Desmotomy of the accessory ligament of the deep digital flexor tendon in the forelimb of 24 horses 2 years and older

Objective: To report outcome after desmotomy of the accessory ligament of the deep digital flexor tendon (ALDDFT) in adult horses (≥2 years) for treatment of desmitis of the ALDDFT or flexural deformity of the distal interphalangeal joint (FDDIJ). Study Design: Case series. Animals: Horses with desmitis of the ALDDFT (n=9) and FDDIJ (n=15). Methods: Records (April 1996–July 2008) of 24 adult horses (mean age, 6.7 years) that had ALDDFT desmotomy were reviewed. Follow‐up data was obtained 12–120 months after desmotomy. Results: Outcome was available for 22 horses; 18 (82%; 6 of 8 horses with desmitis of the ALDDFT and 12 of 14 with FDDIJ) returned to their intended use within 6–24 months (mean, 12 months). Conclusion: In mature horses, ALDDFT desmotomy resulted in successful return to intended use in most horses with ALDDFT desmitis (75%) or FDDIJ (86%).     

Acquired flexural deformity of the distalinterphalangeal joint in horses: Treatment by desmotomy of the accessory ligament of the deep digital flexor tendon: A retrospective study

Hospital records of 29 horses treated by desmotomy ofthe accessory ligament of the deep digital flexor tendon for correction of acquired flexural deformity of the distal interphalangeal joint in one or both forelimbs were reviewed and evaluated retrospectively. Information on correction of the deformity, cosmetic appearance of the surgery site, and current use of the horses was obtained by interviews with the owners.At the time of surgery, 27 horses were less than one year old and two horses were more than one year old. Eleven months to five years after surgery, 26 horses had normal appearance of the hoof and limb, and 26 horses had acceptable cosmetic appearance of the surgery site due to no or minimal scarring. At the time of interview, all but two of the 11 horses more than three years old were in full training.It is concluded that desmotomy of the accessory ligament of the deep digital flexor tendon is an effective and cosmetically acceptable treatment for acquired flexural deformity of the distal interphalangeal joint in the horse.     

Arthroscopically assisted arthrodesis of the distal interphalangeal joint with transarticular screws inserted through a dorsal hoof wall approach in a horse

CASE DESCRIPTION: A 16-year-old Thoroughbred gelding was examined because of chronic right forelimb lameness. CLINICAL FINDINGS: On radiographs of the right front foot, the distal interphalangeal (DIP) joint space was narrow, and osteophytes and periarticular bony proliferation indicative of severe osteoarthritis were seen. Arthrodesis of the right DIP joint was recommended to improve the horse's comfort on the limb. TREATMENT AND OUTCOME: The horse was anesthetized, and palmar and dorsal arthroscopic approaches were used to remove as much of the articular cartilage as was accessible. Holes were then drilled through the dorsal aspect of the hoof wall, and 3 transarticular, 5.5-mm cortical screws were placed in lag fashion through these holes across the distal phalanx and into the middle phalanx. Defects in the hoof wall were filled with gentamicin-impregnated polymethyl methacrylate plugs and sealed with cyanoacrylate. Eight months after surgery, fusion of the DIP joint was evident radiographically and the horse was sound at a walk. CLINICAL RELEVANCE: Transarticular placement of cortical screws through a dorsal hoof wall approach combined with arthroscopically guided cartilage removal can result in fusion of the DIP joint in horses.     

