SLE, comparing the main characteristics of each subgroup to the global cohort. RELESSER has become one of the most important clinical SLE registers around the world, with a high yield in terms of knowledge generation about the disease in Spain, also useful for the entire scientific community.

The lupus register of the Spanish Society of Rheumatology (RELESSER) is a multicentre register of patients with systemic lupus erythematosus (SLE) under follow-up by Spanish Rheumatology Services. It contains data on a total of 4024 patients with SLE. So far, 14 studies have been published from the transversal phase of RELESSER. Here we report the more relevant contributions of those studies, according to the authors' perspective, concerning cumulative clinical characteristics, level of activity, treatments, refractory disease, damage and mortality. We also review the main results of the analysis regarding incomplete SLE, lupus nephritis, respiratory manifestations, cardiovascular disease, serious infection, malignancies, fibromyalgia, SLE in males, SLE in Hispanics and juvenile-onset SLE, comparing the main characteristics of each subgroup to the global cohort. RELESSER has become one of the most important clinical SLE registers around the world, with a high yield in terms of knowledge generation about the disease in Spain, also useful for the entire scientific community.

SUMMARYAntibody CIS43 binds Plasmodium falciparum circumsporozoite protein (PfCSP) and protects against malaria, as recently demonstrated clinically. To improve the efficacy of CIS43, we developed an in silico pipeline to optimize the interaction energy of CIS43 to its junctional epitope (peptide 21: PfCSP residues 101-115). Starting from two improved CIS43 variants, recently elicited from a CIS43-germline knock-in mice, single and double amino acid substitutions in the peptide 21-proximal heavy (VH) and light (VL) variable regions were introduced. CIS43-variants, selected on the basis of improved in silico interface and stability energies, showed increased affinity to peptide 21 and superior malaria-protective efficacy. The best designed variant, antibody P3-43, was significantly more protective than its template antibody m43.151, with greater liver-burden protection than the current best-in-class (antibody iGL-CIS43.D3). Crystal structures of improved antibodies revealed atomic-level interactions explaining gains in binding affinity. The reported pipeline provides a powerful in silico approach to improve antibody functionality.

Background The effect of intrathecal anaesthesia of the carpal sheath on distal forelimb sensitivity in horses remains unknown. Objectives To assess the effect of carpal sheath anaesthesia on skin sensitivity of the distal forelimb and to determine potential locations for desensitisation of palmar nerves. Study design In vivo experimental and descriptive anatomical studies. Methods Mepivacaine hydrochloride 2% (0.6 mg/kg) was injected unilaterally in the carpal sheath of 8 horses. Mechanical nociception of the distal forelimb was measured with a dynamometer and compared with the control limb at t0, t15, t30, t60, t90, t120 and t180 minutes . Additionally, the carpal sheath of 10 pairs of cadaveric limbs was injected with latex and potential locations for anaesthetic diffusion to the neighbouring nerves were identified during longitudinal dissection (one limb) and in 3-cm-thick transverse cuts (opposite limb). Results Six of 8 horses (75%) were completely desensitised at the level of both heel bulbs. Anaesthetic injection was not smooth in the 2 horses without desensitisation. Desensitisation started between 30 and 60 minutes in 67% of desensitised heel bulbs (8/12), and 50% (6/12) of them were still completely desensitised at 180 minutes. Cadaveric specimens revealed close proximity between the sheath and the medial palmar nerve as it travels inside the mesotenon of the digital flexor tendons in the carpal region and with both palmar nerves at the proximal metacarpal region. Main limitations Skin mechanical nociception does not necessarily correlate with deep pain but remains the main clinical tool used by practitioners to assess distal limb anaesthesia. Conclusions Intrathecal anaesthesia of the carpal sheath led to distal limb skin desensitisation through diffusion to the palmar nerves at 2 possible locations. Carpal sheath anaesthesia should be interpreted within 15 minutes following injection and anaesthetic blocks distal to the carpus should be delayed for more than 3 hours following carpal sheath anaesthesia.

This study investigated the pharmacokinetics of ceftiofur after intravenous regional limb perfusion (IVRLP). Six horses were involved in 3 IVRLP sessions. For each session, operators with varying clinical experience placed the tourniquet. A wide-rubber tourniquet was applied in the antebrachium as 2 g of ceftiofur in a total volume of 100 mL was injected into the cephalic vein. Plasma and metacarpophalangeal synovial fluid samples were obtained to evaluate perfusate leakage and synovial fluid concentrations of ceftiofur over 24 h. Overall, mean plasma concentrations were not significantly different before and after tourniquet removal. Mean synovial fluid ceftiofur concentrations were significantly higher 5 min and 8 h after tourniquet removal versus 24 h, after which values above the minimum inhibitory concentration (MIC) (1 μg/mL) were not detected. Concentrations above the MIC were detected in 72% and 50% of the horses at 5 min and 8 h, respectively. Overall, higher synovial fluid concentrations were obtained for the operator with the most recent clinical experience performing IVRLP.

La presente investigación tuvo como objetivo el desarrollo y estudio de evidencias de validez de una escala para evaluar las percepciones de personas adultas respecto a la educación sexual, tomando en cuenta sus actitudes, creencias y conocimientos respecto al tema. La recolección fue virtual con una muestra piloto de 21 madres y padres y una muestra final de 297 participantes entre 17 y 75 años de edad. Se utilizó la Escala de Percepciones Respecto a la Educación Sexual (EPES) desarrollada para esta investigación, el Test de Actitudes sobre Educación Sexual e ítems del Cuestionario de actitudes y creencias de Educación Sexual. Como resultados se obtuvo un nivel alto de confiabilidad (.92) según el alfa de Cronbach para la escala EPES desarrollada. El análisis factorial exploratorio sugirió relación entre los ítems en tres factores principales. Se observaron coeficientes de correlación aceptables entre la EPES y las demás escalas aplicadas, lo que indicó evidencias de validez convergente. El estudio incentiva al desarrollo de pruebas de medición de creencias y conocimientos de adultos acerca de la educación sexual dirigida a niños y jóvenes que viven en Costa Rica.

