A RADIOGRAPHIC STUDY OF THE DISTAL INTERPHALANGEAL JOINT AND NAVICULAR BURSA OF THE HORSE

Radiographic contrast studies were used in 50 forelimbs from 13 live horses and 12 fresh adult cadavers to determine the frequency of communication between the navicular bursa and the distal interphalangeal joint. Injections of contrast medium were made into the dorsal aspect of the distal interphalangeal joint of one limb and into the navicular bursa of the other forelimb of each horse. In 25 limbs in which contrast medium was injected into the distal interphalangeal joint, no communication was demonstrated between the joint and the navicular bursa. In 20 of the 25 limbs in which injection was made into the navicular bursa, no communication between joint and bursa was seen. In five horses, contrast medium was visible in both the distal interphalangeal joint and the navicular bursa. However, in four of five horses the communication was clearly iatrogenic. In both limbs of one horse, contrast medium was seen to enter the digital flexor tendon sheath after injection into the navicular bursa.
There is probably no naturally occurring communication between the navicular bursa and distal interphalangeal joint in the horse.     

Heel bulb lacerations in horses: 101 cases (1988-1994)

OBJECTIVE: To determine clinical history, structures involved, treatment, and outcome of lacerations of the heel bulb and proximal phalangeal region (pastern) in horses. DESIGN: Retrospective study. ANIMALS: 101 horses. PROCEDURES: Medical records of horses with lacerations of the heel bulb and pastern were reviewed, and follow-up information was obtained. RESULTS: 75 horses were Quarter Horses. Most horses were not treated with antimicrobial drugs prior to referral. Mean +/- SD time from injury to referral was 24 +/- 45 hours (range, 1 to 168 hours). Lacerations were most frequently caused by contact with wire or metal objects. In 17 horses, lacerations involved synovial structures; the distal interphalangeal joint was most commonly affected. One horse was euthanatized after initial examination. Wound treatment consisted of cleansing, lavage, debridement, lavage of affected synovial structures, suturing of fresh wounds, and application of a foot bandage or cast. Fifty-six horses were treated with systemically administered antimicrobial drugs. Follow-up information was collected for 61 horses. Fifty-one horses returned to their intended use and had no further complications; 10 horses had complications associated with the wound, and of those horses, 5 were euthanatized and 1 horse died from an unrelated cause. Horses with lacerations that involved synovial structures had worse outcomes than horses with lacerations that did not involve synovial structures. CONCLUSIONS AND CLINICAL RELEVANCE: Horses that sustain heel bulb lacerations can successfully return to their intended use. Involvement of the distal interphalangeal joint is associated with poor prognosis.     

Use of sodium monoiodoacetate to fuse the distal hock joints in horses

SUMMARY Intra-articular injection of sodium monoiodoacetate (MIA) was investigated as an agent for chemical arthrodesis of the distal hock joints in the horse. Five horses diagnosed with either spavin (three horses), a small tarsal bone fracture or a failed surgical arthrodesis, had 150 mg of MIA injected into the tarsometatarsal (TMT) joint of the affected hock(s). Eight joints were treated in the five horses. Follow-up evaluation by clinical and radiological examination took place over 9 to 14 months. Two of the five horses were sound at the conclusion of the study and one horse, although lame after flexion, was considered by the owner to have been treated successfully. One of eight TMT joints showed complete radiographic fusion. Complications after treatment included pain, chronic lameness and swelling. It was concluded that chemical arthrodesis using this technique can not be recommended as being a superior treatment as compared with surgical arthrodesis at this time but is deserving of further clinical evaluation.     

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.     

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.     

