A comparison of subjective and quantitative methods for detection of physitis in Thoroughbred foals

AIM: To compare subjective and quantitative methods of assessing physeal swelling of the distal third metacarpal (Mc3) and metatarsal (Mt3) bones of Thoroughbred foals. METHODS: The fetlocks of 16 Thoroughbred foals were filmed on five occasions over a period of 5 months and the video images were transferred to computer and digitised. The rate of change of each of the medial and lateral contours of the distal Mc3 and Mt3 bones was determined by calculating values for the second derivative of the contour. The degree of physeal swelling at the same site was subjectively assessed and allocated a grade based on an ordinal scale of severity. The maximum value for the second derivative was compared with the grade of physeal swelling. RESULTS: The second derivative values for sites with slight to distinct physeal swelling (Grade >/=1.5) were significantly higher (p=0.001) than the second derivative values for sites with no apparent physeal swelling (Grade 0). CONCLUSION: This finding indicates that the value of the second derivative of the contour of a limb has potential as a diagnostic tool for quantitative detection of physitis.     

Physeal form of the longbones of the foal

The possible relationship between physeal diseases and physeal form prompted investigation of change in steepness of the physis in young foals. The distal and proximal aspects of the longbones were sawn sagittally in the right and frontally in the left bones. The slabs were washed to remove saw debris, arranged in order and inspected. The proximal physes had a flat or gently arched form, without obvious inclination. In the distal physes there were distinct inclinations. Inspection of an identical slab from the medial aspect of the distal radius of two series of foals of different breeds showed that the degree of inclination of the physis with respect to the long axis of the bone increased with age. In a further series of foals, the angle of inclination was measured from radiographs of identical sagittal and frontal slabs of the distal radius. A line drawn through the secondary spongiosa was produced to intersect a line drawn along the physis where it was mostly steeply inclined, and the angle measured. The angle decreased (physeal inclination increased) with increasing age, up to 35–90 days. The steepness in the lateral aspect of the physis was similar to that in the medial aspect, although evident in a different plane.     

Articular/epiphyseal osteochondrosis in Thoroughbred foals at 5 months of age: Influences of growth of the foal and prenatal copper supplementation of the dam

AIMS: To determine the influence of copper (Cu) supplementation by injection of mares in late gestation on the frequency and severity of osteochondrosis (OC) lesions in their foals at around 160 days of age. To determine if there was any influence of the concentration of Cu in the liver, growth rate, birthweight, weight at 160 days of age, fatness, sex, or year of birth of the foal on the frequency and severity of OC lesions. To determine the influence of dam's age, and sex and birthweight of the foal on the growth rate from birth to 160 days of age, and weight at 160 days of age.

METHODS: Thirty-three Thoroughbred foals, born in two consecutive years, were weighed every 2 weeks from birth. The dams had been supplemented with parenteral Cu or saline during late gestation, and the supplementation regimens were different in each year. Foals had liver biopsies harvested at birth for determination of Cu concentration. Pasture samples were collected every 4–8 weeks for analysis of concentration of Cu and zinc (Zn). At 160 days of age, articular cartilage of long bones was examined. Gross lesions were counted and scored, then sawn and radiographed, and processed for histopathology. Lesions were given radiographic scores and histopathological scores. Maximum scores for each lesion were combined to give a total OC score for each joint and each foal. The fatness of 20 foals (10 each from Years 1 and 2) at 160 days of age was determined chemically.

RESULTS: Supplementation of dams with Cu had no significant effect on the concentration of Cu in the liver of foals at birth, or on the frequency or severity of lesions in articular cartilage at 160 days of age. The Cu and Zn concentrations of pasture were similar in Years 1 and 2, and were lower than current recommendations. All foals in Year 2, and 9/10 foals in Year 1 had irregularities in cartilage that was confirmed histologically to be indicative of OC. The average number of lesions per foal was 4.7 (SD 1.1) and 5.7 (SD 1.1) in Years 1 and 2, respectively. However, the severity of the lesions was considered mild, and no foals showed any clinical evidence of OC while alive. The number of lesions in the tarsocrural (TC) joint and the TC OC score at 160 days were positively associated with average daily weight gain (ADG) in the previous 4 weeks (p=0.005 and p=0.001, respectively). There was no significant effect of sex, fatness, birth-weight, weight at 160 days of age, or year of birth of the foal on the frequency and severity of OC lesions.