BackgroundSeveral patients with Interstitial Lung Disease show autoimmune characteristics but do not meet the classification criteria for a connective tissue disease. In order to define this condition, the classification of patients with interstitial pneumonia with autoimmune features (IPAF) has been adopted (Fischer’s criteria).ObjectivesTo describe the sociodemographic, clinical, functional characteristics and therapeutic management of IPAF in clinical practice and to evaluate the incidence rate of functional respiratory impairment.MethodsA longitudinal observational study was performed (NEREA registry). Patients diagnosed with IPAF according to Fischer’s criteria were included from ILD diagnosis (Feb 2007 to Dec 2019) and followed until loss of follow-up or Jan 2021. The study was carried out by a multidisciplinary team (pneumologists and rheumatologists) in seven Hospitals of Madrid. The relative functional respiratory impairment, defined as a ≥ 5% decline in percent predicted forced vital capacity (FVC%) compared to the previous visit was set as main outcome. Respiratory function was measured at baseline and every 6-12 months. Covariates included: a) sociodemographic, b) clinical, c) radiological pattern (non-specific interstitial pneumonia [NSIP]; usual interstitial pneumonia [UIP], others); d) FVC% DLCO%; e) laboratory tests; f) therapy used. Survival techniques were used to estimate the incidence rate (IR) of relative functional respiratory impairment, expressed per 100 patient-semester with their respective confidence interval [95 % CI].Results79 IPAF were included, with a follow up of 462.8 patients-semester and a maximum follow-up of 12.3 years. 79% were women with a mean age of 66±11 years. Along with obesity (40%), the most frequent comorbidities at baseline were hypertension, hypercholesterolemia, followed by ischemic heart disease. Baseline FVC% and DLCO% were 88.5±22.7 and 64.2±19.3, respectively. Distribution of IPAF classification criteria was: a) clinical domain: arthritis (46.2%), Raynaud`s phenomenon (35.8%) and mechanic hands (9.3%); b) serological domain: 80.8% positive ANA at >1/320 titer; 29% RF (> 40 IU/ml); 25% positive anti-Ro; c) morphological domain: 46.8% of NSIP and 36.7% of UIP. During the study period, 77.2% of patients (n=61) received treatment: glucocorticosteroids (n=52), mycophenolate (n=25), azathioprine (n=21), rituximab (n=15) and antifibrotics (n=11).During the follow-up, 50 patients presented 111 relative functional respiratory impairment events over time. The estimated IR was 23.9 [19.9-28.8] per 100 patient-semester, and 50% of the patients developed functional respiratory impairment at 16 months from diagnosis.IR was similar between patient gender, baseline overall comorbidity, baseline pulmonary functional tests, and age strata, with slight difference in patients >80 years of age. Patients with baseline associated emphysema (IR: 17.6 [10-31]) or without baseline associated fibrosis (IR: 21.1 [15-28]) had lower IR compared to the opposite (IR without emphysema: 24.5[19.3-31]; IR with fibrosis emphysema: 27.5 [19.9-37.9]). As expected, IR was higher in UIP (32.2 [24-42]) compared to NSIP or any other pattern. With respect to serologic markers, patients with ANA titers >=1/320 had a higher IR (26.7 [21-33]) in comparison with those with lower or non-titers of ANA (IR: 15.7 [9.9-25.1]).ConclusionIn a multicenter registry of Madrid, we have performed a descriptive longitudinal study. IPAF were mostly women in their sixties. The most frequent clinical criteria were arthritis and Raynaud`s phenomenon. An NSIP radiological pattern predominated. At onset, patients have a slightly diminished lung function. The incidence rate of functional deterioration was estimated in 23.9% patient-semester and 50% of the patients developed pulmonary functional deterioration at 16 months from ILD diagnosis. This Incidence rate was higher in patients with an UIP pattern, baseline fibrosis or ANA at medium-high titers.Disclosure of InterestsNone declared

BackgroundHypogammaglobulinemia (HGGS) is one of the adverse effects of Rituximab (RTX), a chimeric monoclonal antibody directed against the CD20 receptor, frequently observed in ANCA-associated vasculitis (AAV) patients.ObjectivesTo study the characteristics of patients with AAV on RTX treatment and to analyze the factors associated with HGGS, as well as to compare them with patients with rheumatoid arthritis (RA) on the same treatment.MethodsRetrospective descriptive study of patients with a diagnosis of AAV or RA treated with RTX who had immunoglobulin levels prior to treatment and after each cycle were included. Demographic, clinical and analytical variables were analyzed. Patients who developed HGGS versus those who did not were compared using Student’s t and Mann-Whitney U for continuous variables and chi-square for categorical variables.ResultsNinety-five patients were included, 19 (20%) with AAV and 76 (80%) with RA. Of the 34 (35.8%) who developed HGGS, 19 had RA (25%) and 15 AAV (79%) (pThe overall sample was divided into patients with HGGS and patients without (Table 1). Significant differences were obtained in relation to diagnosis (pTable 1.Total sample (n= 95)HGGS IgG (n= 34)No HGGS IgG (n= 61)PWomen n/N(%)70/95(73.7)23/34(67.6)47/61(77)0.318Age (m±SD)64±1268±1062±120.005Age at start of treatment (m±SD)57±1262±1054±120.001Years of evolution (m±SD)11±98±912±100.036RA n/N(%)76/95(80)19/34(55.9)57/61(93.4)AAV n/N(%)19/95(20)15/34(44.1)4/61(6.6)Glomerular filtration rate 7/91(7.7)4/34(11.8)3/61(4.9)0.164GCS AD in the previous year (m±SD)2918±31023265±30502690±31550.238GC AD during treatment (m±SD)4656±177132889±27785576±217750.271Total GC AD (m±SD)56411±326716117050±4841865879±60890.159CFM AD (m±SD)0.51±2.251.1±3.10.2±1.50.032Baseline IgG (m±SD)1107±340933±3461203±297Infection n/N(%)58/95(61.1)23/34(67.6)35/61(57.3)0.325Severe infection n/N(%)19/95(20)12/34(35.3)7/61(11.5)0.005Time to infection (months)(m±SD)43±4330±3657±450.017Exitus n/N(%)8/95(8.4)2/34(5.9)6/61(9.9)0.270ConclusionA significantly higher percentage of HGGS is observed in patients with AAV treated with RTX compared to patients with RA. The development of HGGS seems to be influenced by age at diagnosis and at the start of treatment, years of disease evolution and low levels of IgGs prior to the start of treatment. In addition, there is a higher frequency of severe infections in the HGGS group. Studies with larger sample sizes are needed to confirm these results.References[1]Roberts DM, Jones RB, Smith RM, Alberici F, Kumaratne DS, Burns S, Jayne DR. Rituximab-associated hypogammaglobulinemia: incidence, predictors and outcomes in patients with multi-system autoimmune disease. J Autoimmun. 2015 Feb;57:60-5. doi: 10.1016/j.jaut.2014.11.009.Disclosure of InterestsNone declared

