Long-term outcome of horses with a slab fracture of the central or third tarsal bone treated conservatively: 25 cases (1976-1993)

OBJECTIVE: To determine clinical features of horses with a slab fracture of the central or third tarsal bone and to report outcome of horses in which treatment did not include surgery. DESIGN: Retrospective study. ANIMALS: 25 horses (14 Standardbreds, 6 Thoroughbreds, 5 Quarter Horses). PROCEDURE: Medical records of horses with a slab fracture of the central (n = 9) or third (16) tarsal bone were reviewed. Only horses for which treatment consisted of confinement to a stall were included in this study. Clinical features and radiographic findings were recorded and summarized. Outcome was determined for racing breeds by obtaining official lifetime race results. Outcome for Quarter Horses was determined by phone survey of the owners. RESULTS: 16 (64%) horses had a successful outcome. Ten of 14 (71%) Standardbreds and 2 of 6 Thoroughbreds returned to racing and started at least 5 races after injury. Four of 5 Quarter Horses for which follow-up information was available successfully returned to their previous activity. Sex, age, limb affected, or gait was not associated with final outcome. Percentage of racehorses with central tarsal bone fractures that had a successful outcome (2/7) was significantly less than percentage with third tarsal bone fractures that did (10/13). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that enforced rest without surgical fixation can be an effective therapeutic option for horses with a slab fracture of the central or third tarsal bone, even if athletic function is expected.     

Outcome and racing performance after internal fixation of third and central tarsal bone slab fractures in horses. A review of 20 cases

Twenty horses with central and third tarsal bone slab fractures, were treated internal fixation. Eighteen of the 20 cases were Standardbred trotters, one was a Thoroughbred racehorse and one a Swedish Warmblood. The central tarsal bone (CT) was involved in 12 cases and the third tarsal bone (T3) in 8 cases. The fractures were treated by lag screw fixation with one (18 cases) or two (2 cases) 3.5 or 4.5 mm cortical screws. Horses were confined to stall rest for one month and then put on a gradually increasing exercise programme. Convalescence time was 3-8 months until the fracture had healed and training could be resumed. Fifteen of the horses regained athletic soundness. Thirteen of the horses (72%) raced after surgery (12 Standardbreds and 1 Thoroughbred). Nine (69%) of these 13 horses won races after surgery.     

Central tarsal bone fracture in the border collie

Fracture of the plantar process of the central tarsal bone together with a dorsomedial displacement of the body of the bone was seen in six border collies. All injuries occurred during free exercise, with no extrinsic trauma. Three dogs had concomitant tarsal fractures. Primary treatment was by lag screwing the central tarsal bone to the fourth tarsal bone. All cases eventually made an excellent recovery. The superficial radiographic appearance was of a luxation of the bone as reported in a previous series, but appraisal of the radiographs showed evidence of fracture in all cases. A cadaver study to assess the mechanism of luxation showed that it is unlikely to occur naturally.     

Comparison between radiography and computed tomography for diagnosis of equine skull fractures

The equine head is a complex structure prone to traumatic injuries. To determine the value and limitations of radiography and (CT) for the diagnosis of skull fracture, the differences between the two modalities were described. Two observers retrospectively reviewed the radiographic and CT images of 18 horses with a skull fracture. To allow direct comparison between the two modalities, a simplified fracture classification system was used. In 3/18 cases the evaluation of the radiographic examination concluded no injuries visible. In 2/15 cases soft tissue involvement was not detected and in 7/15 cases the extension of the fracture was underestimated with radiography. Radiography classified 4/10 multiple fractures incorrectly as single fracture and 5/15 comminuted fractures on CT were diagnosed as simple fracture with radiography. The number of fragments was underestimated with radiography in 14/15 cases. In conclusion, radiography is able to diagnose a skull fracture in most cases. Skull fractures however are not similarly classified after radiographic and CT evaluation, which causes a difference in interpretation and perception of the fractures. Therefore, CT should be the modality of choice for surgical planning and prognosis.     

