Traumatic sacral fracture following dystocia in a Thoroughbred foal

A Thoroughbred colt with a history of dystocia was referred for further management of suspected hypoxia. The foal showed signs of neonatal maladjustment syndrome and hindlimb paralysis. Radiography revealed the presence of a severe lumbosacral injury. The foal was subjected to euthanasia due to a hopeless prognosis. Computed tomography was performed post‐mortem and revealed a type I Salter Harris fracture of the cranial physis of the first sacral vertebra.     

Femoral Capital Physeal Fractures in 25 Foals

The medical records of 25 horses 1 year of age or younger affected with femoral head and neck fractures during an 18 year period were reviewed. Each fracture involved the capital physis. The foals were 11 days to 12 months of age (mean, 5 months). No femoral capital physeal fractures occurred in horses older than 1 year of age during the same period. The history in each case included acute onset of severe unilateral hindlimb lameness, 3 hours to 2 months (mean, 12 days) before presentation. Injuries observed were violent falls, struggles, and kicks. Crepitation, swelling, pain with manipulation or palpation or both, and apparent fracture fragment displacement were inconsistently noted. Tentative clinical diagnoses were confirmed by radiography in 24 foals and by necropsy alone in one foal. Twenty-one foals were euthanatized due to poor prognosis. One foal sent home for stall rest was lost to follow-up. Surgical repair was attempted in three foals. Two fractures were repaired with multiple intramedullary pins and the foals were euthanatized within 2 weeks due to surgical failure and, in one case, contralateral limb breakdown. The third fracture was repaired with a compressing screw and plate device; the animal was pasture sound at month 20.     

Treatment of a Periarticular Tibial Fracture in a Foal with a Hybrid External Fixator

Objective— To report repair of a right proximal tibial Salter-Harris type II fracture in a foal with a hybrid external fixator (HEF).
Study Design— Case report.
Animals— A 5-month-old male foal.
Methods— After open surgical reduction, an HEF built with wires, 2 half-rings, 3 half-threaded connecting rods, and Schanz pins was used to stabilize the fracture.
Results— Immediately after surgery, the foal had relatively good weight bearing. The HEF was removed at 60 days after radiographic confirmation of healing.
Conclusions— HEF can be used to stabilize a proximal tibial Salter-Harris type II fracture in a 5-month-old foal.
Clinical Relevance— HEF should be considered as another option for repair of proximal tibial Salter-Harris type II fractures in foals.     

Computed tomography assisted diagnosis and treatment of a comminuted fracture of the plantar aspect of the medial trochlear ridge and the proximal tubercle of the talus in a foal

Isolated fractures of the proximal tubercle of the talus and the medial trochlear ridge of the talus have been reported in the equine literature. A comminuted, intra-articular fracture of the plantar medial trochlear ridge and proximal tubercle of the talus has not been previously reported. The current case report describes this unique comminuted fracture in a 6-week-old Thoroughbred foal with acute onset lameness. The diagnosis was achieved by a combination of radiography, ultrasonography and computed tomography (CT) followed by CT arthrography. Surgical removal of the fracture fragments was recommended; the intra-articular fracture fragments were removed under arthroscopic visualisation of the plantar pouch of the tarsocrural joint; due to ligamentous attachments and partial extra-articular nature, the fracture fragment of the proximal tubercle of the talus was removed via an arthrotomy extension of the medial arthroscopy portal. On follow-up examination 12 months post-operatively, the yearling showed no clinical evidence of lameness or radiographic evidence of secondary degenerative joint disease.     

Computed tomographic diagnosis of a fracture of the floor of the pelvis in a Thoroughbred foal

This case report describes the clinical and diagnostic imaging findings, treatment and outcomes of a 15-day-old Thoroughbred foal referred for the evaluation of severe left hindlimb lameness of 8 days' duration. Radiographic examination of the left hindlimb and transcutaneous ultrasonographic examination of the pelvis were unremarkable. A computed tomographic (CT) examination was performed to investigate the proximal aspect of the limb and the pelvis; CT scans of the thorax were also acquired. In this case, CT images allowed detection of a closed, slightly displaced, oblique wedge-like fracture of the left caudal ramus of the pubis and medial ramus of the ischium, allowing an accurate diagnosis to guide appropriate treatment and prognostication. The foal was treated with anti-inflammatory drugs and box-rest. A follow-up by telephone interview with the trainer 3 years later revealed that the horse is in full athletic activity without any residual gait alteration related to the pelvic fracture.     