Based on human surgical guidelines, intravenous antimicrobials are recommended to be administered within 60 min of surgical incision. Achieving this target in horses is reportedly challenging and influenced by hospital policies. The objectives of this study were to evaluate and improve: (1) the timing of antimicrobial administration to surgical incision (tAB-INC), (2) contributions of anesthesia pre-induction (tPRI) and surgical preparation (tPREP) periods to tAB-INC, and the (3) completeness of antimicrobial recording. Two clinical audits were conducted before and after the policy changes (patient preparation and anesthesia record keeping). tPRI, tPREP, and tAB-INC were calculated and compared for elective arthroscopies and emergency laparotomies within and between the audits. The percentage of procedures with a tAB-INC p < 0.0001, both audits). The percentage of procedures with tAB-INC p r = 0.77; audit 2, p < 0.001, r = 0.59). Between audits, antimicrobial recording significantly improved for elective arthroscopies (82–97%, p = 0.008) but not emergency laparotomies (76–88%, p = 0.2). Clinical audits successfully quantified the impact of introduced changes and their adherence to antimicrobial prophylaxis guidelines. Antimicrobial recording was improved but further policy changes are required to achieve a tAB-INC

Scleractinian corals are modular colonial organisms and are the main framework builders of coral reefs. Most corals reproduce by broadcast spawning with external fertilization and these processes are essential to replenish reef coral populations. Despite decades of research, many aspects of coral reproductive biology remain poorly studied. For example, two important reproductive life history traits, colony size and age at the onset of sexual maturity, are mostly unknown for many reef-building corals. In this study, wild colonies of different size classes and colonies of a known age (i.e. colonies sexually cultured and reared from larvae to adults) of the massive scleractinian Favites abdita were examined for the presence or absence of mature oocytes to determine size and age at the onset of sexual reproduction. Fecundity at the onset of reproductive maturity across size classes of wild colonies was also determined. Surveyed and sampled colonies were grouped into three size classes based on maximum colony diameter (A = 0.1-4.0 cm, B = 4.1-8.0 cm, and C = >8.1 cm). For both wild and sexually propagated colonies, the smallest colonies containing gametes were 1.8 cm in diameter, suggesting that this is the minimum colony size at onset of sexual maturity. Colonies of size class A had lower mean oocyte counts per polyp (44 ± 6.08; mean ± SE) compared to colonies of classes B and C (469 ± 62.41, 278 ± 57.15, respectively). However, mean oocyte geometric mean diameter of size class A colonies was greater (340.38 ± 7.68 μm) than classes B and C (283.96 ± 6.94 μm, 317.57 ± 9.18 μm, respectively). Results of this study bring in to question the widely applied operational definition of coral juveniles being colonies ≤4.0 cm diameter and suggest that even quite small colonies may play a role in contributing to the natural larval pool on reefs than previously thought.

In primary hip replacement, different materials are used for bearing surfaces. In our medium metal or ceramic heads with highly crossed-linked polyethylene (PA) are the most used. These combinations have good results, but it is not clear which is clinically superior. The objective of this study is to determine whether there is any clinically significant difference based on a systematic review of the literature and national registries of arthroplasty.We conduct a systematic review of the literature and national registries of arthroplasty and we were looking for studies comparing bearing surfaces: ceramic-highly cross-linked polyethylene (CP) and metal-highly cross-linked polyethylene (MP); describing the revision rate according to the surface type with a minimum 10-year follow-up. The outcome evaluated was: review rate for any cause depending on surface type.Two out of fifteen national registries were included. The Australian registry shows a difference in the 15-year revision rate: CP: 6.3 (IC 5.8, 6.7) vs MP: 5.1 (IC 4.6, 5.7). The New Zealand registry shows no differences in revision rate/100 components/year: CP 0.54 (0.48-0.61) vs MP 0.61 (0.57-0.66). We do not find clinical studies with inclusion criteria that answer the research question.The results of this review show a high survival rate with the use of highly cross-linked polyethylene, the results are similar when using ceramic or metal heads.En un reemplazo total de cadera primario (RTC), diferentes materiales son los que se usan para las superficies de apoyo. En nuestro medio, las cabezas de metal o cerámica con polietileno altamente entrecruzado (PA) son los más utilizados. Estas combinaciones tienen buenos resultados, pero no es claro cuál es superior clínicamente. Basados en una revisión sistemática de la literatura y de los registros nacionales de artroplastía, el objetivo de este estudio es determinar si existe alguna diferencia significativa desde el punto de vista clínico.Realizamos una revisión sistemática de la literatura y de los registros nacionales de artroplastía. Buscamos estudios en los que se compararan los tipos de superficie de contacto: cerámica-polietileno altamente entrecruzado (CP) y metal-polietileno altamente entrecruzado (MP), además de los registros nacionales de artroplastía que describieran, con un seguimiento mínimo de 10 años, la tasa de revisión según el tipo de superficie. El desenlace evaluado fue: tasa de revisión por cualquier causa según el tipo de superficie.Dos de quince registros nacionales fueron incluidos: el registro australiano muestra una diferencia en la tasa de revisión a 15 años, comparando CP: 6.3 (IC 5.8, 6.7) contra MP: 5.1 (IC 4.6, 5.7). El registro de Nueva Zelanda no muestra diferencias en la tasa de revisión/100 componentes/año: CP de 0.54 (0.48-0.61) en comparación con MP de 0.61 (0.57-0.66). No encontramos estudios clínicos con los criterios de inclusión que respondan la pregunta de investigación.Los resultados de esta revisión muestran una alta supervivencia cuando se usa polietileno altamente entrecruzado; asimismo, los resultados son similares cuando se utilizan cabezas de cerámica o metálicas.