Necrosis of the collateral cartilage of the distal phalanx in horses: 16 cases (1970-1985)

The medical records of 16 horses with necrosis of the collateral cartilage of the distal phalanx were reviewed. Typical history included a laceration or puncture wound over the affected cartilage, resulting in persistent drainage proximal to the coronary band. All horses had signs of lameness. The duration of drainage prior to admission to the hospital ranged from 5 days to 5 months. The involved cartilages were left front lateral (n = 4), right front lateral (n = 5), left rear lateral (n = 1), right rear lateral (n = 4), left front medial (n = 1), and left rear medial (n = 1). The affected cartilage was curetted or resected in 13 horses, and conservative treatment was used in 3 horses. Follow-up information on 15 horses (2 to 72 months after discharge) revealed that 66% were sound and able to perform at their previous level. One horse was euthanatized 2 months after discharge from the hospital because it had septic arthritis of the distal interphalangeal joint. The outcome of treatment for each horse was evaluated with respect to the duration of drainage and the method of treatment. Horses with drainage of less than 1 month's duration had a better prognosis for eventual soundness, compared with horses with drainage of greater than or equal to 1 month's duration prior to initiation of treatment. Nine of the 13 horses managed surgically and 1 of the 3 horses managed conservatively were sound at follow-up evaluation.     

Diagnosis and treatment of the navicular syndrome in horses

Navicular syndrome can be treated in a variety of ways. This is related to the fact that it has a variety of causes. Prognostically, most horses will improve with treatment. One can expect about 50 per cent of the horses to become useably sound for 1 year, no matter what treatment is used. The disease is progressive, and affected horses eventually will need to be retired because of lameness. The author's therapeutic approach is to utilize shoeing as the primary therapy. Shoeing is performed to correct structural problems and to ensure that shoeing is physiologically sound. Nonsteroidal anti-inflammatory drugs are not used unless radical changes have been made in the shoeing. In cases of confirmed distal interphalangeal joint synovitis, either sodium hyaluronate or polysulfated glycosaminoglycans will be used in conjunction with shoeing. In cases where decreased circulation is documented, isoxsuprine hydrochloride will be administered if shoeing alone has not improved the horse within 6 weeks. If therapy does not improve the horse within 6 to 12 weeks, palmar digital neurectomy is recommended.     

Complete Excision of a Fractured Fourth Metatarsal Bone in Eight Horses

Proximal open comminuted fractures of the fourth metatarsal bone (Mt IV) in eight horses were treated by complete removal of the affected bone and antimicrobial therapy. Two horses had concurrent septic arthritis of the tarsocrural or distal tarsal articulations, and five horses had radiographic evidence of osteomyelitis and sequestration of the affected bone. Five horses became athletically sound for their intended use, two horses with septic arthritis had residual lameness but were pasture sound, and one horse was lost to follow-up. Excision of the entire bone appears to be an acceptable treatment of open comminuted fractures of the proximal one-third of Mt IV that do not respond to more conservative modes of therapy.     

Lameness due to pain associated with the distal interphalangeal joint: 45 cases

This paper describes the clinical and radiographic features, and response to treatment, of 45 horses which showed lameness that was improved by intra-articular anaesthesia of the distal interphalangeal (DIP) joint. Although many horses had poor conformation of the foot of the lame limb, the majority showed no localising clinical signs suggestive of involvement of the DIP joint. Lameness was usually unilateral. No horse with bilateral lameness responded to treatment. Palmar digital nerve blocks frequently improved or alleviated lameness, although in some horses palmar (abaxial sesamoid) nerve blocks were required to eliminate lameness. This difference in response did not affect response to treatment. Intra-articular anaesthesia of the DIP joint usually resulted in resolution of lameness within 5 mins; a partial improvement in lameness or a slow response were poor prognostic indicators. None of the horses had radiographic abnormalities compatible with navicular disease. Radiographic changes of the distal interphalangeal joint per se were generally detectable only in lateromedial views and were identified in less than one third of the horses. Success rates were low following treatment of cases with radiographic abnormalities. In those with no radiographic abnormalities the response to corrective trimming and shoeing and intra-articular administration of sodium hyaluronate, once or repeatedly, was variable and no parameters could be used to predict the likely outcome. Treatment was successful in approximately 30 per cent of cases. Subsequent treatment of horses which remained lame, by intra-articular administration of polysulphated glycosaminoglycans, was not helpful; only a small proportion became sound following prolonged (nine months) rest.(ABSTRACT TRUNCATED AT 250 WORDS)     