Crosspin Fixation of Fractures of the Proximal Tibia in Three Foals

Three foals, each less than 1 month of age, were presented with Salter Type II fractures of the proximal tibial physis. Reduction of the fractures was accomplished manually and maintained by crosspin fixation. Fracture healing in two of the foals was uncomplicated. The third foal developed an infection around the implants, which responded to periodic local antiseptic flushing and administration of penicillin and gentamicin. Follow-up information ranging from 11 to 22 months after surgery revealed satisfactory results in two of three foals; premature closure of the proximal tibial physis was found in the other foal, resulting in the development of an angular limb deformity.     

Surgical reconstruction of a ruptured medial collateral ligament in a foal

An avulsed carpal medial collateral ligament was diagnosed by clinical and radiographic examination in a 1-day-old foal that was unable to bear weight on the affected limb. The foal had a valgus deviation originating at the carpus and medial to lateral instability of the affected carpus. The ligament was reconstructed with screws and suture tape. Surgical reconstruction is a viable alternative to long-term casting or splinting for treatment of a ruptured carpal medial collateral ligament in a foal.     

Multiple rib fracture in a neonatal foal using a nylon strand suture repair technique

OBJECTIVES: To report rib fracture repair using the Securos Cranial Cruciate Ligament Repair System (SCCLRS; Securos Veterinary Orthopedics, Charlton, MA) in a neonatal foal. STUDY DESIGN: Case report. ANIMALS: A 1-day-old Standardbred foal with fracture of left ribs 2-9. METHODS: Four days after admission the foal was anesthetized and rib fractures were repaired using open reduction and the SCCLRS. RESULTS: Rib fractures were successfully stabilized and the foal was discharged 7 days postoperatively without further complications. CONCLUSIONS: The SCCLRS provided a straightforward, effective method of rib fracture repair in neonatal foals. CLINICAL RELEVANCE: Effective rib fracture repair in neonatal foals can be achieved with the SCCLRS.     

Gluteal pyomyositis associated with septic proximal femoral physitis in a 12-day-old Standardbred filly foal

A 12-day-old Standardbred filly foal was presented with an acute onset hindlimb lameness of 24 hours duration. Initial ultrasonographic evaluation of the right gluteal region revealed oedematous change to the muscle architecture. Conservative therapy consisting of antimicrobials and stall rest was initiated. Forty-eight hours after admission a localised gluteal pyomyositis had developed. This was drained twice by percutaneous aspiration. Four days after admission the foal was euthanased. Necropsy examination revealed a septic proximal femoral physis with no grossly apparent joint involvement.     

Retrospective study of 38 cases of femur fractures in horses less than one year of age.

Medical records of 38 horses less than 1 year of age and diagnosed as having a fracture of the femoral diaphysis, metaphysis or distal physis were evaluated. Twenty-six foals had fractures of the femoral diaphysis or metaphysis with the most common fracture configuration being comminuted. Twelve foals had distal physeal fractures with the most common fracture configuration being a Salter-Harris type II. Twenty-one foals with fractures of the capital femoral physis, neck or greater trochanter during the same time period were excluded from this study. Surgical repair was attempted in 16 diaphyseal and 2 distal physeal fractures. Most of the diaphyseal fractures were repaired by placing plates on the lateral and cranial surfaces of the bone. Dynamic condylar screw plates or angle blade plates were used for increased bone purchase in 4 foals with short distal fragments. Five foals with distal physeal fractures were treated; 2 were surgically treated by placing an angle blade plate on the lateral cortex, and 3 foals with minimally displaced distal physeal fractures were managed with stall confinement. Eight of the 16 surgically repaired diaphyseal fractures healed. Fracture location and configuration was not a determinant of outcome, but the mean age of foals with successfully repaired diaphyseal fractures was 2 months compared with 4 months for the unsuccessful cases, indicating that the age and size of the foal was important. Long-term follow up revealed that 6 of the 8 successfully repaired diaphyseal fractures had no residual effects of the fracture observed during performance of the horse for its intended use. Only 1 of the 2 surgically repaired distal physeal fractures healed, but this horse was eventually killed because of unthriftiness related to a malabsorption syndrome. Some form of complication developed in 13 of the 18 surgically repaired fractures. Infection was the primary cause of failure. The greatest determinant associated with infection was the inability to control post-surgical seroma formation.     

Fractures of the proximal sesamoid bones in thoroughbred foals.