The objective of this study was to determine if abdominal elevation could induce radiographically visible widening of the interspinous spaces in the thoracolumbar region of standing sedated horses and facilitate the surgical approach to the region. Radiographs centered on T13 and T18 were taken while applying different degrees of tension on a wide strap placed under the abdomen of 7 healthy horses. Then, the interspinous spaces between T11 and L2 were measured following a standardized method. The interspinous spaces widen radiographically between T11 to L2, except for T18–L1. Thus, the reported technique could potentially facilitate the surgical approach for horses with impinging and overriding dorsal spinous processes.

OBJECTIVE To describe the antimicrobial susceptibility patterns of the most commonly isolated bacteria cultured from synovial fluid samples from horses with suspected septic synovitis treated at an equine referral hospital between May 1, 2008, and September 24, 2017. SAMPLE 131 synovial fluid samples from 108 client-owned horses. PROCEDURES A retrospective medical record search was conducted to identify horses with suspected septic synovitis and results of synovial fluid bacterial culture and antimicrobial susceptibility testing. Data collected included signalment, known or suspected origin of synovial contamination, synovial structures affected, antimicrobial treatment, and results of synovial fluid cytologic evaluation and bacterial culture and susceptibility testing. Horses were grouped as adults (≥ 6 months old) or foals (< 6 months old). RESULTS Results of bacterial culture were positive for 34 of 70 (49%) and 18 of 61 (30%) samples from 68 adult horses and 40 foals, respectively. Gram-positive bacteria were more common in adult horses, whereas gram-negative bacteria were more common in foals. No multidrug-resistant microorganisms were identified. For adult horses, 92% (23/25) of gram-positive isolates tested with penicillin and gentamicin were susceptible to the combination. For foals, 94% (15/16) of isolates tested with penicillin, gentamicin, or both had susceptibility to 1 or both antimicrobials. CONCLUSIONS AND CLINICAL RELEVANCE Periodic review of bacterial profiles and antimicrobial susceptibility in horses with septic synovitis can help to detect early changes in bacterial pressure and antimicrobial resistance. Findings suggested that in the geographic area we serve, a combination of penicillin and gentamicin would be an effective empirical antimicrobial treatment for most horses with septic synovitis while results of bacterial culture and susceptibility are pending.

Objective To describe the technique to perform diagnostic standing scapulohumeral joint needle arthroscopy with a 1.2-mm-diameter arthroscope in horses. Study design Experimental study. Animals Eight thoracic limbs in phase 1 and six horses in phase 2. Methods In phase 1, the feasibility of the technique was evaluated by using a craniolateral arthroscopic approach. An evaluation of the visible structures of the scapulohumeral joint was performed with both a needle arthroscope and a 4-mm-diameter arthroscope. In phase 2, the technique was performed in six healthy sedated horses to validate the technique in live animals and to report any complications or limitations. Results In phase 1, joint evaluation was similar between arthroscopes and allowed complete evaluation of approximately the lateral half of the humeral head and the lateral glenoid rim. In phase 2, all joints were successfully accessed, and fluid extravasation was mild. Arthroscopic visualization was complete for the centrolateral aspect of the joint in all horses and either complete (3/6) or partial (3/6) for the craniolateral and caudolateral structures, respectively. The procedure was rapidly performed and well tolerated, and no postoperative complications occurred. Conclusion The described technique was simple and allowed direct inspection of the scapulohumeral joint. Nonetheless, the standing nature of the technique prevents evaluation of the medial aspect of the humeral head and most of the glenoid cavity. Clinical significance Needle arthroscopy of the scapulohumeral joint is feasible in horses and offers a diagnostic technique that may improve the surgeon's diagnostic ability for certain shoulder pathologies.

Objective To develop a technique for standing diagnostic needle arthroscopy of the radiocarpal and middle carpal joints in standing sedated horses. Study design Experimental study. Animals Six cadaveric forelimbs (phase 1) and six healthy horses (phase 2). Methods In phase 1, six cadaveric forelimbs were used to assess needle arthroscopic evaluation of both joints. Six healthy horses were subsequently enrolled in phase 2 to validate the procedure in live animals. The joint was maintained in flexion with a custom-made splint and base. Results In phase 1, needle arthroscopy allowed thorough evaluation of the dorsal and palmar recesses of both joints with traditional arthroscopic portals. In phase 2, joint evaluation was also thorough but only dorsal approaches were performed. All horses underwent radiocarpal joint arthroscopy, whereas the middle carpal joint was evaluated in only three of six horses because of limb movement. The technique was quickly performed and well tolerated by all horses. Complications included moderate movement, mild iatrogenic cartilage damage, and mild hemarthrosis. Conclusion Standing needle arthroscopy allowed thorough evaluation of the dorsal aspect of both joints, although only three of six middle carpal joints were assessed because of movement limitations. Clinical significance The proposed technique offers an alternative diagnostic tool for radiographically silent intra-articular lesions of the carpus while initially avoiding the cost and risks associated with general anesthesia. Arthroscopy of a single joint is recommended to minimize risks associated with movement during the procedure.