Closed Suction Drainage in the Treatment of Infectious Arthritis of the Equine Tarsocrural Joint

Infectious arthritis of the tarsocrural joint was treated in 13 horses with closed suction drainage through a flat, fenestrated, latex (Jackson-Pratt) drain, broad-spectrum antimicrobial agents, nonsteroidal anti-inflammatory drugs, and bandage immobilization. In 11 horses, arthroscopic lavage and debridement were also performed. Ingress drains were placed for lavage in six horses. Ten horses returned to their previous level of competition or were sound. One horse raced but had lameness of the affected tarsocrural joint and dropped in racing class; one horse was euthanatized because of laminitis in the supporting limb; and one horse was lame, but useful as a breeding animal. Closed suction drainage appeared to be a useful treatment in horses with infectious arthritis. Although arthroscopy was not necessary, it facilitated fibrin removal, lavage, and partial synovectomy. Because of the development of Pseudomonas superinfection in one horse, the use of simultaneous ingress catheters was not recommended.     

RADIOGRAPHIC MEASUREMENTS OF HOOF BALANCE ARE SIGNIFICANTLY INFLUENCED BY A HORSE'S STANCE

Hoof balance radiographs are commonly used as the basis for corrective farriery decision‐making in horses, however there are limited published data quantifying effects of the stance of the horse or the horizontal radiographic beam angle. In this analytical study, the influence of variation of the horse's stance in the craniocaudal and lateromodial plane on hoof balance measurements as well as the influence of variation of the horizontal radiographic beam angle on dorsopalmar hoof balance measurements was examined. Distal left thoracic limb lateromedial radiographs were acquired using a standardized protocol while varying the craniocaudal stance of five horses, each selected to be sound and conformationally normal. Dorsopalmar foot radiographs were acquired while varying the lateromedial stance; and variable angle horizontal beam dorsopalmar foot radiographs were acquired while keeping the limb position constant. Analyses of measurements demonstrated that hoof pastern angle had a linear relationship (R² = 0.89, P < 0.001) with craniocaudal stance of the horse. The relationship of joint angle and stance was greater for the distal interphalangeal joint angle (R² = 0.89, P < 0.001) than the proximal interphalangeal joint angle (R² = 0.65, P = 0.001). The distal phalanx angle did not change with craniocaudal stance variation. The proximal interphalangeal joint width, distal interphalangeal joint width, or distal phalanx height did not change with lateromedial stance variation, nor within a 15 degree dorsolateral to caudomedial and dorsomedial to caudolateral variation from the dorsopalmar axis. Findings indicated that positioning of the thoracic limb needs to be considered during radiographic interpretation and decision‐making for corrective farriery.     

Osteochondral fragmentation of the palmarolateral/plantarolateral aspect of the distal phalanx in four horses: A novel location

Four horses presenting for lameness were diagnosed with unilateral osteochondral fragmentation (OCF) of the palmarolateral/plantarolateral aspect of the distal phalanx within the distal interphalangeal joint (DIPJ). Histological evaluation of one case supported a diagnosis of osteochondritis dissecans (OCD), with patient age and history from two cases suggesting a traumatic origin. Lesion appearance on conventional radiography, computed tomography (CT), nuclear scintigraphy and magnetic resonance imaging (MRI) are described. Fragmentation was best identified on dorsal 65° proximal-palmaro/plantarodistal oblique (D65°PrPDiO/D65°PrPlDiO) and dorsal 65° proximal-palmaro/plantarodistal lateral oblique (D65°Pr45°L-PDiMO/D65°Pr45°L-PlDiMO) radiographic projections of the foot, but articular pathology appeared more severe on cross-sectional imaging modalities. In all cases, lameness was refractory to conservative management. Arthroscopic evaluation of the DIPJ was performed in three horses, although the lesion was inaccessible in two. In one horse, access to the lesion was possible due to increased joint laxity, presumably due to concurrent soft tissue injury. One horse was euthanased after failed conservative management, one was pasture sound following palmar digital neurectomy 12 months after initial presentation, one returned to racing and one was lost to follow-up. Osteochondral fragmentation at this location has not previously been described, treatment options are limited and the prognosis appears to be poor.     