Two clinical manifestations of desmopathy of the accessory ligament of the deep digital flexor tendon in the hindlimb of 23 horses

REASONS FOR PERFORMING STUDY: Desmopathy of the accessory ligament of the deep digital flexor tendon (ALDDFT) in the hindlimb is an unusual cause of lameness in horses, and reports of the condition are sparse. OBJECTIVES: To describe the clinical and ultrasonographic findings, therapy and outcome of 23 horses treated for desmopathy of the ALDDFT in the hindlimb. METHODS: Records of 23 horses with ultrasonographic evidence of desmopathy of the ALDDFT in one or both hindlimbs from 3 referral centres were reviewed retrospectively. Age, breed, sex, duration and nature of clinical signs, results of clinical and lameness examinations, treatment and outcome were recorded. RESULTS: In 13 horses (Group A), there was an acute onset of unilateral lameness. Ten horses (Group B) had an insidious or sudden onset of postural abnormality. There were 10 cobs, 5 British native-breed ponies and 8 horses of various larger breeds. Twenty horses were used for general purposes, and mean age was 12 years. Enlargement of the ALDDFT in the affected hindlimb(s) was identified in all horses. In 44% of horses, ultrasonographic abnormalities were localised to part of the ALDDFT. Treatment included box-rest and controlled exercise, and 10 horses were subjected to desmotomy or desmectomy of the ALDDFT. Seventy-three percent of horses in Group A returned to full function, while 90% of those in Group B remained lame. CONCLUSIONS: Two distinct clinical conditions are associated with the ALDDFT of the hindlimb. Traumatically induced injury resulting in acute onset lameness appears to have a favourable prognosis, with most horses returning to previous work. However, postural changes, once present, are irreversible and indicate a poor prognosis. POTENTIAL RELEVANCE: Desmopathy of the ALDDFT should be recognised as a potential cause of hindlimb lameness and this study provides clinical and prognostic information. Knuckling and/or semiflexion of the metatarsophalangeal joint may accompany the condition; therefore, if a horse is presented with a flexural deformity of this joint, desmopathy of the ALDDFT should be considered as a primary differential diagnosis.     

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.     

Active tension‐extension splints: A novel technique for management of congenital flexural deformities affecting the distal limb in the foal

A variety of methods are described for managing distal limb flexural deformities in the foal, including intravenous oxytetracycline and splint or cast use. This case series describes a novel technique that creates an ‘active tension‐extension splint’ by wiring the toe into a custom‐made fibreglass splint and therefore into active extension. A dorsal fibreglass splint is made by halving a cast that is set around the affected leg with padding underneath it, so that it is sculpted to a more appropriate anatomical shape. Cerclage wire is placed through the toe and the dorsal aspect of the splint, then tightened to pull the limb into active extension. Foals with distal limb flexural deformities that were treated in this way were followed up by examination of hospital records and telephone questionnaire. Records were examined for 13 foals treated between 2004 and 2010. One foal developed septic osteitis of the distal phalanx due to suspected laminar penetration; other post operative complications seen were bandage sores and minor cosmetic scarring. Out of 10 foals where follow‐up by questionnaire was available, 8 had complete resolution of their deformity following active tension‐extension splinting, one required inferior check ligament desmotomy for complete correction and one had carpal flexural deformities that did not resolve. All that survived to adulthood are sound and have achieved their intended purpose. This previously unpublished technique using a wire through the toe to create an active tension‐extension splint has a high success rate for correction of congenital flexural deformities affecting the distal interphalangeal and metacarpo‐/metatarsophalangeal joints in the foal. The majority of post operative complications are minor and easily managed. This is a simple technique that can improve the management of neonatal distal limb deformities both in a hospital situation and for equine practitioners in the field.     

An investigation of the relationships between angles and shapes of the hoof capsule and the distal phalanx