Bone scintigraphy as an aid in the diagnosis of occult distal tarsal bone trauma in three horses

History, physical examination, and bone scintigraphy were used to diagnose central and/or third tarsal bone trauma in 3 acutely lame horses. In all 3 cases, the results of initial radiographic examination were negative. Bone scintigraphy revealed focal, intense radioisotope uptake at the level of the distal tarsal bones in the 3 horses. Radiographs obtained 4 weeks after injury in one horse demonstrated a slab fracture of the central tarsal bone. Conservative management of the tarsal bone disease resulted in acceptable return to function in all 3 horses.     

Arthroscopic removal of fracture fragments involving a portion of the base of the proximal sesamoid bone in horses: 26 cases (1984-1997)

OBJECTIVE: To determine the outcome of horses with basal fractures of the proximal sesamoid bone from which a fracture fragment involving a portion of the base of the bone was removed arthroscopically and to determine whether fragment size was associated with outcome. DESIGN: Retrospective study. ANIMALS: 26 horses. PROCEDURE: Dorsopalmar and axial-abaxial lengths of the fracture fragment were measured on the dorsopalmar and mediolateral radiographic views, respectively, and percentage of the base of the sesamoid bone involved was estimated. Fractures were classified as grade 1 (< or = 25% of the base involved) or grade 2 (> 25% but < 100% of the base involved). Outcome was classified as successful if the horse started at least 2 races or unsuccessful if the horse started only 1 race or failed to return to racing. RESULTS: There were 24 racehorses and 2 nonracehorses. Twelve (50%) of the racehorses returned to racing and started at least 2 races. Eight of 14 horses with grade-1 fractures and 4 of 10 horses with grade-2 fractures had a successful outcome. Ten of 16 horses without associated articular disease had successful outcomes, compared with 2 of 8 horses with associated articular disease. However, fragment size and presence of associated articular disease were not significantly associated with outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Horses with basal fractures of the proximal sesamoid bone from which a fracture fragment involving a portion of the base of the bone is removed arthroscopically have a fair prognosis for return to racing.     

Incomplete Oblique Sagittal Fractures of the Dorsal Cortex of the Third Metacarpal Bone in Six Horses

Objective —To describe incomplete oblique sagittal dorsal cortical fractures of the equine third metacarpal bone, their surgical repair, and subsequent performance of the horses.
Study Design —Retrospective examination of medical records and racing performance.
Animal Population —Six Thoroughbred race horses, 2 to 4 years of age.
Methods —Radiographic confirmation of all fractures preceded general anesthesia and surgical correction. Three fractures were treated by intracortical compression using screws placed in lag fashion, and five fractures were treated by osteostixis. Race records were reviewed for each horse to determine performance after surgery.
Results —Fractures were best observed on palmarodorsal radiographic projections. Three horses treated by intracortical compression returned to racing, but fracture recurred in one horse and was treated by osteostixis. This horse and the other three horses treated by osteostixis raced after surgery.
Conclusions —Horses with incomplete oblique sagittal fractures of the dorsal cortex of the third metacarpal bone can race after surgical management of the fracture by screws placed in lag fashion or osteostixis. The authors' preferred surgical procedure for managing this fracture is osteostixis.
Clinical Relevance —Palmarodorsal radiographic projections of the third metacarpal bone are recommended in young Thoroughbred race horses suspected of having dorsal metacarpal stress fractures.     