CONCLUSIONS: Many of the lesions classified as OC, using classification systems described by other authors, were likely to be normal variations of the process of endochondral ossification. Despite the high frequency of such lesions, they were considered to be of minor significance and none were clinically evident. The distribution of lesions was not typical, and most probably reflected the subtlety of the lesions. These results support the hypothesis that Cu is an over-emphasised factor in the aetiopathogenesis of OC. The relationship between subtle macroscopic lesions and lesions resulting in clinical signs of disease requires further investigation.     

Articular / epiphyseal osteochondrosis in Thoroughbred foals at 5 months of age: influences of growth of the foal and prenatal copper supplementation of the dam

AIMS: To determine the influence of copper (Cu) supplementation by injection of mares in late gestation on the frequency and severity of osteochondrosis (OC) lesions in their foals at around 160 days of age. To determine if there was any influence of the concentration of Cu in the liver, growth rate, birthweight, weight at 160 days of age, fatness, sex, or year of birth of the foal on the frequency and severity of OC lesions. To determine the influence of dam's age, and sex and birthweight of the foal on the growth rate from birth to 160 days of age, and weight at 160 days of age. METHODS: Thirty-three Thoroughbred foals, born in two consecutive years, were weighed every 2 weeks from birth. The dams had been supplemented with parenteral Cu or saline during late gestation, and the supplementation regimens were different in each year. Foals had liver biopsies harvested at birth for determination of Cu concentration. Pasture samples were collected every 4-8 weeks for analysis of concentration of Cu and zinc (Zn). At 160 days of age, articular cartilage of long bones was examined. Gross lesions were counted and scored, then sawn and radiographed, and processed for histopathology. Lesions were given radiographic scores and histopathological scores. Maximum scores for each lesion were combined to give a total OC score for each joint and each foal. The fatness of 20 foals (10 each from Years 1 and 2) at 160 days of age was determined chemically. RESULTS: Supplementation of dams with Cu had no significant effect on the concentration of Cu in the liver of foals at birth, or on the frequency or severity of lesions in articular cartilage at 160 days of age. The Cu and Zn concentrations of pasture were similar in Years 1 and 2, and were lower than current recommendations. All foals in Year 2, and 9/10 foals in Year 1 had irregularities in cartilage that was confirmed histologically to be indicative of OC. The average number of lesions per foal was 4.7 (SD 1.1) and 5.7 (SD 1.1) in Years 1 and 2, respectively. However, the severity of the lesions was considered mild, and no foals showed any clinical evidence of OC while alive. The number of lesions in the tarsocrural (TC) joint and the TC OC score at 160 days were positively associated with average daily weight gain (ADG) in the previous 4 weeks (p=0.005 and p=0.001, respectively). There was no significant effect of sex, fatness, birthweight, weight at 160 days of age, or year of birth of the foal on the frequency and severity of OC lesions. CONCLUSIONS: Many of the lesions classified as OC, using classification systems described by other authors, were likely to be normal variations of the process of endochondral ossification. Despite the high frequency of such lesions, they were considered to be of minor significance and none were clinically evident. The distribution of lesions was not typical, and most probably reflected the subtlety of the lesions. These results support the hypothesis that Cu is an over-emphasised factor in the aetiopathogenesis of OC. The relationship between subtle macroscopic lesions and lesions resulting in clinical signs of disease requires further investigation.     

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.     

Severe bilateral physitis with instability and Salter‐Harris type 1 fractures in two foals

This Case Report describes the clinical, radiographic, computed tomographic and post mortem findings in 2 foals with severe bilateral physitis of the distal third metatarsal bones (MtIII). The foals were admitted because of bilateral hindlimb lameness of several weeks' duration. Initial examination revealed that the physeal regions of the distal MtIII were enlarged, warmer than normal and painful on palpation. Case 1 was treated conservatively and discharged but was readmitted 8 weeks later because of clinical deterioration. In both foals, radiographs showed plantar dislocation of both epiphyses through the physis and a Salter‐Harris type 1 fracture. The foals were subjected to euthanasia and a post mortem examination.     

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.     

A XERORADIOGRAPHIC STUDY OF THE DEVELOPING EQUINE FOREDIGIT AND METACARPOPHALANGEAL REGION FROM BIRTH TO SIX 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 meta-carpophalangeal regions of six Quarter Horse foals were radiographed at one day of age and at two-week intervals until the foals were six weeks old. The foals were then radiographed at four-week intervals until they were 12 months old. This report deals specifically with the first six months of postnatal development. 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 for each examination. The foals were weighed and measured at the withers immediately prior to each examination. Representative xeroradiographs were selected and appropriately labeled to demonstrate normal radio-graphic anatomy of these regions. First radiographic appearance of distal epiphyseal ossification in metacarpal 2 and metacarpal 4 was extremely variable and ranged from four to 38 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). When xeroradiographic physeal closure times were compared with scintigraphic closure times from a companion study, results correlated very well. A crena marginis solearis was observed in ten of 12 forelimbs (83.3%); its first radiographic appearance ranged from four to 22 weeks (mean = 11–12 weeks). A consistent groove in the hoof wall, which formed near the time of birth and moved distally at about 3 mm per week, was noted. The groove's distance from the proximal hoof border may be useful in age estimation of foals less than 18–20 weeks old.     