Reasons for performing study: There is little scientific evidence to support the premise that poor foot conformation predisposes to foot pain and lameness. Objectives: To determine relationships between external characteristics of the hoof capsule and angles of the distal phalanx; to determine variability in shape of the distal phalanx; and to investigate association between distal phalanx angles and the injury causing lameness. Materials and methods: Feet were documented photographically and radiographically. Linear and angle measurements were obtained for the hoof capsule and distal phalanx and compared statistically. Horses were categorised according to injury group, and angles and linear ratios were compared between groups. Results: There was modest correlation between hoof wall and heel angles and angles of the distal phalanx. There was variation in shape of the distal phalanx. There was no significant association between injury type and angles of the distal phalanx, although there was a trend for the angle of the dorsal aspect of the distal phalanx with the horizontal to be smaller in horses with injuries of the podotrochlear apparatus or deep digital flexor tendon compared with other groups. Conclusions: There are variations in shape of the distal phalanx largely due to differences in orientation of the concave solar border and the solar border to the horizontal. Variations in shape of the distal phalanx were not accurately correlated with external characteristics of the hoof capsule. There were weak associations between injury groups and angles of the distal phalanx. Clinical relevance: Further work is required to elucidate risk factors for foot‐related lameness.     

Lag screw fixation of an extensor process fracture in a foal with flexural deformity.

A 4-month-old colt with stage I flexural deformity of the distal interphalangeal joint was diagnosed as having a type IV nondisplaced fracture of the extensor process of the 3rd phalanx. An inferior check ligament desmotomy and internal fixation of the fracture were performed. Favorable long-term results for internal fixation of extensor process fractures are presented.     

A singular case of traumatic total hoof capsule avulsion

Total, full thickness hoof wall avulsion is rare in horses. Sometimes complications such as fracture of the distal phalanx, osteomyelitis, septic arthritis and degenerative joint disease have been reported. Limiting motion at the affected site and hoof stabilisation are essential to obtain a good hoof regeneration. This case report reviews the clinical features including diagnostic techniques (radiographic examination and venography) of a Quarter Horse filly presented with a complete and full‐thickness traumatic hoof capsule avulsion complicated by an open fracture of the third phalanx. A transfixation casting technique was performed followed after one month by 2 short limb casts applied for 2 months each. Twenty‐four months after trauma the foot had completely regrown. The dorsal aspect of the hoof wall appears to be remarkably shorter compared to the heels. From a radiographic viewpoint, the lateral aspect of the left hind foot shows diffuse bone remodelling and a deformed distal phalanx.     

Arthrodesis of the Distal Interphalangeal Joint in Two Horses Using Three Parallel 5.5-mm Cortical Screws

The distal interphalangeal joint was successfully arthrodesed in two horses using three parallel 5.5-mm cortical screws and an autogenous cancellous bone graft. The screws were directed from the palmar proximal border of the second phalanx dorso-distally across the joint space and into the third phalanx. The technique was first developed on a normal horse. The second horse, a clinical case, ruptured its deep digital flexor tendon with complete luxation of the distal interphalangeal joint. Bony fusion of the distal interphalangeal joint occurred in both horses, but both also had residual lameness at a walk. Twenty-one months after the arthrodesis procedure, the clinical patient died from complications related to a subsolar abscess in the operated limb.     

Osteochondral fragmentation of the distal aspect of the patella in horses

A condition characterised by osteochondral fragmentation of the distal aspect of the patella in 15 horses is described. The problem was unilateral in six horses and bilateral in nine. There were eight Quarterhorses, three Thoroughbreds, two American Saddlebreds, one American Paint and one Warmblood-Thoroughbred cross. A previous medial patellar desmotomy had been performed on 12 of the 15 horses. The condition manifested as hindlimb lameness and stiffness ranging from mild to severe. There was fibrous thickening in the stifle area in the 12 cases with a previous medial patellar desmotomy, and synovial effusion in seven of 12 cases. Synovial effusion was present in two of the three cases in which a previous medial patellar desmotomy was not performed. The radiographic changes included bony fragmentation, spurring (with or without an associated subchondral defect), subchondral roughening and subchondral lysis of the distal aspect of the patella. All horses were treated with arthroscopic surgery. The lesions at arthroscopy varied from flaking, fissuring, undermining or fragmentation of the articular cartilage to fragmentation or lysis of the bone at the distal aspect of the patella. The subchondral bone was involved in all cases that had a previous medial patellar desmotomy. Of the 12 horses that had a previous medial patellar desmotomy, eight became sound at their intended use, one was sold in training without problems, one is in early training without problems, one never improved and one is in convalescence. Of the three that did not have a patellar desmotomy, two performed their intended use well but one was unsatisfactory.     