Association between findings on palmarodorsal radiographic images and detection of a fracture in the proximal sesamoid bones of forelimbs obtained from cadavers of racing Thoroughbreds

OBJECTIVE: To determine the distribution for limbs and bones in horses with fractures of the proximal sesamoid bones and relationships with findings on palmarodorsal radiographic images. SAMPLE POPULATION: Proximal sesamoid bones obtained from both forelimbs of cadavers of 328 racing Thoroughbreds. PROCEDURE: Osteophytes; large vascular channels; and fracture location, orientation, configuration, and margin distinctness were categorized by use of high-detail contact palmarodorsal radiographs. Distributions of findings were determined. Relationships between radiographic findings and fracture characteristics were examined by use of chi2 and logistic regression techniques. RESULTS: Fractures were detected in 136 (41.5%) horses. Biaxial fractures were evident in 109 (80%) horses with a fracture. Osteophytes and large vascular channels were evident in 266 (81%) and 325 (99%) horses, respectively. Medial bones typically had complete transverse or split transverse simple fractures, indistinct fracture margins, > 1 vascular channel that was > 1 mm in width, and osteophytes in abaxial wing and basilar middle or basilar abaxial locations. Lateral bones typically had an oblique fracture and distinct fracture margins. Odds of proximal sesamoid bone fracture were approximately 2 to 5 times higher in bones without radiographic evidence of osteophytes or large vascular channels, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Biaxial fractures of proximal sesamoid bones were common in cadavers of racing Thoroughbreds. Differences between medial and lateral bones for characteristics associated with fracture may relate to differences in fracture pathogeneses for these bones. Osteophytes and vascular channels were common findings; however, fractures were less likely to occur in bones with these features.     

Fractures of the lateral malleolus of the tibia in 16 horses.

Clinical and radiological features of 16 horses with fractures of the lateral malleolus of the tibia are reported. The paper describes surgical techniques used, results obtained and discusses justification for removal. Fourteen fractures were unilateral and two bilateral. There was no left:right disparity. The history included a known traumatic incident in 14 cases. All animals had a tarsocrural joint effusion and 10 had palpable thickening of the lateral collateral ligaments. Crepitus was also palpable in 10 horses. The fracture was identified in all dorsoplantar and 14 of 18 dorsomedial-plantarolateral oblique radiographic projections. Nine fractures were simple and 9 comminuted. All fractures were removed via a tarsocrural arthrotomy. Approaches were dorsolateral in 14 joints, plantarolateral in 3 and dorsolateral and plantarolateral in 1. After an ascending exercise programme horses returned to work 6 months after surgery: 15 horses were free of lameness after 17-62 months, with 13 animals performing at a level similar to pre-injury standard.     

The onset and consequences of tarsal bone fractures in foals

Fractures of the central tarsal and/or third tarsal bones involving both limbs of six foals are described. Five of the subjects were born either premature or of twin pregnancies. Fractures occurred in the neonatal period and coincided with disablement. Features of behaviour, posture and gait are described, together with gross radiographic findings, bone ash determination and blood chemistry. Lesions observed on the artitular faces of tarsal bones recovered from adult horses may have originated during the neonatal period.     

The onset and consequences of tarsal bone fractures in foals

Fractures of the central tarsal and/or third tarsal bones involving both limbs of six foals are described. Five of the subjects were born either premature or of twin pregnancies. Fractures occurred in the neonatal period and coincided with disablement. Features of behaviour, posture and gait are described, together with gross radiographic findings, bone ash determination and blood chemistry. Lesions observed on the articular faces of tarsal bones recovered from adult horses may have originated during the neonatal-period.     

DISTAL PHALANX FRACTURES IN HORSES

The case records of 274 horses with fractures of the distal phalanx were reviewed. Fifty-two horses had bilateral forelimb fractures, for a total of 326 distal phalanx fractures. The fractures were classified into one of five previously described types, based on the radiographic anatomic configuration of the fracture. Solar margin fractures, which have been briefly described in other reports and previously classified as type V fractures, were identified in 132 horses. This type of fracture is distinct from other distal phalanx fractures. Due to the high incidence of solar margin fractures, these fractures were classified as a separate type (type VI). Follow-up radiographic examinations to assess fracture healing were available for 36 horses. Twenty-two horses with distal phalanx fractures (three type I, nine type II, two type III, one type IV, one type V, and six type VI) had radiographic evidence of complete bony union of the fracture at a mean of 11 months after injury. Eight horses with complete type II fractures involving the articular surface had bony union of the body and solar margin, but not the subchondral bone at the articular surface, a mean of 11 months after injury. Six horses (four type II and two type IV) had little radiographic evidence of bony healing during the follow-up period. All fractures that eventually healed had evidence of progression toward bony union by 6 months after injury.     