Ankylosis of the distal interphalangeal joint in a horse after septic arthritis and septic navicular bursitis.

A 6-month-old 300-kg Quarter Horse filly was treated for septic arthritis of the distal interphalangeal joint and septic navicular bursitis that developed as a result of a deep puncture to the foot. Initial treatment consisted of establishing ventral drainage for the navicular bursa, lavage of the distal interphalangeal joint, and administration of broad-spectrum antimicrobial drugs and non-steroidal anti-inflammatory drugs. Because of continuing sepsis in the distal interphalangeal joint, subsequent treatment included packing the defect in the bottom of the foot with cancellous bone in an attempt to prevent ascending contamination of the joint, placing the limb in a short limb cast, and inserting a Penrose drain into the joint for passive drainage of septic exudate. The goal of treatment was to encourage ankylosis of the distal interphalangeal joint. Because of the filly's persistent lameness and laxity of the lateral collateral ligament in the contralateral carpus, the palmar nerves of the affected foot were injected with a long-acting local anesthetic at the level of the proximal sesamoid bones to encourage weight-bearing. Ankylosis of the distal interphalangeal joint was complete 9 months after the puncture, but a grade-2 lameness remained and the horse had a varus deformity resulting from ligamentous laxity of the lateral collateral ligament in the contralateral carpus.     

Kinematics and ground reaction forces in horses with superficial digital flexor tendinitis

OBJECTIVE: To measure and correlate kinematic and ground reaction force (GRF) data in horses with superficial digital flexor tendinitis. ANIMALS: 6 sound horses. PROCEDURE: Horses were evaluated before (sound evaluation) and after (lame evaluation) induction of superficial digital flexor tendinitis in 1 forelimb (randomized) by injection of collagenase. As each horse trotted, kinematic data were collected by use of an optoelectronic system, and GRF data were measured by use of a force plate. Three-dimensional kinematic and GRF data were projected onto a 2-dimensional sagittal plane. RESULTS: Lame limbs had significantly lower peak vertical GRF, less flexion of the distal interphalangeal joint, and less extension of the metacarpophalangeal joint, compared with compensating limbs. Carpal joint kinematics did not change. Compensating limbs had a more protracted orientation throughout the stance phase and higher braking longitudinal force and impulse; however, total range of rotation from ground contact to lift off did not change. Transfer of body weight from lame to compensating limbs was smooth, without elevation of the body mass into a suspension phase. Propulsive components of longitudinal GRF did not differ between limbs. CONCLUSIONS AND CLINICAL RELEVANCE: In horses with experimentally induced superficial digital flexor tendinitis, changes in vertical GRF were reflected in angular excursions of the distal interphalangeal and metacarpophalangeal joints, whereas changes in longitudinal GRF were associated with alterations in the protraction-retraction angle of the entire limb.     

Injection of corticosteroids, hyaluronate, and amikacin into the navicular bursa in horses with signs of navicular area pain unresponsive to other treatments: 25 cases (1999-2002)

OBJECTIVE: To determine history, clinical and radiographic abnormalities, and outcome in horses with signs of navicular area pain unresponsive to corrective shoeing and systemic nonsteroidal anti-inflammatory drug administration that were treated with an injection of corticosteroids, sodium hyaluronate, and amikacin into the navicular bursa. DESIGN: Retrospective study. ANIMALS: 25 horses. PROCEDURE: Data collected from the medical records included signalment, history, horse use, severity and duration of lameness, shoeing regimen, results of diagnostic anesthesia, radiographic abnormalities, and outcome. RESULTS: 17 horses had bilateral forelimb lameness, 7 had unilateral forelimb lameness, and 1 had unilateral hind limb lameness. Mean duration of lameness was 9.2 months. All horses had been treated with corrective shoeing and nonsteroidal anti-inflammatory drugs for at least 6 months; 18 had previously been treated by injection of corticosteroids and sodium hyaluronate into the distal interphalangeal joint. Fourteen horses had mismatched front feet, and 21 horses had signs of pain in response to application of pressure over the central aspect of the frog. Palmar digital nerve anesthesia resulted in substantial improvement in or resolution of the lameness in all horses. Twenty horses (80%) were sound and returned to intended activities 2 weeks after navicular bursa treatment; mean duration of soundness was 4.6 months. Two horses that received numerous navicular bursa injections had a rupture of the deep digital flexor tendon at the level of the pastern region. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that navicular bursa treatment may provide temporary improvement in horses with signs of chronic navicular area pain that fail to respond to other treatments.     