The detailed knowledge of the void evolution is helpful to understand and interpret traditional electromigration (EM) lifetime experiments. As void formation and subsequent evolution is highly dynamic, an in situ observation experiment was employed using an SEM allowing for void detection down to a few nanometers in diameter. For void nucleation, it has been suggested that due to the large anisotropy in modulus in Cu, incompatible grain boundaries can act as stress concentrators for both stress-induced and EM-induced voiding. In addition, during growth, the shape change and migration have been associated with the microstructure. To better understand void formation and evolution, we examined the Cu microstructure using EBSD during the experiment without interruption. We tested interconnects consisting of Cu-based damascene (M1) drift type structures, capped with SiCN. Void formation could be confirmed to be associated with features such as incompatible grain boundaries in some instances. In other cases, triple points and grain boundary/sidewall intersections were found as void nucleation sites. Void growth and migration is found strongly correlated with the driving current density. We show conditions under which void migration takes place or is suppressed. In particular, a critical current density of approximately 10 $\mbox{mA}/\mu\mbox{m}^{2}$ is observed, below which no void migration occurs. At current densities of 15 $\mbox{mA}/\mu\mbox{m}^{2}$ and above, all voids migrated at a net drift velocity proportional to the current density. Independent of migration, all voids are observed to grow at rates consistent with published data for a mixed near bamboo microstructure and interface diffusion.

Thromboelastometry evaluates viscoelastic changes in the coagulation process. It offers a graphic representation of the formation of the coagulum, its stability and the presence of lysis.This first case of transfusion management guided by thromboelastography in Mexico and we conducted a review of the literature.A metasearch search was performed (PubMed, Scielo, Medigraphic) with the words thromboelastometry, coagulopathy, transfusion medicine and the most influential works were included.The rotational thromboelastometry is a diagnostic tool that graphs the functionality of the clot, for a directed and individualized management of the coagulopathy associated with bleeding.La tromboelastometría evalúa los cambios viscoelásticos en el proceso de coagulación. Ofrece una representación gráfica de la formación del coágulo, su estabilidad y la presencia de lisis.Se notifica el primer caso de manejo transfusional guiado por tromboelastografía en México con revisión de la bibliografía.Se realizó una búsqueda en metabuscadores (PubMed, Scielo, Medigraphic) con las palabras tromboelastometría, coagulopatía y medicina transfusional y se incluyeron los trabajos más influyentes.La tromboelastometría rotacional es una herramienta diagnóstica que grafica la funcionalidad del coágulo para un manejo dirigido e individualizado de la coagulopatía relacionada con ­hemorragia.

Introduction Thromboelastometry evaluates viscoelastic changes in the coagulation process. It offers a graphic representation of the formation of the coagulum, its stability and the presence of lysis. Objective This first case of transfusion management guided by thromboelastography in Mexico and we conducted a review of the literature. Method A metasearch search was performed (PubMed, Scielo, Medigraphic) with the words thromboelastometry, coagulopathy, transfusion medicine and the most influential works were included. Conclusions The rotational thromboelastometry is a diagnostic tool that graphs the functionality of the clot, for a directed and individualized management of the coagulopathy associated with bleeding.

Objective To develop and assess a needle arthroscopic technique to diagnose conditions of the tarsocrural joint (TCj) in standing sedated horses. Study design Experimental study. Sample population Six cadaveric hind limbs (phase 1) and six healthy horses (Phase 2). Methods In phase 1, each TCj was examined with a 1.2-mm-needle arthroscope. Suitability of the needle arthroscope and degree of joint visualization with traditional arthroscopic approaches were assessed. In phase 2, the feasibility of the procedure was assessed in six standing healthy horses. A custom-made splint and base were developed to maintain joint flexion during the procedure. Results Thorough evaluation of the dorsal intra-articular structures of the TCj via dorsomedial and dorsolateral approaches was possible in both phases. The procedure was feasible, quickly performed, and well tolerated by all horses. Complications consisted of moderate movement (2/6 horses) and hemarthrosis (3/6 horses). Conclusion Diagnostic standing needle arthroscopy of the TCj allowed thorough evaluation of the dorsal aspect of the joint while avoiding the cost and risks associated with general anesthesia. Inadvertent puncture of the dorsomedial vasculature with the cannula and obturator led to significant hemarthrosis. Clinical impact Needle arthroscopy of the TCj offers an alternative diagnostic tool when traditional imaging techniques (radiography and ultrasonography) are unrewarding or nondiagnostic. The technique is conceived mainly for diagnostic purposes, but its use during short interventions warrants investigation.

Objective To investigate the use of a needle arthroscope for diagnostic tenoscopy of the carpal sheath in standing horses. Study design Experimental study. Sample population Six forelimbs for the cadaveric part of the study and six horses for the in vivo part of the study. Methods Six cadaveric limbs were used to perform carpal sheath tenoscopy with a 1.2-mm-diameter needle arthroscope (65 and 100 mm long), followed by tenoscopy with a 4-mm arthroscope through a standard proximolateral approach. Then, unilateral standing carpal sheath tenoscopy was performed in six healthy sedated horses with a 65-mm-long needle arthroscope. Limbs were maintained in flexion during the procedure by using a custom-made splint and base. Degree of tenoscopic evaluation, safety, horse tolerance, and complications were recorded. Results Visibility at the most distal aspect of the sheath was absent for the needle arthroscopes vs a standard arthroscope. The maneuverability with a 65-mm needle arthroscope was excellent and allowed exhaustive visualization of the proximal region of the carpal sheath in cadaveric limbs and standing horses (six of six). However, visualization of the intertendinous recess was partial in most horses (four of six) vs cadavers (complete in six of six) because of remaining flexor tendon tension in standing horses. No major complications were encountered. Conclusion Standing carpal sheath tenoscopy allowed a safe and thorough evaluation of most structures in the proximal region of the sheath and offers an alternative diagnostic technique. Clinical significance Horses with unrewarding results after traditional imaging or that require an accurate diagnosis before treatment may benefit from this alternative procedure.