A Lateral Approach to the Repair of Propagating Fractures of the Medial Condyle of the Third Metacarpal and Metatarsal Bone in 18 Racehorses

Objectives— To report the technique, observations on fracture configurations and results of treatment by fixation lag screw following the fracture plane determined by an approach to the third metacarpal/metatarsal bone (MC3/MT3) that begins laterally over the metacarpo(metatarso)phalangeal joint and extends dorsally over the diaphysis of the bone.
Study Design— Case series.
Animals— Thoroughbred horses (n=18) with propagating fractures of the medial condyle of MC3/MT3.
Methods— Retrospective analysis of case records of horses with fractures of the medial condyle of MC3/MT3 that propagated sagittaly or in a spiral configuration into the diaphysis, repaired surgically under general anesthesia by screw fixation in lag fashion through a lateral approach with periosteal reflection.
Results— Fractures were readily identified at surgery, enabling screw fixation in lag fashion following the fracture plane. Fracture configurations varied and could be classified as sagittal and spiral fractures with fractures within each group generally following a similar course. All horses recovered relatively uneventfully from general anesthesia and surgery, and all fractures healed well. Thirteen horses returned to training; 5 subsequently raced.
Conclusions— Repair of propagating sagittal and spiral fractures of the medial condyle of MC3/MT3 with diaphyseal involvement, through a lateral approach with periosteal reflection permits stable fixation with minimal complications. In this series there were no catastrophic failures.
Clinical relevance— Fractures of the medial condyle of MC3/MT3 that propagate either sagittaly or in a spiral configuration into the diaphysis can be successfully repaired with screw fixation in lag fashion using a lateral approach with periosteal reflection.     

Fractures of the central and third tarsal bones in horses

The case histories and follow-up data for 11 horses with slab fractures of the central or 3rd tarsal bones were examined for information pertaining to the diagnosis, which was difficult to identify, treatment, which was proven ineffective, and the prognosis, which was shown to be poor for return to racing. The purpose of the study was to define the results that could be obtained by nonoperative methods, in an attempt to determine whether surgical treatment was advisable. Nine of the horses were Standardbreds and 2 were Thoroughbreds; all horses were 2 to 4 years old and were being exercised at race speed when the injury occurred. The diagnosis usually was made at the referral examination, some time after injury. Distention of the tibiotarsal joint usually developed following fracture of the central tarsal bone. In some fractures, local anesthetic injection or multiple radiographic views were required for diagnosis. Not all fracture planes were demonstrable radiographically. Prolonged rest was ineffective in restoring athletic soundness. Lag screw fixation was used in 1 horse, the only horse in the series that raced successfully after injury.     

Fractures of the palmar aspect of the carpal bones in horses: 10 cases (1984-2000)

OBJECTIVE: To determine clinical and radiographic findings, treatment, and outcome of horses with fractures of the palmar aspect of the radial carpal bone, with or without concurrent fractures of the palmar surfaces of the other carpal bones. DESIGN: Retrospective study. ANIMALS: 10 horses. PROCEDURE: Medical records were reviewed to obtain information on history, signalment, clinical and radiographic findings, treatment, and outcome. Follow-up information was gathered from owners and referring veterinarians. RESULTS: 7 horses became lame after recovery from general anesthesia for treatment of an unrelated problem. The remaining 3 horses developed a fore-limb lameness after falling (1 horse) or being turned out in a pasture (2 horses). Fractures involved the palmar surface of the radial carpal bone in all 10 horses; in addition, the ulnar carpal bone was affected in 2 horses, the intermediate carpal bone in 2 horses, and the distal aspect of the radius in 4 horses. None of the 4 horses treated nonsurgically returned to work, and 3 were euthanatized because of recalcitrant lameness. In the other 6 horses, fragments were removed surgically. Two were euthanatized because of continued lameness, 1 was euthanatized for other reasons, 2 were sound enough for light work, and 1 returned to athletic work. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that fractures of the palmar aspect of the carpal bones are uncommon in horses. The prognosis appears to be poor for affected horses but may be better for horses that undergo arthroscopic removal of intra-articular fragments.     