Arthroscopic Approach and Intra-articular Anatomy of the Palmaroproximal or Plantaroproximal Aspect of Distal Interphalangeal Joints

An arthroscopic approach to the palmaroproximal or plantaroproximal pouch of the distal interphalangeal joint was developed in six cadaver limbs and seven limbs of three clinically normal horses. The dorsal aspect of the proximal border and the proximal articular margin of the distal sesamoid (navicular) bone, the palmar aspect of the distal articular margin of the middle phalanx, the collateral sesamoidean ligaments of the distal sesamoid bone, and the joint capsule attachments were readily accessible. Distending the joints with fluid gave access to portions of the articular surface between the distal sesamoid bone and the middle phalanx in all joints, and to a small portion of the distal phalanx in two hind distal interphalangeal joints. Two horses allowed to recover from anesthesia were not lame on days 30 and 37, respectively. Problems encountered initially were difficulty entering the joint, hemarthrosis, and minimal iatrogenic cartilage damage.     

Osseous cyst‐like lesions in the feet of lame horses: Diagnosis by standing low‐field magnetic resonance imaging

Osseous cyst‐like lesions (OCLLs) were diagnosed by standing low‐field magnetic resonance (MR) imaging in 9 mature horses (age range 6–17 years). All horses had been subjected to a routine lameness evaluation (including standard foot radiographs) with no diagnosis being reached prior to MR imaging. The duration of lameness ranged from one month to one year. OCLLs were diagnosed in 12 feet. The site of the lesions included the distal phalanx in 11 feet (subchondral bone in 4, insertion of collateral ligaments of the distal interphalangeal joint in 4, insertion of the distal sesamoidean impar ligament in 3) and the subchondral bone of the distal aspect of the middle phalanx in one foot. OCLLs were characterised by discrete spherical or elliptical areas of high or intermediate signal in all MR sequences. In most cases the lesion was surrounded by a rim of bone with abnormally low signal.     

Long‐Term Outcome after Arthroscopic Debridement of Distal Phalanx Extensor Process Fragmentation in 13 Horses

Objective— To report long-term outcome after arthroscopic removal of fragmentation of the extensor process of the distal phalanx in horses.
Study Design— Case series.
Animals— Adult horses (n=13).
Methods— Medical records (2003–2004) of horses that had arthroscopic debridement of fragmentation of the extensor process of the distal phalanx were reviewed. Inclusion criteria included: lameness localized to the foot, fragmentation of the extensor process of the distal phalanx debrided arthroscopically, and a follow-up period of ≥4 years.
Results— Of the 13 horses, lameness was resolved in 11 (85%) initially but distal interphalangeal joint pain recurred in 2 (15%) within 1 year of surgery. Three (23%) other horses were retired because of lameness at other sites during the follow-up period resulting in 46% (6/13) being not lame and in full work after 4 years. Substantial changes were identified at surgery in the contralateral joint of 7 horses, even when fragments were only present unilaterally.
Conclusions— Arthroscopic debridement of fragmentation of the extensor process of the forelimb distal phalanx has a good short-term prognosis for resolution of lameness and return to work but a more guarded prognosis for long-term soundness.
Clinical Relevance— These results allow for more accurate prognostication preoperatively and may support early debridement of fragmentation of the extensor process of the distal phalanx.     