Electromigration (EM) and TDDB reliability of Cu interconnects with a barrier/wetting layer as thin as 2 nm employing a PVD-reflowed through-Co self-forming barrier (tCoSFB) is demonstrated to meet the required specifications for 7 nm BEOL. The resulting Cu EM lifetime is 2000X longer than Cu interconnects with a standard scaled barrier/wetting layer. This tCoSFB Cu EM and TDDB reliability performance were equivalent to pure Co metal interconnects, but with a 50% lower line resistance even down to 30 nm pitch dimensions. However, the annealing process for PVD-reflow Cu seed that enhances EM reliability caused Cu agglomeration at dual damascene line-end vias, leading to poor via-chain yield. Resolving this geometry-sensitive via-fill problem was identified as key to extending Cu manufacturability to 7 nm and beyond. We propose, and show preliminary data, for Cu/tCoSFB metallization with CVD Co via pre-fill as potential solution.

Objective The aim of this study was to report the technique, experience and outcome of standing arthroscopic removal of dorsal osteochondral fragmentation of the metacarpophalangeal and metatarsophalangeal joint using a 1.2-mm needle arthroscope. Study Design This was a prospective clinical study. Materials and Methods All horses referred for standing arthroscopic removal of dorsoproximal first phalanx fragments or fragments embedded in the distal aspect of the synovial plica were included. Relevant information from the cases was recorded. Follow-up was obtained by a telephone questionnaire. Results Twenty-one horses with a mean age of 4.5 years old were included. Osteochondral fragments removed were from the proximal margin of first phalanx in 18 horses (24 joints), in the synovial plica in 2 horses (2 joints) or free-floating fragment in 1 horse (1 joint). Fifteen out of twenty-one horses were unilaterally affected and 6/21 bilaterally. Fifteen out of twenty-seven affected joints were forelimbs and 12/27 hindlimbs. All articular structures within the dorsal recess of the joint were visible. The arthroscope was deemed easy to use and manoeuvre. Only minor complications occurred during the procedure. Surgery time was 15 to 20 minutes for most patients. Conclusions All fragments were successfully removed and needle arthroscopy allowed a thorough evaluation of the dorsal aspect of the joint. The technique offers an alternative for standing fetlock arthroscopy for surgeons concerned about equipment damage or portability.

OBJECTIVE To describe the technique, experience, and limitations of using a 2-mm flexible endoscope to perform standing minimally invasive sinoscopy. STUDY DESIGN In phases 1 and 2, we used cadaveric heads (ex vivo). In phase 3, we used unaffected horses (in vivo). ANIMALS Five cadaveric equine skulls in phase 1 and 10 cadaveric equine skulls in phase 2. Six horses older than 5 years in phase 3. METHODS In phase 1, the specimens were used to determine the suitability of the endoscope for sinoscopy and the ideal landmarks to approach the paranasal sinuses through minisinusotomies performed with a 14 gauge needle. In phase 2, a nonblinded evaluation of the visualization of the different sinus compartments was performed, and a score was attributed to each structure. Procedures were video recorded and compared with direct visualization of the sinuses after performing frontal and maxillary flaps. In phase 3, the technique was validated in healthy horses under sedation. RESULTS The landmarks determined in phase 1 allowed a thorough exploration of the sinuses in phases 2 and 3. Sinoscopy findings were confirmed after direct visualization of the sinuses via frontal and maxillary bone flaps in phase 2. The procedure was well tolerated by all horses. CONCLUSION Minimally invasive sinoscopy was readily performed without relevant complications in standing horses. A thorough evaluation of most sinus structures was obtained only using the frontal and the rostral maxillary portals. CLINICAL SIGNIFICANCE Minimally invasive sinoscopy offers an alternative diagnostic tool to veterinarians. A specialized endoscope and appropriate training are required to perform this minimally invasive procedure.

One of the most critical points in the planning of hip replacement surgeries is the selection of the implant, since its survival significantly impacts the patients health. However, the ideal survival time that an implant must prove to be selected has not been defined. The objective of this consensus is to define minimum performance standards for the selection of conventional primary hip replacement prosthesis.The consensus was carried out using the methodology of nominal group. This included: 1. A review of the available evidence and the issues to be evaluated, 2. Meeting for the vote and discussion, 3. Quantitative statistical analysis with median (M) and interquartile range (IQR) and qualitative one with proportions of the results to generate recommendations.The primary source of information for prosthesis selection (M: 8; IQR: 7-9), choice in the event of conflicting evidence (M: 8; IQR: 7-9), or limited evidence in the literature (M: 7; IQR: 4.75-825) should be national registries. The minimum acceptable follow-up is 10 years (M: 9; IQR: 8-9) and the minimum acceptable survival is 90% at 10 years (M: 8; IQR: 5-8.5).According to these results, the consensus of experts proposed that the selection of the implant for conventional primary hip replacement must be based on the information published in the national registries and that the prosthesis must have a minimum follow-up of 10 years and show a minimum survival of 90%.Uno de los puntos más críticos en la planeación de las artroplastías de cadera es la selección del implante, puesto que su supervivencia impacta significativamente la salud de los pacientes. Sin embargo, hasta el momento no se ha definido cuál es la supervivencia ideal que debe demostrar un implante para ser seleccionado. El objetivo de este consenso es definir los estándares mínimos de desempeño para la selección de prótesis en reemplazo primario convencional de cadera.El consenso se realizó mediante la metodología de «grupo nominal». Esto incluyó: 1. Revisión de la evidencia disponible y definición de los temas a evaluar, 2. Reunión para la votación y discusión y 3. Análisis estadístico cuantitativo con medianas (M) y rangos intercuartílicos (RIC) y cualitativo con proporciones de los resultados obtenidos para generar recomendaciones.La fuente primaria de información para la selección de prótesis (M: 8; RIC: 7-9) y de elección en caso de evidencia contradictoria (M: 8; RIC: 7-9) o limitada en la literatura (M: 7; RIC: 4.75-825) son los registros nacionales. El mínimo seguimiento aceptable es 10 años (M: 9; RIC: 8-9) y el mínimo de supervivencia aceptable es 90% a 10 años (M: 8; RIC: 5-8.5).De acuerdo con estos resultados, el consenso de expertos propone que la selección del implante en el reemplazo articular primario convencional de cadera se realice con base en la información publicada en los registros nacionales y que dicha prótesis tenga un seguimiento mínimo de 10 años y demuestre una supervivencia mínima de 90%.