Eighteen cases of fractures of the proximal sesamoid bones in Thoroughbred foals are described. Most of the fractures were in foals under 2 months old and all but one occurred in the forelegs. The bones commonly fractured when the foal galloped to exhaustion trying to keep up with its dam in the paddock. The types of fracture varied but a simple fracture of the medial sesamoid was most frequent and the majority were towards the base of the bone. Six foals sustained a fracture of more than one sesamoid bone and one foal fractured all 4 proximal sesamoid bones in its front legs. Treatment included box rest and the surgical removal of the separated piece of sesamoid bone. Only 3 of the foals treated have raced. One of these was treated surgically.     

Evaluation of an Interfragmentary Compression System for the Repair of Equine Femoral Capital Physeal Fractures

Femoral neck and proximal epiphyseal lengths were measured in 37 femurs from 19 cadaver foals that were 1 day to 12 months old to determine the applicability of a human interfragmentary compression system to equine femoral capital physeal fractures. Because components of the implant system are available only in fixed sizes, its use was possible in foals older than 5 weeks of age, but not in younger foals. The 135 degree angle plate conformed best to the equine femur. Femoral capital physeal fractures were created surgically and repaired with the implant system in three foals. Fracture stability was evident clinically and radiographically in all three foals until euthanasia at month 3. At necropsy, the treated femurs were 4, 8, and 27 mm shorter than their mates. Epiphyseal viability was verified in all three foals by tetracycline deposition and new appositional bone growth comparable with that in the contralateral control epiphyses. The treated capital physis was open but reduced in thickness in one foal, disorganized in one foal, and closed in one foal. Fixation by compression with the implant system resulted in stability sufficient for fracture healing and maintenance of epiphyseal viability, although it was associated with reduced longitudinal femoral growth.     

Minimally‐invasive plate osteosynthesis of a Salter‐Harris type 2 fracture of the proximal phalanx in a filly

A 7‐month‐old Warmblood filly was referred to the equine hospital because of a Salter‐Harris type 2 fracture of the proximal physis of the right hind P1. On admission, the filly had acute grade 3/5 lameness at the walk and diffuse swelling in the area of the right hind proximal phalanx. Radiographs were taken to assess the fracture and plan treatment. Surgical treatment using two 4.5 mm narrow locking compression plates (PIP‐LCPs) resulted in fracture stabilisation and rapid healing. This case report suggests that internal fixation using PIP‐LCPs is useful for the treatment of Salter‐Harris type 2 fractures of the proximal physis of P1 in large foals.     

Congenital bilateral aplasia of the metacarpophalangeal joints in a foal

A 2‐day‐old Warmblood filly was presented for examination of an angular limb deformity of the left front limb and an upright conformation of both metacarpophalangeal joints. Radiological examination revealed bilateral absence of the metacarpophalangeal joint space with fusion of the third metacarpal bone and first phalanx (synostosis). No treatment was undertaken. The filly was readmitted to the clinic 10 weeks later for bilateral front limb lameness. On radiological examination, the synostosis of the front metacarpophalangeal joints was still present. Physitis of the distal growth plate of the right third metacarpal bone and proximal growth plate of the right proximal phalanx, and an avulsion fracture of the palmaromedial and proximal aspect of the left middle phalanx, with a cystic like lesion on the medial aspect of distal first phalanx and proximal middle phalanx were diagnosed. Given the poor prognosis, the foal was subjected to euthanasia. Post mortem examination confirmed the absence of the metacarpophalangeal joint space with a trabecular bony union between the third metacarpal bone and the first phalanx. A rudimentary joint capsule was present at the level of the absent joints as well as a small zone of articular cartilage, which invaginated over a short distance into the dorsal trabecular bone on the right front limb. On the medial aspect of the left proximal interphalangeal joint, a focal defect of articular cartilage with exposure of subchondral bone was observed. This is the first case report of a foal born with congenital aplasia of both metacarpophalangeal joints. Congenital malformations should be considered as differential diagnosis in lame foals or foals born with angular or flexural limb deformities.     

