Standing low‐field magnetic resonance imaging of a comminuted central tarsal bone fracture in a horse

This report describes the use of low‐field standing magnetic resonance imaging (MRI) in the diagnosis and clinical decision making process in a 14‐year‐old Dutch Warmblood mare with a comminuted central tarsal bone fracture. Magnetic resonance imaging in the standing horse was preferred over computed tomography examination under general anaesthesia because the animal had sustained the injury during a poor recovery from a previous general anaesthetic episode. Magnetic resonance imaging examination identified a comminuted central tarsal bone fracture with a configuration that was not identifiable with radiography. Due to extensive comminution of this fracture, conservative management was pursued. Standing low‐field MRI examination enabled safe examination of this animal and provided useful diagnostic information whilst facilitating the clinical decision making process.     

FRACTURE OF THE CENTRAL TARSAL BONE IN NONRACEHORSES: FOUR CASES

Fractures of the central tarsal bone are a rarely recognized cause of acute severe hind limb lameness in nonracehorses. Diagnosis of these fractures can be challenging and little is known about their configuration or outcome. The objectives of this retrospective case series study were to describe the clinical features, imaging findings, and outcomes of fractures of the central tarsal bone in a sample of nonracehorses. Medical records from 2001 to 2014 were searched for cases of central tarsal bone fractures in nonracehorses. All available imaging findings including radiography, ultrasound, computed tomography (CT), and/or nuclear scintigraphy were reviewed. History, clinical presentation, and outcome were collected from the records. Four horses met the inclusion criteria. All had a similar configuration as a simple nondisplaced slab fracture in a dorsomedial to plantarolateral orientation. Initial radiographs failed to reveal the fracture in three of four cases. When additional plantarolateral‐dorsomedial oblique radiographic views were obtained, the fracture could be identified in all cases. Fractures of the central tarsal bone seemed to occur in a consistent dorsomedial to plantarolateral orientation in this sample of nonracehorses, which is different from the configuration previously reported in racehorses. While CT can be used for detection and assessment of these fractures, authors propose that radiography can also identify these fractures with the appropriate view. Authors recommend the use of several plantarolateral to dorsomedial radiographic projections at varying degrees of obliquity for horses with a suspected central tarsal bone fracture.     

Granulosa thecal cell tumour in a mare causing hypertrophic osteopathy

Hypertrophic osteopathy (HO) is a rare condition in the horse characterised by symmetrical proliferation of connective tissue and subperiosteal bone, along the diaphyses of limb bones. In this case, a 10‐year‐old Irish Draught cross Thoroughbred mare was presented for investigation of weight loss, lethargy and firm swelling of all 4 distal limbs. Radiographs of the distal limbs revealed palisade‐like periosteal new bone formation perpendicular to the cortex of the distal third metacarpal and metatarsal bones, proximal (P1) and mid (P2) phalanges. Rectal examination revealed a mass of approximately 20 x 30 cm in the right caudoventral abdomen. The mare was diagnosed with HO due to a granulosa thecal cell (GTC) tumour. The GTC tumour was removed and the diagnosis confirmed on histological examination. Clinical examination and radiographs of the distal limbs after surgery demonstrated reduction in size of the limb swellings and new bone formation. To the authors' knowledge this is the first report of HO due to a GTC tumour in a mare.     

Computed Tomography of the Normal Bovine Tarsus

The objective of this study was to provide a detailed multiplanar computed tomographic (CT) anatomic reference for the bovine tarsus. The tarsal regions from twelve healthy adult cow cadavers were scanned in both soft and bone windows via a 16‐slice multidetector CT scanner. Tarsi were frozen at ?20^o C and sectioned to 10‐mm‐thick slices in transverse, dorsal and sagittal planes respecting the imaging protocol. The frozen sections were cleaned and then photographed. Anatomic structures were identified, labelled and compared with the corresponding CT images. The sagittal plane was indispensable for evaluation of bone contours, the dorsal plane was valuable in examination of the collateral ligaments, and both were beneficial for assessment of the tarsal joint articulations. CT images allowed excellent delineation between the cortex and medulla of bones, and the trabecular structure was clearly depicted. The tarsal soft tissues showed variable shades of grey, and the synovial fluid was the lowest attenuated structure. This study provided full assessment of the clinically relevant anatomic structures of the bovine tarsal joint. This technique may be of value when results from other diagnostic imaging techniques are indecisive. Images presented in this study should serve as a basic CT reference and assist in the interpretation of various bovine tarsal pathology.     