Asynchronous Growth of the Canine Radius and Ulna: Surgical Correction following Experimental Premature Closure of the Distal Radial Physis

Marked lameness and elbow incongruity occurred in seven 21-week-old dogs following experimental premature closure of the distal radial physis at 10 weeks of age. Midradial transverse osteotomies and bone plate stabilization performed on five dogs resulted in marked reduction of elbow incongruity and forelimb lameness. Two dogs had no surgery and served as controls for the surgical procedure. At 50 weeks of age the proximal radial articular surface was displaced 5.3 mm farther from the coronoid process in control dogs as compared to dogs having transverse radial osteotomy. Markedly worse clinical, radiographic, and pathologic changes in the control group demonstrated the importance of reestablishing and preserving elbow congruity when treating asynchronous growth of the canine forelimb caused by premature closure of the distal radial physis. The technique described is recommended as one method to treat premature distal radial physeal closure clinically.     

Premature Closure of the Distal Radial Physis in the Dog A Review of Eleven Cases

Premature distal radial physeal closure, while not as commonly diagnosed as premature closure of the distal ulnar physis, presented a surgical problem in the 11 cases reviewed. The diagnosis was suggested by clinical signs including lameness, angular deformity of the forelimb, pain, crepitation, and limited range of motion in the elbow. Radiographic examination confirmed the diagnosis. Surgical treatment depended on the abnormalities present. Two animals with growth potential were treated by resecting the restricting physeal bone bridge and placing an autogenous fat graft in the defect. Corrective osteotomy procedures for seven animals with total closure of the physis were directed toward re-establishing functional elbow anatomy by radial osteotomy or correcting angular limb deformity with an oblique radial osteotomy. Two animals did not receive treatment. Surgical treatment resulted in improved use of the forelimb.     

Cryosurgical Epiphysiodesis in the Dog

Transphyseal freezing of the canine distal femur was evaluated to determine its effect on physeal growth and closure. A specially designed cryoprobe was used to freeze the distal right femoral physis in 17 immature dogs. The left distal femoral physis was sham operated to serve as a control. Dogs were radiographed weekly and euthanized from 2 days to 8 weeks following surgery. The rate of long bone growth decreased in all dogs, and the physis was closed at 6 to 8 weeks.
Histologic studies on the distal femoral physes revealed that immediately after freezing, there was extensive hemorrhage in the epiphysis and metaphysis with disruption of the physis. Inflammation and death of the physeal cartilage followed. Blood vessels invaded the physis, and eventually bone was formed between the epiphysis and metaphysis, resulting in complete and premature physeal closure.     

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).     

Septic osteitis of the distal phalanx in foals: 22 cases (1995-2002)

OBJECTIVE: To determine the clinical characteristics and outcome of foals with septic osteitis of the distal phalanx. DESIGN: Retrospective case series. ANIMALS: 22 foals. PROCEDURES: Information obtained from medical records included signalment; clinical, laboratory, and radiographic findings; treatment method; and outcome. Foals included in the study had lameness referable to the foot, radiographic evidence of localized lysis or focal loss of bone density of the distal phalanx, and suppurative discharge or necrosis of the affected bone evident at surgery. Foals with a history or evidence of penetrating wounds or subsolar abscessation were excluded. RESULTS: Mean age of foals at initial evaluation was 40.8 days (range, 3 to 122 days). Twenty-one (95%) foals had lameness as the primary complaint. Lesions consistent with septic osteitis of the distal phalanx localized to specific areas of the bone on the basis of radiographic and surgical findings were located on the solar margin or toe (14/22 [64%]), extensor process (5/22 [23%]), and palmar or plantar process (3/22 [13%]). Hind limbs (18/26 [69%] affected limbs) were more frequently affected. Two foals had > 1 affected limb, 2 had additional sites of osteomyelitis, and 4 had concurrent septic arthritis. Surgical debridement and regional antimicrobial perfusion were performed during general anesthesia. Extensor process lesions were not debrided. Nineteen of 22 (86%) foals survived to be discharged from hospital, and 16 horses reached racing age. Eleven of 16 had race starts, of which 8 had official race starts and 3 had unofficial race starts. CONCLUSIONS AND CLINICAL RELEVANCE: Septic osteitis of the distal phalanx should be considered as a source of lameness in foals with signs referable to the foot and does not necessarily preclude a career in racing. Although infection may occur secondary to bacterial penetration of the hoof or sole, the distal phalanx should also be considered as a potential site for hematogenous septic arthritis or osteomyelitis in foals.     