Chemical arthrodesis of the distal tarsal joints using sodium monoiodoacetate in 104 horses

OBJECTIVE: To evaluate chemical arthrodesis using sodium monoiodoacetate for treatment of degenerative joint disease of the tarsometatarsal and distal intertarsal joints. DESIGN: Retrospective clinical study. METHOD: Horses were diagnosed with degenerative joint disease of one or more of the tarsometatarsal or distal intertarsal joints based on history, lameness examination, radiographic findings and, in some cases, response to intra-articular anaesthesia or medication. Intra-articular injections of sodium monoiodoacetate were performed using 23 gauge needles in the sedated, standing horse. Positive contrast arthrography of the distal intertarsal joint was performed in all horses to evaluate needle placement and the presence or absence of communication with other synovial structures. The mean intra-articular dose of sodium monoiodoacetate was 192 mg. Horses were subject to a graded exercise program commencing 7 to 10 days after treatment. Where possible, follow up lameness examination and radiography was performed at 3, 6, 12 and 24 months after treatment. RESULTS: At 3, 6, 12 and 24 months after treatment, respectively, 0/57, 14/55, 41/50, and 29/34 of horses were sound. At 3, 6, 12 and 24 months after treatment, respectively, 5/55, 24/38, 26/30 and 18/18 of horses had radiographic evidence of ankylosis of treated joints. Post injection pain was marked in 6.7% of horses and significant complications requiring further treatment occurred in 3.8% of horses. CONCLUSIONS: Chemical arthrodesis using sodium monoiodoacetate was an effective treatment method for degenerative joint disease of the distal tarsal joints. The technique was performed in the sedated standing horse and required minimal equipment. Results were comparable to those achieved following surgical arthrodesis. The risk of significant complications was minimised through good technique using an appropriate injection volume and concentration.     

Evaluation of Skin Bacterial Flora Before and After Aseptic Preparation of Clipped and Nonclipped Arthrocentesis Sites in Horses

Objective —This study evaluates skin bacterial flora before and after aseptic preparation of clipped and nonclipped arthrocentesis sites in horses. Study Design —The hair over one midcarpal joint and one distal interphalangeal joint on each horse was clipped. The contralateral joint served as the nonclipped comparison. Animals or Sample Population —Twelve adult horses. Methods —A prescrub sample for microbial culture was taken from the dorsal surface of all four joints for each horse. Each site was aseptically prepared with povidone iodine and 70% alcohol, followed by postscrub sampling for microbial culture. Colony forming units (CFUs) were determined for each sample, 24 hours after inoculation of blood agar plates. Results —There was no significant difference (P >.05) in number of postscrub CFUs between clipped and nonclipped skin over the midcarpal or distal interphalangeal joints. Percent bacterial reduction (mean ± SD%) after aseptic preparation differed significantly (P=.02) between clipped (99.8 ±.003%) and nonclipped (96.2 ±.05%) skin at the midcarpal joint, but not at the distal interphalangeal joint (clipped, 98.5 ±.03% and nonclipped, 97.8 ± 0.21%). There was a significant difference (P=.009) in number of prescrub CFUs obtained from clipped and nonclipped skin for the midcarpal joint. There was no significant difference in number of prescrub CFUs between clipped and nonclipped skin at the distal interphalangeal joint. Bacteria isolated from both clipped and nonclipped skin sampled postscrub included Bacillus sp, nonhemolytic Staphylococcus sp, and Micrococcus sp. Conclusions —The presence of hair over the midcarpal and distal interphalangeal joints does not appear to inhibit the ability of antiseptics to effectively reduce bacterial flora to an acceptable level for arthrocentesis. Clinical Relevance —Aseptic preparation of the skin over the midcarpal and distal interphalangeal joints can be accomplished without hair removal in horses.     