Fractures of the rostral portion of the mandible and maxilla in horses: 89 cases (1979-1997).

OBJECTIVE: To compare fracture locations, repair methods, complications, and outcomes of horses with fractures of the rostral portions of the mandible and maxilla. DESIGN: Retrospective study. ANIMALS: 89 horses with fractures of the rostral portions of the mandible and maxilla. PROCEDURE: Medical records and radiographs were reviewed. Fractures were categorized by fracture location and stability. Postoperative complications and long-term outcome were determined by clinical examination and telephone interviews with horse owners. RESULTS: 4 fracture types were recognized. Fractures involving just the alveolar plate (33%) and those involving the alveolar plate and the body of the bone (32%) were most common and were often repaired by interdental wiring. Unilateral fractures of the mandible (11%) were managed without surgery if stable. Unstable fractures were repaired with wires, a U-shaped bar (U-bar), or a bone plate. Bilateral fractures (24%) were often repaired with orthopedic wires in foals or with a U-bar, acrylic splint, wires, or bone plate in adult horses. In 2 horses, bilateral fractures were managed conservatively. Short-term complications developed in 24 of 89 (27%) horses. Soft tissue infections and wire loosening or failure were the most common short-term and long-term complications. Wire replacement was not required in any horses after release from hospital. Persistent draining tracts were most often associated with bone sequestration. Long-term functional and cosmetic outcomes were favorable for all fracture types and repair methods. CLINICAL IMPLICATIONS: Although complications in horses with fractures of the mandible and maxilla are common, long-term prognoses for functional and cosmetic outcome are favorable.     

Comparison of radiography and computed tomography to evaluate fractures of the canine tarsus

Detection and accurate classification of traumatic tarsal fractures are important for identifying cases requiring surgical intervention. The aim of this prospective, experimental, methods comparison study was to directly compare the accuracy, sensitivity, and specificity of tarsal computed tomography (CT), ten‐view and two‐view digital radiographs for detecting traumatic fractures of the canine tarsus. The working hypothesis was that tarsal fractures would be detected with higher accuracy, sensitivity, and specificity using CT imaging compared to radiography, and a ten‐view would be superior to a two‐view radiographic study. Ten cadaver hind limbs of medium to large dogs received a CT scan and ten‐view radiographic study before and after induction of fractures with a hydraulic press. All bones included in the radiographic images were assessed for fractures by two observers and gross dissection was used as the gold standard. The two‐view radiographic study (dorsoplantar, lateromedial) was created from the ten‐view study and reviewed 2 years later. All limbs sustained fractures, the most common locations were the talus and calcaneus (n = 7). The sensitivity of CT was greater than ten‐view radiographic study (77% vs. 57%), while the specificity was similar (97% vs. 98%). The sensitivity and specificity of the ten‐view and two‐view radiograph studies were similar (57% vs. 55%; both 98%). Computed tomography images were reassessed postdissection to determine if failure to identify fractures resulted from observer error. Overall, CT was better than radiography for detecting fractures of the canine tarsus, however there was little improvement with ten‐view compared to two‐view radiographic studies.     