A XERORADIOGRAPHIC STUDY OF THE DEVELOPING QUARTERHORSE FOREDIGIT AND METACARPOPHALANGEAL REGION FROM SIX TO TWELVE MONTHS OF AGE

The purpose of the project was to provide a reference for radiographic anatomy of the developing equine foredigit and metacarpophalangeal region. Using xeroradiographic techniques, both foredigits and metacarpophalangeal regions of six Quarter Horse foals were radiographed at 1 day of age and then at 2-week intervals until the foals were 6 weeks old. The foals were then radiographed at 4-week intervals until they were 12 months old. The period from birth to 6 months has been described in a previous report. This paper deals with the period from 6 to 12 months of age. Lateromedial and dorsopalmar xeroradiographs of each foredigit and metacarpophalangeal region and a dorsal 65° proximal-palmarodistal oblique view of the distal part of the digit were made at each examination. Foals were weighed and were measured at the withers immediately prior to each examination. Representative xeroradiographs were selected and appropriately labeled to demonstrate normal radiographic anatomy of these regions. Earliest radiographic visualization of distal epiphyseal ossification in metacarpal 2 and metacarpal 4 was extremely variable and ranged from 4 to 38 weeks. It was not possible to determine accurately the ages at which distal physes of the small metacarpal bones closed. In one foal, three of four of these physes were closed at 26 weeks, while in another foal, none had closed when last radiographed at 54 weeks. Radiographic closure of the proximal physis of the middle phalanx ranged from 18 to 30 weeks (mean = 26 weeks). Radiographic closure of the proximal physis of the proximal phalanx ranged from 22 to 38 weeks (mean = 30 weeks). Radiographic closure of the distal physis of metacarpal 3 ranged from 18 to 38 weeks (mean = 29 weeks).     

Transphyseal vessel involvement in repair of metaphyseal retained cartilage

SUMMARY A foal with retained cartilage in the distal metaphysis of the right and left radii and third metacarpal bones had abnormal physeal vasculature. In areas where cartilage was retained, vessels crossed the physis, and branched at the physeal-metaphyseal junction or at the site of retained cartilage. Vessels appeared to be involved in re-initiation of endochondral ossification and in the repair reponse to the presence of retained cartilage. In areas where the physis was radiographically and histologically normal, no vessels crossed the physis. A function of transphyseal vessels may be as a reserve blood supply in areas of metaphyseal abnormality, at a stage of maturity when metaphyseal vessels are not well developed.     

Complex stifle injury in a foal

A 130 kg, 60-day-old Quarter Horse male foal presented with bilateral stifle effusion and severe left hindlimb lameness. Clinical examination and imaging including radiography, ultrasound and computed tomography revealed bilateral stifle trauma. Specifically, disruption of the left medial meniscus and deep bone injury to the left medial femoral condyle (MFC) were detected, and bilateral injury to the origin of the cranial cruciate ligaments was suspected. Treatment consisted of stall rest and joint injection with corticosteroids, however there was little improvement in lameness. Due to the poor prognosis for soundness, the foal was subject to euthanasia 10 weeks after initial presentation. Post-mortem examination supported the left medial meniscus and MFC injuries and revealed avulsions of the origin of the cranial cruciate ligaments (complete on the left and partial on the right) from the lateral femoral condyle. Histopathology of the left stifle joint revealed varying depths of MFC osteochondral injury and severe left medial meniscus damage.     

Fixation of a complete scapular neck fracture in a foal using two 3.5 mm locking compression plates

This report describes the successful surgical repair of a transverse, displaced scapula fracture in a foal. A 3.5 mm locking compression plate (LCP) was used on either side of the spine of the scapula. The suprascapular nerve was apparent upon dissection as it passed directly over the fracture line and care was taken to leave it intact, although the fracture line itself caused some irritation. The foal recovered without long‐term nerve damage and is sound at 1.5 years post surgery.     

Ulnar osteotomy for treatment of cubital subluxation,following locking compression plate osteosynthesis of a radius fracture in a foal

A closed mid‐diaphyseal fracture in a one‐day‐old foal was treated using a 3.5 mm locking compression plate on the cranial aspect of the radius. The foal showed good fracture healing, but a radio‐ulnar synostosis developed despite the absence of transfixation by any implant into the ulna. Four months after surgery the radiographs revealed a cubital subluxation, which was managed by an osteotomy of the ulna at the time of plate removal, allowing the ulna to adjust into a normal position. One year after surgery the foal was clinically sound; the radiographs showed good healing of the osteotomy gap as well as good remodelling of the radius; however, a slight elbow subluxation was present.     

Closed reduction and blind cross-pinning for repair of a proximal tibial fracture in a foal

A 4-day-old foal underwent repair of a proximal metaphyseal fracture of the tibia. After closed reduction, fixation was achieved by use of blind cross-pinning. Thirty-five days after surgery, radiography demonstrated complete healing. The foal was mildly lame 4 months after repair of the fracture. Blind cross-pinning may be considered as a method of repair for certain long bone fractures in small foals.