Intra-articular Anesthesia of the Distal Interphalangeal Joint Alleviates Lameness Associated With the Navicular Bursa in Horses

Objective — To determine if intra-articular anesthesia of the distal interphalangeal joint could alleviate lameness associated with the navicular bursa in horses.
Study Design — Experimental investigation.
Animals — Six clinically normal horses.
Methods — Lameness was induced in each horse by injecting either the left or right front navicular bursa with 5 mg of amphotericin-B. Forty-eight hours later each horse was videotaped walking and trotting before, and 5, 30, and 60 minutes after injecting the distal interphalangeal joint of the treated limb with 5 mL of 2% mepivacaine hydrochloride. All video recordings were then rerecorded onto master tapes in a random sequence. Four clinicians, unaware of the animal identity related to observation time or limb treated, independently viewed these tapes and graded the lamenesses.
Results — There was a significant reduction in lameness 5 and 30 minutes after anesthetic was injected into the distal interphalangeal joint. Lameness scores 60 minutes after anesthetic administration were not significantly different than baseline values. Gross pathological examination confirmed marked inflammation of the treated navicular bursae and normal appearance of the distal interphalangeal joints.
Conclusions — Intra-articular anesthesia of the distal interphalangeal joint can alleviate lameness associated with the navicular bursa.
Clinical Relevance — Intra-articular anesthesia of the distal interphalangeal joint is not specific only for lameness originating in the distal interphalangeal joint.     

FEASIBILITY FOR ULTRASOUND‐GUIDED INJECTION OF THE COLLATERAL LIGAMENTS OF THE DISTAL INTERPHALANGEAL JOINT IN HORSES

Desmitis of the collateral ligament of the distal interphalangeal joint is a cause of lameness in performance horses. The objective of this prospective, experimental, ex vivo feasibility study was to evaluate the success of ultrasound‐guided injection of the collateral ligaments of the distal interphalangeal joint in the equine forelimb. Seventy‐six ultrasound‐guided dye injections of the collateral ligament of the distal interphalangeal joint were performed on horses’ cadaver limbs. The hooves were sectioned transversely to verify the location of the dye relative to the collateral ligaments and surrounding structures. Evaluations of transverse sections were performed independently by two experienced observers. A scoring system was used to assess injection of the collateral ligament of the distal interphalangeal joint at the proximal, middle, and distal aspect over the length of the ligament. The collateral ligament was injected at any point in 97.4% of cases. The ligament was injected over the entire scored length in 43.2% of cases (32/74), over two scored length areas in 45.9% of cases (34/74), and in one area in 10.8% of cases (8/74). The distal interphalangeal joint and the common digital extensor tendon were also injected in 81.6% (62/76) and 43.4% (33/76) of the cases, respectively. Use of the ultrasound had a positive and negative predictive value of 98% and 9%, respectively. In this study, ultrasound guidance was useful for confirming injection of the collateral ligament of the distal interphalangeal joint but did not prevent injecting the distal interphalangeal joint and the common digital extensor tendon.     

Fenestration of the abaxial hoof wall and implantation of gentamicin-impregnated collagen sponges for the treatment of septic arthritis of the distal interphalangeal joint in cattle.

A novel surgical approach to the distal interphalangeal joint of cattle, through the abaxial hoof wall, for the treatment of septic arthritis is described. In seven cattle a rectangular piece of horn (15 x 40 mm) was excised from the abaxial hoof wall and the joint was lavaged with Ringer's solution. Infected and/or necrotic tissue was removed from the joint and gentamicin-impregnated collagen sponges were introduced. The piece of horn was reattached, a rubber block was glued to the contralateral claw, and a bandage applied. Aftercare consisted of changes of bandage, systemic administration of antimicrobial drugs and box rest. At follow-up, six of the cattle were sound but one cow which had been slaughtered five months after surgery had remained slightly lame.