The effect of training on equine metacarpal bone breaking strength

Right third metacarpal bones (n=24) from Thoroughbreds, 24 to 48 months old and in race training, were tested to failure in 3 point bending. The neutral load axis was estimated and the distance from the axis to the outer dorsal cortical surface measured. Mid-diaphyseal dorsopalmar and lateromedial outer cortical and medullary diameters were measured. Breaking strength, cortical area and area moment of inertia were also calculated. Significant correlations were demonstrated between months in training and dorsopalmar bone diameter, cortical area and area moment of inertia. Significant linear models were illustrated between the same 3 variables and number of months in training. It was concluded that increased duration of training significantly enlarges dorsopalmar bone diameter, cortical area and area moment of inertia. Training did not affect metacarpal bone breaking strength as determined by 3 point bending.     

Standing repair of an articular dorsal medial oblique fracture of the proximal third metacarpal bone in a racing Standardbred

The third metacarpal bone (McIII) is a common site of long bone fractures in racehorses. However, articular fractures of the dorsomedial aspect of McIII are a rare location of such injuries. This report describes the successful standing surgical repair of an articular fracture of the dorso-medial proximal McIII in a 4-year-old Standardbred racing mare using lag screw fixation.     

Computed tomographic diagnosis of incomplete palmar cortical (fatigue) fracture of the third metacarpal bone in two young adult endurance horses

Two young adult endurance horses were presented for investigation of sudden-onset forelimb lameness during competition. Clinical examination revealed a severe forelimb lameness and pain on palpation of the proximal palmar metacarpal area. Initial radiographic survey of the affected forelimb was unremarkable in both cases. A week of box rest resulted in only a mild improvement in the lameness. A second radiographic examination did not reveal any significant abnormalities. In both cases, scintigraphic examination was suggested, but was declined by the owner, and the lameness had significantly improved after local infiltration of 3 mL of anaesthetic solution in the proximal suspensory region. Radiographic and ultrasonographic examinations of the carpus and proximal suspensory region were unremarkable in Case 2. Case 1 had increased thickness of the medial lobe of the proximal aspect of the suspensory ligament. A computed tomographic examination was performed and an incomplete longitudinal (fatigue) fracture of the proximal third metacarpal bone was detected. After 8 months of box rest and rehabilitation, re-examination revealed resolution of the lameness in both cases. Advanced diagnostic imaging should be considered in young endurance horses with severe lameness during competition or training, in which radiographic and ultrasonographic examinations are unremarkable or do not explain the severity of the lameness. Computed tomography imaging is considered a useful diagnostic imaging technique to detect incomplete longitudinal palmar metacarpal cortical (fatigue) fractures due to its ability to provide excellent bone detail.     

Computed tomography as a method of estimating bone mineral content in horses

With the advancement of technology, more tools and methods are being made available for the assessment of bone density in the live animal. Computed tomography (CT) is one such tool. In a CT scan, x-rays are passed through a subject and detectors record transmitted energy. The CT computer then constructs cross-sectional images from this data to represent the internal anatomy.The first objective of this study was to investigate CT as a means of estimating bone mineral content of the equine third metacarpal bone. Our hypothesis was that the cross-sectional area of the third metacarpal bone, as measured on CT images, would correlate significantly with ash weight of that section. Our second objective was to use CT to measure and compare bone density in the dorsal, palmar, lateral and medial cortices of the equine third metacarpus. We hypothesized that CT would detect differences in density by cortex.Twelve cadaver thoracic limb specimens, from horses of varying age, breed and prior use, were scanned on a CT 9800 (GE Medical Systems). Scanned sections of the limb were then skinned, dried, ether-extracted and ashed in a muffle furnace. Bone mineral content was expressed as grams of ash/cm section of bone. The image recorded by the CT was developed and assessed using an imaging photodensitometer and a corresponding software package to estimate the area of each bone section. Correlation was determined using SAS (6.12). Differences in bone density by cortex were calculated using a simple t-test. The maximum, minimum and mean estimates of third metacarpal bone cross-sectional area as determined by CT were 519, 351 and 423 mm², respectively, while the maximum, minimum and mean ash weights were 8.9, 4.8 and 6.4 g/cm, respectively. Estimates of bone mineral content by ash and cross-sectional area as determined by CT were significantly correlated (r=.91, P=.0001). There was no difference in CT density numbers between lateral and medial cortices, however the dorsal cortex was lower in density than the lateral (P<.05) and the palmar cortex was lower in density than all other cortices (P<.05). This data suggests that in a research setting, CT is an effective method by which to calculate cross-sectional area and, hence, estimate bone mineral content. Computed tomography was also able to detect differences in bone density by cortex.     