Alteration of distal tarsal subchondral bone thickness pattern in horses with tarsal pain

REASONS FOR PERFORMING STUDY: Understanding of the development of pathology and source of pain in distal tarsal osteoarthritis is poorly understood. Magnetic resonance imaging is often used in the analysis of human osteoarthritis (OA) because it is sensitive to early changes. HYPOTHESIS: In association with distal tarsal joint (DTJ) pain, there will be an alteration in the characteristic subchondral bone (SCB) thickness pattern of horses with no history of pain when subjected to low-level exercise. METHODS: Sixteen cadaver tarsal joints were collected from 9 mature horses with a history of tarsal pain and radiographic evidence of OA; 3 cadaver tarsi were collected from 2 mature horses with a history of tarsal pain and no radiographic abnormality. Magnetic resonance images were acquired using high-resolution sagittal 3D T1 weighted spoiled gradient echo sequence. Subchondral bone thickness was measured on sagittal images at dorsal and plantar locations on the proximal and distal aspects of the central (CT) and third (T3) tarsal bones and proximal aspect of the third metatarsal bone (MT3). RESULTS: In tarsi with radiographic evidence of OA medial and lateral SCB thicknesses were greater than midline on the proximal and distal aspects of CT and T3. Lateral SCB thickness was greater than medial on the proximal aspect of MT3. There was an increase in SCB thickness at the majority of sites compared with normal horses. There were too few joints in the group without radiographic changes to analyse statistically. In painful tarsi SCB thickness was greater medially than laterally at all sites. In horses without tarsal pain all lateral sites had greater SCB thickness, except the proximal aspect of CT. CONCLUSIONS: There is alteration of normal SCB thickness patterns in painful tarsi. Different thickness patterns could represent different types of pathological processes. Potential clinical relevance: Further work is required to elucidate the pathological processes leading to OA of the DTJs.     

The prevalence of temporal bone fractures is high in horses with severe temporohyoid osteoarthropathy

Temporohyoid osteoarthropathy is a well‐recognized cause of equine neurologic disease. Temporal bone fractures associated with temporohyoid osteoarthropathy have been recognized with CT, however, little information is available regarding these fractures. The aims of this retrospective analytical study were to assess the prevalence of these fractures and to describe the specific configurations and associated imaging and clinical features. Fracture of the temporal bone was identified with CT in 16 of 39 included horses. All fractures were unilateral, minimally displaced and extended through the temporal bone in a rostrodorsal to caudoventral orientation. Two fracture configurations were identified: in nine cases, the fracture extended the full width of the petrous pyramid into the cranial vault and in seven cases, the fracture only extended through the lateral part of the petrous temporal bone, not involving the cranial vault. Fusion of the temporohyoid joint was present in 13 of the 16 fracture cases. Quarter Horses were over‐represented in the fractured population (14/16). All horses with fractures had ipsilateral neurologic deficits. Patient outcomes were not significantly different between temporohyoid osteoarthropathy horses with and without temporal bone fractures (P = 0.68). However, six of the nine patients with cranial vault involvement did not return to their previous use. Findings support previous studies indicating that temporal bones should be carefully assessed for concurrent fractures when temporohyoid osteoarthropathy is identified in CT images, especially when there is fusion of the temporohyoid joint. An improved awareness of specific fracture configurations will help with detection of these fractures.     

RADIOGRAPHY AND COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF NONNEOPLASTIC EQUINE MANDIBULAR DISEASE

We compared the information gained from computed tomography (CT) vs. radiography in horses with nonneoplastic disease of the mandible. We hypothesized that CT would provide additional diagnostic information. Medical records, radiographs, and CT images of horses with nonneoplastic mandibular disease evaluated between 1994 and 2008 were reviewed. Nineteen horses were identified; 11 had a tooth root abscess and related disease, four had a fracture of the teeth and/or mandible, and four had a nonneoplastic mass. Both CT images and radiographs allowed identification of diseased teeth that appeared clinically normal otherwise. CT allowed identification of teeth that were clinically affected but appeared normal radiographically. Parameters such as tooth pulp involvement, lamina dura destruction, presence of bone fragments, lingual and buccal mandibular bone periosteal reaction, and cortical bone destruction were more conspicuous with CT. Performing radiography and CT in horses with nonneoplastic mandibular disease provides a more complete evaluation than either technique alone. CT contributes additional information that could otherwise be overlooked with radiographs alone in horses with a mandibular fracture. CT provides ancillary information to radiographs in horses with dental infection or a nonneoplastic mass of the mandible.