Computed tomographic diagnosis: Traumatic lingual process fracture and surgical resection

A 9‐year‐old mare was presented with abnormal behaviour and head‐shaking when ridden. Pathology of the hyoid apparatus was suspected and computed tomographic (CT) examination of the head was suggested. Computed tomographic images revealed a fractured lingual process (LP) of the basihyoid bone. Surgical resection of the fractured LP was performed. The mare recovered uneventfully and symptoms improved 10 weeks post‐operatively.     

Computed tomography assisted repair of a central tarsal bone slab fracture in a horse

A 13‐year‐old Quarter Horse gelding was presented for repair of a central tarsal bone fracture. Radiographs showed a single large nondisplaced sagittal slab fracture; however, computed tomography (CT) revealed an additional small, displaced central tarsal bone fragment. The complex fracture was repaired, under the same anaesthetic period as the CT examination, using the CT hard copies images, intraoperative fluoroscopy and radiographs. The horse recovered well and after rehabilitation showed no residual lameness at work. Computed tomography was instrumental in achieving precise screw placement and successful fracture repair.     

Lameness Associated with Mineralization of the Central Tarsal Bone and a Small Osseous Cyst-Like Lesion in Two Sport Horses

The clinical features, response to local analgesia, and imaging findings of two mature sport horses with lameness associated with abnormal mineralization of the dorsal aspect of the central tarsal bone and a small osseous cyst-like lesion are described. Although the radiological findings and the lesions identified using magnetic resonance imaging were similar, the lameness characteristics and responses to perineural analgesia differed. One horse failed to respond to treatment and was retired. The second horse was humanely destroyed. Postmortem examination confirmed the presence of an osseous cyst-like lesion distal to the subchondral bone plate of the central tarsal bone and extensive dense cancellous bone extending one-half the dorsoplantar depth of the bone.     

Tiludronate infusion in the treatment of bone spavin: A double blind placebo‐controlled trial

Reasons for performing study: Tiludronate regulates bone remodelling through a decrease of the resorptive process and should therefore ameliorate the remodelling processes active in osteoarthritis of the distal tarsal joints (‘bone spavin’) and alleviate pain associated with abnormal bone lysis. Objective: To confirm the efficacy of tiludronate, administered as a single infusion at a dose of 1 mg/kg bwt, in the treatment of bone spavin in the horse. Methods: A double blind placebo controlled trial on 108 clinical cases of bone spavin was undertaken. The lameness score of the lamest limb was assessed following distal tarsal analgesia of the contralateral limb and followed‐up using the same procedure throughout the study. Bone spavin in the lamest limb was confirmed by distal tarsal analgesia and radiography. Horses were treated at Day 0 and reassessed 60 days later after controlled exercise. A second nonblinded treatment was given to unresponsive horses and all horses were re‐examined at Day 120. Exercise levels were recorded at each examination. Results: Eighty‐seven horses completed the trial as per the protocol. The tiludronate horses were significantly less lame than the placebo horses (P = 0.0318). Horses treated at Day 60 with tiludronate showed further improvement in lameness at Day 120 (P = 0.0096 and P = 0.0034 for horses treated with tiludronate and placebo at Day 0, respectively). The only significant difference in radiographic findings between tiludronate and placebo was for presence of periarticular osteophytes (P = 0.006). Conclusions: Tiludronate treatment is proven to be effective in bone spavin in horses in association with a controlled exercise programme. Clinical relevance: Tiludronate in combination with controlled exercise offers an alternate medical treatment for bone spavin.     