Frequency distributions of 174 fractures of the distal condyles of the third metacarpal and metatarsal bones in 167 Thoroughbred racehorses (1999–2009)

Reasons for performing study: Although fractures of the metacarpal and metatarsal condyles are the most common long‐bone fractures of Thoroughbred horses in training, limited data on variations in morphology and incidence have been published. Additionally, grouped analyses of previous studies from the UK and USA would permit comparison between study groups and the creation of a substantial pool of international data. Methods: Retrospective analysis of case records of horses with fractures of the distal condyles of third metacarpal/metatarsal bones seen over the last 10 years at Newmarket Equine Hospital. The current series was compared with a prior series from the UK; pooled analyses of these, and series from the USA were also compared. Results: One hundred and seventy‐four fractures were identified in 167 racehorses. The current series contained a significantly lower proportion of medial condylar fractures than in a similar population 17 years earlier. Fractures that originated more abaxially tended to be shorter, and a significant proportion of lateral condylar fractures arose outside of the condylar groove. There was also some apparent seasonality of fractures of the lateral condyles in 2‐year‐old horses, but not so in older horses or those with medial condylar fractures. Conclusions and potential relevance: A substantial portion (approximately 50%) of fractures in the present series cannot be explained by unifying theories of aetiopathogenesis, which suggest that fractures usually arise within the condylar groove, as a focus of cumulative fatigue and failure of adaptation of bone. A separate aetiopathogenesis may be responsible for a proportion of condylar fractures encountered in racehorses, and further work is required to elucidate this. Changes in the number of medial condylar fractures encountered may reflect the introduction of artificial racing and training surfaces, and also may reflect changes in the age demographic of horses racing in the UK since the introduction of year‐round ‘all‐weather’ racing.     

Influence of intensity and changes of physical activity on bone mineral density of immature equine subchondral bone

Reasons for performing study: Subchondral bone provides structural support to overlying articular cartilage and plays an important biomechanical role in osteochondral diseases. Mechanical features of bone correlate strongly with bone mineral density, which is directed by the loading conditions to which the tissue is subjected. Objective: To investigate the influence of physical activity levels on subchondral bone mineral density (sBMD) in foals during early development. Methods: Three groups of foals were subjected to different physical activity levels from birth until age 5 months. A proportion of these foals were subjected to euthanasia at 5 months while remaining foals were subjected to similar physical activity levels for 6 months until euthanasia at 11 months. Osteochondral specimens were collected for measurement of sBMD with peripheral quantitative computed tomography at 2 differently loaded anatomical sites of the proximal phalangeal bone at 1, 2, 3, 4 and 5 mm depth from the osteochondral junction. Results: Growth significantly increased sBMD but by a different amount depending on anatomical location and physical activity level. Significantly higher sBMD was found at the habitually loaded central area in comparison to the intermittently peak loaded marginal site. Exercise increased sBMD throughout the whole depth of analysed tissue, but changes were generally more obvious at a depth of 2 mm. Interestingly, foals subjected to additional sprint training preserved the exercise‐induced sBMD increase at the habitually loaded central area during the 6 months of the second phase of the study. Conclusions: Habitual low‐intensity loading elicits a greater response in sBMD in quantitative terms than high‐intensity low‐frequency loading at the sites investigated in this study. Future sBMD may be influenced by means of well‐tailored exercise regimens at young age. Potential relevance: Specific physical activity levels during early development may potentially reduce the prevalence of osteochondral injury later in life.     

Diffuse osteomyelitis of the fourth metacarpal bone in a horse caused by Clostridium perfringens

Osteomyelitis in adult horses, often associated with trauma or iatrogenic infection following surgery, usually presents as a focal area of infected bone. Diffuse osteomyelitis, affecting both the cortex and medulla, along the full length of a bone is encountered less frequently and treatment of such infections is not well reported in horses. The 2-year-old Warmblood mare in this case was diagnosed with diffuse osteomyelitis affecting the 4th metacarpal bone with concurrent unicortical fracture of the third metacarpal bone following traumatic injury. Computed tomography (CT) aided diagnosis in this case, providing critical additional detail to that obtained with radiography and ultrasound. This case highlights the value of CT in the diagnosis of diffuse osteomyelitis. This is the first reported case of diffuse osteomyelitis caused by Clostridium perfringens in horses. Successful treatment in this case consisted of surgical debridement of the associated abscess, followed by systemic and locoregional antimicrobial therapies.     