Summary A 15-year-old Hanoverian mare presented with a 10-day history of facial swelling in the right maxillary and frontal regions, left epiphora and intermittent right epistaxis. Radiographs revealed suture exostosis of both nasofrontal sutures and a deviated and thickened nasal septum. Computed tomography (CT) of the skull revealed exostosis of the nasolacrimal sutures and ducts bilaterally of both nasofrontal sutures and of the right zygomatocomaxillary and lacrimomaxillary sutures. The mid-to-caudal aspect of the nasal septum was thickened and had multiple well demarcated hypoattenuated regions within the septum. Histological examination of biopsies taken from the right nasofrontal suture and the nasal septal mass revealed suture exostosis and nasal septum chondrosarcoma. The horse was treated with rest and anti-inflammatories. The facial swelling and left epiphora were improved at 7 months telephone follow-up. This report is the first to describe a nasal septum chondrosarcoma in a horse. Additionally, we suggest that the suture exostosis may have developed due to an alteration of the biomechanics of the skull sutures secondary to the septal tumour.

Background The use of biological therapy (BT) in rheumatoid arthritis (RA) has supposes a very important change in the disease9s treatment and prognosis. Drugs like Anti-TNFα have proven unquestionable effectiveness. However, the lack or loss of such effectiveness over time raises the dilemma of what factors may influence it. There are studies that suggest the influence of BMI on the efficacy of these drugs and therefore on the control of the disease. Objectives To determine the influence of BMI on disease activity and response to treatment with infliximab (ifx) in patients with RA. Methods A retrospective observational study of a population of 76 patients with RA who received infliximab treatment, in a standard guideline of 3 mg/kg, in our service between 2000 and 2016 inclusive. The BMI was classified for some sub-studies in four categories: low ( 1.2, or>0.6 and DAS28 Results Characteristics of the 76 patients included in the study when initiating IFX therapy were: 66 (86.8%) were women, median (range) age 54 (21–83) years, 77,% RF+, 81% ACPA+, disease duration 10,8 (1,0–39,0) years, 59% with concomitant methotrexate and 55% with other DMARDs. Median (range) BMI was 25,5 (16,7–40,2) kg/m 2 . According to BMI, patients with underweight, normal, overweight and obesity were 0 (0,0%), 41 (53,9%), 22 (28,9%) and 13 (17,2%), respectively. The association between BMI and disease activity (median DAS28 (p25-p75)) is shown in Table 1: The association between BMI and treatment response (median deltaDAS28 (p25-p75) and EULAR response (%)) is shown in Table 2: In the longitudinal analysis, a trending but not statistically significant relationship between adjusted BMI and DAS28 was observed at six month and at one year of treatment onset: β: 0,051; 95% CI (-0,06 to 0,109) and β: 0,037; 95% CI (-0,022 to 0,097) Conclusions BMI seems to influence, in a non significantly manner, in disease activity and in treatment response in RA treated with infliximab. Obesity BMI values are associated with increased activity and a lower response to this treatment than lower BMI values. Disclosure of Interest None declared

Background IL-17-expressing FoxP3 regulatory T cells have been described, and their suppressive capacity has been questioned. An inflammatory environment seems to favor IL-17 secretion by regulatory CD4+CD25+FoxP3+ T cells. Objectives To assess the suppressive function and IL-17 producing capacity of CD4+CD25+CD127-FoxP3+ T cells in the synovial fluid of RA patients (RASFd). Methods Synovial fluid was drawn from 35 patients with established RA who were receiving methotrexate and low-dose oral prednisone. The frequency of CD4+CD25+CD127-FoxP3+ T cells was assessed by flow cytometry. Total CD4+ T cells, CD4+CD25+CD127- T reg cells and CD4+CD25- Tresp cells were isolated by Ficoll-Hypaque gradient, followed by sorting. After isolation, cells were stimulated for 5 hours with PMA+ionomycin or cultured for 5 days in flat-bottom 96-well plates coated with an anti-CD3 monoclonal antibody. Treg cell function was assessed using two different approaches: A.The regulatory function of natural proportions of Tregs was inferred by comparing the proliferative and cytokine responses of total CD4+ T cells (TCD4T) versus CD25+ depleted CD4+ T cells (CD4+CD25-T cells or Tresp cells); B. The per cell suppressor potency of Tregs was assessed in cocultures of isolated Tregs with Tresp, established at different Treg/Tresp ratios. Proliferation was determined by 3Hthymidine incorporation and CFSE dilution; cytokine secretion was measured by ELISA of culture supernatants. Results A high proportion of CD4+CD25+CD127- T cells was present in RASFd (mean ± SD, 21.1%±6.2), which is significantly higher than reported frequencies of this cell population in the peripheral blood of both RA and healthy subjects. These RASFd CD4+CD25+CD127- T cells expressed FoxP3 but did not express CD69. The proliferation rate, TNFα and IFNγ secretion were significantly higher for isolated Tresp as compared with TCD4T cells, indicating that natural proportions of Treg cells present in the synovial fluid of RA are funcionally suppressive. Surprisingly, TCD4T cells secreted higher amounts of IL-17 as compared with Tresp cells, although the difference did not reach statistical significance. On a per cell basis, RAPB Tregs were potent suppressors of Tresp proliferation, TNFα and IFNγ but not of IL-17 secretion; in fact IL-17 secretion did not decrease but was enhanced in the presence of increasing proportions of Treg cells. Isolated Treg cells did not proliferate or produce cytokines when cultured alone in anti-CD3 coated plates. However, in the presence of plate-bound anti-CD3 plus anti-CD28 and recombinant human IL-2, isolated Treg cells secreted significant amounts of IL-17 whereas no TNFα or IFNγ could be detected in supernatants. Conclusions CD4+CD27+CD127- FoxP3+ Treg cells present in the synovial fluid of RA patients are potent suppressors of Tresp proliferation, TNFα and IFNγ secretion, and at the same time produce significant amounts of IL-17. References Voo KS, et al. Proc Natl Acad Sci U S A. 2009;106:4793. Beriou G et al. Blood. 2009;113:4240. Wang T, et al. Ann Rheum Dis. 2015;74:1293. Komatsu N, et al. Nat Med. 2014;20:62. Yang BH, et al. Mucosal Immunol. 2016;9:444. Disclosure of Interest None declared