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.     

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.     

Exostoses of the caudal perimeter of the radial physis as a cause of carpal synovial sheath tenosynovitis and lameness in horses: 10 cases (1999-2003)

OBJECTIVE: To determine the clinical, radiographic, ultrasonographic, and arthroscopic findings associated with tenosynovitis of the carpal synovial sheath induced by exostoses that originate from the caudal surface of the physeal scar of the distal radius and determine the results of surgical removal of those exostoses in horses. DESIGN: Retrospective study. ANIMALS: 10 horses. PROCEDURE: Medical records of horses with effusion in the carpal synovial sheath and lameness evaluated from 1999 to 2003 were examined. RESULTS: All horses had a history of intermittent mild to moderate effusion of the carpal synovial sheath and lameness of 1 forelimb. Results of regional perineural and intrathecal anesthesia of the carpal synovial sheath confirmed that the lameness originated in the carpal synovial sheath. Radiography revealed exostoses originating from the caudal cortex of the distal radius at the level of the closed physis. Arthroscopy was performed for confirmation and removal of exostoses that penetrated the carpal synovial sheath and impinged on the deep digital flexor tendon. All horses returned to previous athletic activity. One horse had a recurrence of clinical signs 12 months after surgery, which resolved with medical treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Tenosynovitis of the carpal synovial sheath and lameness were caused by impingement of exostoses of the caudal radius on the lining and contents of the carpal synovial sheath. Although the clinical signs and surgical treatment were similar to that caused by osteochondromas, these exostoses developed at the level of the closed physis of the distal radius and were not radiographically or histologically similar to osteochondromas.     

Osteochondrosis and copper: histology of articular cartilage from foals out of copper supplemented and non-supplemented dams

Copper (Cu) supplementation of dams in late gestation may be protective against articular cartilage abnormalities in foals. Articular cartilage was harvested from 22 Thoroughbred foals at 160 days of age, at sites predisposed to osteochondrosis (OC), and examined for evidence of early cartilage abnormalities and established dyschondroplastic (DCP) lesions to determine if there were any significant differences due to mare Cu supplementation by injection during late gestation, or foal liver Cu concentration. Cu supplemented mares received calcium Cu edetate injections in late gestation (250 mg at around 220, 248, 276 and 304 days gestation, then every two weeks until foaling). Foals were euthanased at 160 days of age and articular cartilage was harvested from four defined sites. Samples were examined for histological appearance of chondrocytes after staining with haematoxylin and eosin, and were also stained with toluidine blue to indicate proteoglycan content. Alkaline phosphatase (ALP) activity was detected by histochemistry, and histocytochemical techniques were used to determine the expression of cathepsin B. Cu supplementation of the dam, or liver Cu concentration of the foal at birth or 160 days of age had no statistically significant effect on the frequency of cartilage irregularities observed grossly, or abnormalities detected histologically at four defined sites. ALP expression was similar in all samples. Cathepsin B expression varied between sites, and was seen in chondrocyte clusters. The intensity of toludine blue staining varied between sites. Minor histological cartilage abnormalities were observed in cartilage from clinically normal animals. These abnormalities might be 'early' dyschondroplastic lesions, which could resolve or progress. The role of Cu in the development, resolution or progression of dyschondroplastic lesions is poorly understood.     

Radius fractures in the horse: a retrospective study of 47 cases

The case records, radiographs and treatment results of 47 consecutive equine radius fractures presented to The Ohio State University Veterinary Hospital from 1975 to 1985 were examined retrospectively. Chip fractures and incomplete fractures were not considered. Both diaphyseal fractures and fractures involving the physes were included. Diaphyseal fractures were placed into three major categories: comminuted, oblique and transverse; and subclassified as proximal, mid-diaphyseal, or distal. Fractures involving a physis were classified using the Salter-Harris classification system. The horses ranged in age from one day to 19 years old. Nineteen of the patients were destroyed humanely on presentation, and 28 were treated. Twenty-four of the 28 fractures treated were repaired by open reduction and internal fixation. Success rate was related to the age of the horse and the type of fracture. Adult radius fractures have a poor prognosis. Most fractures in foals are either physeal fractures or transverse or oblique diaphyseal fractures and have an excellent to good prognosis when repaired adequately.