Magnetic resonance imaging findings of bone marrow lesions in the equine distal tarsus

Three horses with sudden onset severe lameness were admitted for further diagnostic investigation. All horses had variable changes on radiographs in the distal tarsal region. Because of the sudden onset and severe degree of lameness, a magnetic resonance imaging (MRI) examination was performed. All horses showed areas of increased signal intensity in short tau inversion recovery (STIR) images involving the central and/or third tarsal bones. These lesions involved both the subchondral bone and bone marrow and are currently defined as bone marrow lesions (BML). Two horses were treated with shockwave therapy, one received intra‐articular medication. Two of the horses returned to previous athletic level and one is still in rehabilitation.     

Quantification of Staphylococcus aureus adhesion to equine bone surfaces passivated with Plasmalyte and hyperimmune plasma

OBJECTIVE: To quantify the adhesion of Staphylococcus aureus to 4 equine bone surfaces passivated in a balanced polyionic solution (Plasmalyte) or hyperimmune equine plasma (Polymune plasma). STUDY DESIGN: In vitro comparative study. SAMPLE POPULATION: Third metacarpal bone (MC3) surface explants from 9 equine cadavers. METHODS: Approximately 1 cm(2) sections of periosteum were removed from MC3 and stapled to sterile stainless steel screens. Three bone surface explants were cut using a surgical saw to present 1 cm(2) surfaces of subperiosteal bone, cut cortical bone, or endosteum. Duplicate explants of each surface were immersed for 1 hour in Plasmalyte or hyperimmune equine plasma. Each explant was then placed in a well of a 6-well sterile tissue culture plate with the surface of interest exposed. Each surface was inoculated with approximately 100 colony-forming units of S. aureus in 10 microL of Mueller Hinton broth and incubated for 6 hours at 37 degrees C. After gentle rinsing to remove non-adherent bacteria, samples were sonicated for 5 minutes at 60 kHz to loosen adhered bacteria. The number of adherent bacteria was determined by serial dilutions and incubation of the sonicate. Scanning electron microscopy (SEM) was performed on samples identically treated from an additional horse to confirm bacterial removal by sonication from all surfaces and support quantitative culture results. RESULTS: Less S. aureus adhered to periosteum than to cortical bone, cut cortical bone, and endosteal surfaces, which were all similar. Exposure of all surfaces to hyperimmune plasma reduced S. aureus adherence compared with Plasmalyte exposure; SEM supported these conclusions. CONCLUSION: Less bacteria adhere to periosteum than other bone surfaces. Hyperimmune plasma reduces bacterial adhesion to all bone tissue surfaces. CLINICAL RELEVANCE: Understanding the factors that affect bacterial adhesion to bone will facilitate development of improved intraoperative lavage solutions to reduce the morbidity and mortality associated with postoperative infection.     

Standing magnetic resonance imaging detection of bone marrow oedema‐type signal pattern associated with subcarpal pain in 8 racehorses: A prospective study

Reason for performing study: The proximal metacarpal region is a common site of origin of lameness in the performance horse. A number of disease entities are recognised as causes of proximal metacarpal lameness but a definitive diagnosis is often elusive. Magnetic resonance imaging (MRI) is hypothesised to offer advantages over traditional imaging modalities in the investigation of proximal metacarpal pain. Objective: To describe clinical and imaging features of cases of lameness in racehorses arising from the proximal metacarpal region in which standing MRI identified ‘bone marrow oedema‐type’ (BMO‐type) signal patterns. Methods: Records for all horses undergoing standing MRI of the proximal metacarpus/distal carpus from September 2006 to December 2008 were reviewed. Cases underwent a standardised protocol for diagnostic analgesia, radiography and ultrasonography of the proximal metacarpus and distal carpus. Cases with proximal metacarpal lameness displaying a characteristic BMO‐type signal pattern on MRI were identified and outcomes analysed. Results: Eight cases were identified with characteristic MRI findings of extensive hyperintensity on T2* gradient echo and short tau inversion fast spin echo sequences and corresponding hypointensity on T1 gradient echo images within the palmaroproximal aspect of the third metacarpal bone. Follow‐up information was available for all cases; at the time of writing 7/8 had returned to full work and were free from lameness. Conclusions: The BMO‐type signal patterns visible on MR images in these cases may signal the existence of a previously under‐diagnosed pathological process associated with proximal metacarpal lameness in racehorses. This finding is postulated to be associated with a stress reaction and possible prodromal stress fracture of the palmaroproximal metacarpus not appreciable radiographically or ultrasonographically. Potential relevance: MRI of the proximal metacarpal region permits detection of pathological processes, which may elude conventional imaging and, therefore, has important therapeutic and prognostic implications in these cases.     