Objective To determine ex vivo contact data on the equine medial tibial plateau loaded by an intact medial femoral condyle (MFC), by an MFC with an osteochondral defect, and with a screw inserted in lag fashion through the MFC defect. Study Design Ex vivo experiment. Animals Stifles (n = 6). Horses (n = 4). Methods Stifle joints were axially loaded to 1800 N at 155°, 145°, and 130°, under 3 conditions: Intact, MFC with a 15 mm circular osteochondral defect, and with a transcondylar screw inserted in lag fashion through the defect. An electronic pressure sensor (Tekscan®) on the medial tibial plateau recorded contact area, force, peak pressure, and contact maps. Stress load (N/cm2) was calculated for the entire medial plateau and in 3 sub-regions; cranial, caudal, and central. Significance was set at P ≤ .05. Results Flexion increased force, contact area, and stress load for all conditions. An MFC defect significantly reduced force at both flexion angles and contact area at 145°. The transcondylar screw returned force to intact values at 130° and reduced contact area in extension. Intact MFC contact maps revealed pressure peaks on the central cartilage at all angles and contact pressure and area expansion and caudal movement with flexion. Contact maps with an MFC defect amplified the caudal and abaxial pressure movement during flexion, and the screw did not further change them. Conclusions Stifle flexion increases force, contact area, and stress load on the medial tibial plateau and is most pronounced caudally. An MFC defect alters load on the medial tibial plateau, and a transcondylar screw may reverse some of those changes.

CASE DESCRIPTION 4 horses were examined because of signs of chronic hind limb lameness. CLINICAL FINDINGS 3 horses had a history of lameness for > 6 months; specific duration was unknown for 1 horse. On initial evaluation, grade 3 to 4 (on a scale from 1 to 5) hind limb lameness was present in all 4 horses. Radiography of the stifle joint of the affected limb revealed medial femoral condyle subchondral lucencies or subchondral cystic lesions (SCLs) in all 4 horses, medial femorotibial osteoarthritis in 3 horses, and medial tibial condyle SCLs in 3 horses. TREATMENT AND OUTCOME 2 horses were treated medically (stall rest and oral NSAID administration), and 2 horses were treated surgically by means of medial femoral transcondylar lag screw placement through the medial femoral condyle SCLs. The 2 horses treated medically did not improve and were euthanized. Necropsy confirmed the presence of medial femoral condyle and medial tibial condyle SCLs. Surgical treatment did not resolve the lameness in 1 horse with SCLs in the medial tibial condyle and medial femoral condyle, and euthanasia was performed 150 days after surgery. In the second horse, a medial tibial condyle SCL was evident on radiographs obtained 3 months after surgery; however, this was not addressed surgically, and signs of lameness resolved 11 months after surgery. CLINICAL RELEVANCE Results of this small case series suggested that SCLs in the medial tibial condyle can occur in association with SCLs of the medial femoral condyle, with a poor prognosis for return to athletic function in affected horses. Further investigation is indicated.

Summary Gastroscopy is the most common technique used in veterinary medicine to evaluate the stomach in horses and to date, no complications have been described associated with the procedure. This paper reports 4 cases developing a nonstrangulating segmental volvulus of the small intestine after gastroscopy at 3 referral institutions over a 2 year period. After performing diagnostic gastroscopy, all horses developed acute and severe clinical signs of colic unresponsive to medical management. Time range between gastroscopy and onset of colic signs varied from 10 min to 3 h. An exploratory laparotomy revealed a nonstrangulating segmental volvulus of the small intestine that was manually corrected without need for resection in all horses. In all cases, affected small intestine was severely gas distended. Three of those horses survived to discharge and were alive at follow-up. One horse was subjected to euthanasia 2 days after surgery due to diffuse intestinal lymphoma.

El presente artículo muestra los avances que estamos alcanzando en la investigación titulada “Gestión social e institucional del agua y el alcantarillado y su incidencia en la salud y el bienestar de los estratos 1 y 2 del Área Metropolitana de Barranquilla, entre los años 1980 y 2012”. Primero ofrecemos una perspectiva general del estado de la cuestión sobre estos temas en América Latina. Luego se realiza una breve reseña del origen y evolución del acueducto, en el siglo XX, para abordar a continuación como pasa el manejo público hacia una gestión por parte de las empresas privadas, como la Triple A, a partir de los años noventa.

Case Description—A 4-month-old Standardbred colt was examined because of a fractured right calcaneus of 8 days' duration with increased distraction of the fracture fragment evident on sequential radiographs. Clinical Findings—The foal was severely lame with diffuse periarticular tarsal swelling. Radiographically, a complete, displaced long oblique fracture of the right calcaneal body was evident. Because the fracture gap was increasing with time and lameness remained severe, despite medical management, surgical repair was recommended. Treatment and Outcome—The foal was anesthetized, and minimally invasive fracture reduction and internal fixation were achieved by use of two 4.5-mm cortical screws placed in lag fashion via stab incisions over the lateral aspect of the calcaneus. External coaptation with a Robert-Jones bandage only was used after surgery. The foal recovered well and the fracture healed appropriately, but at 8 weeks following surgery, tenosynovitis of the tarsal sheath had developed. This was attributed to the tip of the distal screw encroaching on the sheath. The screw was removed under anesthesia and the tarsal sheath drained. The tenosynovitis resolved with rest and bandaging. Fourteen months after surgery, the colt was free of lameness. Clinical Relevance—Findings suggested that a minimally invasive internal fixation technique for treatment of a calcaneus fracture in horses may be successful and may be associated with decreased morbidity, compared with the use of open reduction and plate fixation.