Digital semiological anesthesia in horses: technique and elements of interpretation

Digital semiological anesthesia in horses: Technique and elements of interpretation. Semiological anesthesia of the pes is used during examinations for lameness in horses. Recent research data on the distal digital, distal interphalangeal articular, and podotrochlear intrathecal nerve blocks indicate that they are less than specific when considered in isolation. They should be used in combination to localize pain in the pes. A positive response to anesthesia of the distal interphalangeal articulation could also indicate that the source of the pain was in the podotrochlear apparatus or the dorsal part of the sole. Podotrochlear anesthesia also anesthetizes the dorsal part of the sole and, later, the distal interphalangeal joint. Distal digital anesthesia affects a large palmar area of the hoof and extends dorsally. Overall, basic research provides little support for the practical uses of semiological blocks.     

Osteochondral fragments involving the dorsomedial aspect of the proximal interphalangeal joint in young horses: 6 cases (1997-2006)

OBJECTIVE: To determine clinical and diagnostic imaging findings in young horses with osteochondral fragments involving the dorsomedial aspect of the proximal interphalangeal (PIP) joint. DESIGN: Retrospective case series. ANIMALS: 6 horses. PROCEDURES: Medical records were reviewed. Follow-up information was obtained through telephone conversations with owners or trainers or by examining race records. RESULTS: Horses were between 1 and 4 years old. Three had bilateral osteochondral fragments in the forelimbs (n = 2 horses) or hind limbs (1). Radiographically, all but 1 fragment seemed to originate from the dorsomedial aspect of the distal end of the first phalanx. Fragment size ranged from 6 x 9 mm to 11 x 21 mm. Three horses had lameness referable to the region of the affected joint; the other 3 horses did not have clinical signs referable to affected PIP joints. Two horses were euthanized shortly after diagnosis at the owners' request because of concerns that the horses would be unsuited for their intended athletic use. Two of the 3 horses in which fragments were incidental findings were able to race successfully, although 1 received intra-articular corticosteroid treatments; the third was retired because of unrelated orthopedic problems. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that osteochondral fragments involving the dorsomedial aspect of the PIP joint may be an incidental finding in young horses. Given the absence of clinical signs in 5 of 9 affected joints and the fact that 3 of 6 horses were affected bilaterally, a developmental origin of the fragments was suspected.     

Histopathology in horses with chronic palmar foot pain and age-matched controls. Part 1: Navicular bone and related structures

REASONS FOR PERFORMING STUDY: Causes of palmar foot pain and the aetiopathogenesis of navicular disease remain poorly understood, despite the high incidence of foot-related lameness. HYPOTHESES: Abnormalities of the collateral sesamoidean ligaments (CSLs), distal sesamoidean impar ligament (DSIL), deep digital flexor tendon (DDFT), navicular bone, navicular bursa, distal interphalangeal (DIP) joint or collateral ligaments (CLs) of the DIP joint may contribute to palmar foot pain. METHODS: Feet were selected from horses with a history of unilateral or bilateral forelimb lameness of at least 2 months' duration that was improved by perineural analgesia of the palmar digital nerves, immediately proximal to the cartilages of the foot (Group 1, n = 32); or from age-matched control horses (Group 2, n = 19) that were humanely destroyed for other reasons and had no history of forelimb foot pain. Eight units of tissue were collected for histology: the palmar half of the articular surface of the distal phalanx, including the insertions of the DDFT and DSIL; navicular bone and insertion of the CSLs; DDFT from the level of the proximal interphalangeal (PIP) joint to 5 mm proximal to its insertion; synovial membrane from the palmar pouch of the DIP joint and the navicular bursa; CLs of the DIP joint and DSIL. The severity of histological lesions for each site were graded. Results were compared between Groups 1 and 2. RESULTS: There was no relationship between age and grade of histological abnormality. There were significant histological differences between groups for lesions of the flexor aspect, proximal and distal borders, and medulla of the navicular bone; the DSIL and its insertion and the navicular bursa; but not for lesions of the CSLs, the dorsal aspect of the navicular bone, distal phalanx and articular cartilage, synovium or CLs of the DIP joint. CONCLUSIONS: Pathological abnormalities in lame horses often involved not only the navicular bone, but also the DSIL and navicular bursa. Abnormalities of the navicular bone medulla were generally only seen dorsal to lesions of the FFC. POTENTIAL RELEVANCE: Adaptive and reactive change may be occurring in the navicular apparatus in all horses to variable degrees and determination of the pathogenesis of lesions that lead to pain and biomechanical dysfunction should assist specific preventative or treatment protocols.     