Computed tomography of proximal metatarsal and concurrent third tarsal bone fractures in a Thoroughbred racehorse

A 2‐year‐old Thoroughbred filly presented to the William R. Pritchard Veterinary Medical Teaching Hospital at the University of California at Davis for whole body nuclear scintigraphic evaluation after an acute onset of nonweightbearing right hindlimb lameness post race. The use of computed tomography (CT) enabled visualisation of additional pathology that was not initially appreciable using combined imaging modalities of nuclear scintigraphy and digital radiography, which ultimately altered the selected course of treatment. Computed tomography in horses with fractures of the cuboidal bones of the hock can provide valuable additional information regarding fracture configuration and radiographically occult pathology, which may help to guide clinical decisions about treatment.     

An in vitro evaluation of plate luting using osteotomized equine third metacarpal bones with a limited contact-dynamic compression plate

OBJECTIVES: To evaluate the effects of plate luting on the biomechanical properties of a broad limited contact-dynamic compression plate (LC-DCP) fixation to repair osteotomized equine 3rd metacarpal (MC3) bones. STUDY DESIGN: In vitro biomechanical testing of paired cadaveric equine MC3 with a mid-diaphyseal osteotomy, stabilized by LC-DCP fixation, with 1 of the pair luted with polymethylmethacrylate (PMMA). ANIMAL POPULATION: Ten pairs of adult equine cadaveric MC3 bones. METHODS: Ten pairs of equine MC3 were divided into 2 test groups (5 pairs each) for (1) palmarodorsal 4-point bending single cycle to failure testing and (2) palmarodorsal 4-point bending cyclic fatigue testing. The LC-DCP (8 hole, 4.5 mm) was applied to the dorsal surface of each pair of MC3 bones. All plates and screws were applied using standard AO/ASIF techniques. All MC3 bones had mid-diaphyseal osteotomies. One of the matched pairs of LC-DCP-MC3 constructs were randomly chosen to be luted with PMMA. Mean test variable values for each method were compared using a paired t-test within each group; significance was set at P<.05. RESULTS: Mean palmarodorsal 4-point bending yield bending moment, failure bending moment of the LC-DCP fixation with luting was not significantly different (P>.05) than those of the LC-DCP fixation without luting. Mean cycles to failure for palmarodorsal 4-point bending was significantly (P<.0003) greater, with a 7.2-fold increase, for the LC-DCP fixation with luting compared with the LC-DCP fixation without luting. CONCLUSION: Luting the broad LC-DCP with PMMA in the fixation osteotomized equine MC3 bones increases the fatigue life of cyclic loading for palmarodorsal 4-point bending under the in vitro conditions studied. CLINICAL RELEVANCE: The cyclic fatigue data supports the conclusion that luted broad LC-DCP fixation is biomechanically superior to the non-luted broad LC-DCP fixation in osteotomized equine MC3 bones.     

Reliability of high‐ and low‐field magnetic resonance imaging systems for detection of cartilage and bone lesions in the equine cadaver fetlock

Reasons for performing study: To determine the reliability of 2 magnetic resonance imaging (MRI) systems for detection of cartilage and bone lesions of the equine fetlock. Objectives: To test the hypotheses that lesions in cartilage, subchondral and trabecular bone of the equine fetlock verified using histopathology can be detected on high‐ and low‐field MR images with a low incidence of false positive or negative results; that low‐field images are less reliable than high‐field images for detection of cartilage lesions; and that combining results of interpretation from different pulse sequences increases detection of cartilage lesions. Methods: High‐ and low‐field MRI was performed on 19 limbs from horses identified with fetlock lameness prior to euthanasia. Grading systems were used to score cartilage, subchondral and trabecular bone on MR images and histopathology. Sensitivity and specificity were calculated for images. Results: High‐field T2*‐weighted gradient echo (T2*W‐GRE) and low‐field T2‐weighted fast spin echo (T2W‐FSE) images had high sensitivity but low specificity for detection of cartilage lesions. All pulse sequences had high sensitivity and low–moderate specificity for detection of subchondral bone lesions and moderate sensitivity and moderate–high specificity for detection of trabecular bone lesions (histopathology as gold standard). For detection of lesions of trabecular bone low‐field T2*W‐GRE images had higher sensitivity and specificity than T2W‐FSE images. Conclusions: There is high likelihood of false positive results using high‐ or low‐field MRI for detection of cartilage lesions and moderate–high likelihood of false positive results for detection of subchondral bone lesions compared with histopathology. Combining results of interpretation from different pulse sequences did not increase detection of cartilage lesions. MRI interpretation of trabecular bone was more reliable than cartilage or subchondral bone in both MR systems. Potential relevance: Independent interpretation of a variety of pulse sequences may maximise detection of cartilage and bone lesions in the fetlock. Clinicians should be aware of potential false positive and negative results.