SCINTIGRAPHIC ASSESSMENT OF THE METACARPOPHALANGEAL AND METATARSOPHALANGEAL JOINTS OF HORSES WITH JOINT PAIN

Our aims were to evaluate the pattern of radiopharmaceutical uptake in horses with lameness related to the metacarpophalangeal and/or metatarsophalangeal joint and compare the results with similar information from sound horses. It was hypothesized that there would be a difference in radiopharmaceutical uptake between the lame and contralateral limb in unilaterally lame horses and that there would be a difference between lame and sound horses. Nuclear scintigraphic images of 43 horses with forelimb lameness and 30 horses with hindlimb lameness were evaluated. In all horses lameness was improved by intraarticular analgesia of the joint, or by perineural analgesia of the palmar/plantar (at the junction of the proximal 3/4 and the distal 1/4 of the metacarpal/metatarsal regions) and palmar/plantar metacarpal/metatarsal nerves. All images were assessed subjectively and a quantitative image analysis was performed by drawing a vertical line profile through the center of each joint in the lateral images and using region of interest analysis in both lateral and dorsal/plantar images. Ratios of radiopharmaceutical uptake were compared for each region between lame and contralateral limbs in unilaterally lame horses and between lame and control horses. There was a significant difference in the ratio of radiopharmaceutical uptake in the proximal aspect of the proximal phalanx between lame and nonlame forelimbs in unilaterally lame horses and in both lame and contralateral limbs of lame horses compared with control horses for the regions of the distal aspect of the third metacarpal/metatarsal bone and the proximal sesamoid bones. However, the profile analysis was of limited clinical value.     

Retrospective study of outcome following desmotomy of the accessory ligament of the deep digital flexor tendon for type 1 flexural deformity in Thoroughbreds

Objective Determine the long‐term outcome for Thoroughbreds undergoing desmotomy of the accessory ligament of the deep digital flexor tendon (DAL‐DDFT) for type 1 flexural deformity of the distal interphalangeal joint (DIPJ). Design Retrospective matched cohort study Procedure Medical records were retrieved over a 17‐year period for Thoroughbreds that underwent DAL‐DDFT for type 1 flexural deformity. Long‐term outcome was determined by analysis of race records and comparison with maternal siblings. Comparisons between cases and controls included 2‐year‐old, 3‐year‐old and total career performance data. Results There were 46 cases of DAL‐DDFT. The mean age at surgery was 151 days (median 118, range 2–562); 48% of case horses and 77% of 90 controls started in a race. For case horses that did race, the time to first race, total number of starts and prize money per race were not significantly different to maternal siblings. Age at the time of surgery did not alter the likelihood of starting a race. Conclusion Thoroughbreds undergoing DAL‐DDFT for type 1 flexural deformity of the DIPJ are less likely to race when compared with their maternal siblings. For those that do race, the time to first race, total races and earnings per race are not different from controls. There is no evidence to suggest that age at the time of surgery influences the likelihood of racing.     

Treatment of solar prolapse using the heart bar shoe and dorsal hoof wall resection technique

This paper describes the treatment of 10 horses suffering from acute laminitis using the heart bar shoe and a dorsal hoof wall resection technique. All cases had progressed to prolapse of the tip of the pedal bone covered by solar corium through the horny sole; in one case the exposed tip of the distal phalanx became visible. Nine cases of distal phalangeal rotation and one case of distal displacement of the distal phalanx (sinking) are described. Two animals were destroyed because of the degree of lameness, one remains slightly lame at the trot and the remaining seven have returned to their previous use at comparable levels of performance.