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.     

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.     

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.     

Treatment of appendicular osteosarcoma in a horse

A 14‐year‐old Arabian gelding was examined for a mass on the lateral aspect of the left tarsus and proximal lateral metatarsus. Radiography revealed a predominately osteolytic lesion involving the fourth tarsal bone and the proximal third and fourth metatarsal bone. Results of histopathological examination of the mass prior to surgery were consistent with an undifferentiated sarcoma. The mass was surgically excised and the remaining bone defect treated with absorbable beads containing cisplatin. Histology and immunohistochemistry of the mass removed at surgery revealed a telangiectatic osteosarcoma. The surgical site healed uneventfully and the horse was performing as a low level jumper 8.5 years after surgery.     

Granulosa cell tumour: An interesting case in a pregnant mare

This report describes the successful management of a pregnant 14‐year‐old seven‐eighths Thoroughbred mare with an ovarian granulosa cell tumour. The mare initially presented with unilateral ovarian enlargement whilst being managed for artificial insemination, demonstrating normal ovarian function with ovulation from the contralateral ovary leading to conception. The mare subsequently re‐presented with stallion‐like behaviour at 3.5 months gestation and ovarian suppression was evident. The mare maintained her pregnancy and delivered a live colt foal at term. Ovariectomy was performed 3 months post foaling and the mare regained cyclic activity 9 months post surgery. The mare then conceived and became pregnant once more. The diagnostic and therapeutic challenges during pregnancy are discussed.     

Complications following tarsal arthrodesis using bone plate fixation in dogs

OBJECTIVES: To report the complications encountered following tarsal arthrodesis surgery with bone plate fixation and describe the previously unreported complication of plantar necrosis. METHODS: Medical records of 40 dogs that had been treated by tarsal arthrodesis with bone plate fixation were reviewed to determine the major and minor complications and the associated risk factors. RESULTS: The major complication rate was 32.5 per cent and the minor complication rate was 42.5 per cent. Pantarsal arthrodeses had a higher major complication rate than partial tarsal arthrodeses. Plantar necrosis was the most common major complication and occurred in 15 per cent of cases. Plantar necrosis occurred more frequently when a bone plate was applied to the medial aspect of the hock, and only occurred in cases where tarsometatarsal joint arthrodesis was performed. CLINICAL SIGNIFICANCE: Plantar necrosis is a catastrophic complication that may be associated with injury to the dorsal pedal artery or perforating metatarsal artery. Application of a bone plate to the medial aspect of the hock should be performed with care during tarsal arthrodesis, particularly where the tarsometatarsal joint is debrided of cartilage. Strict attention to surgical technique and proper postoperative coaptation is critical to reduce the potential for complications with tarsal arthrodesis.     

Third tarsal bone fractures in the greyhound

Objective : To describe the signalment, morphology, response to treatment and prognosis of third tarsal bone fractures in the racing greyhound. Methods : All third tarsal bone fractures seen by the author over a ten year period were included in the study. Diagnosis was by radiography. Treatments were reconstruction with a lag screw, fragment removal, centrodistal joint arthrodesis or conservative management. Results : Twenty-three cases were included in the study of which 16 cases were recent and seven cases chronic fractures. The chronic cases had been rested from between three and six months before an examination for recurrent lameness. There were five concomitant second tarsal bone fractures. Partial dorsal collapse was present in four cases. Thirteen dogs had lag screw fixation; three were lost to follow-up, seven returned to racing and three, all with partial tarsal collapse, failed to return to racing. Two dogs that had a centrodistal joint arthrodesis and one dog treated by rest alone raced again. Two dogs that had fragment removal failed to return to racing. Clinical significance : Veterinary examination of greyhounds with third tarsal bone fractures is often not sought at the time of the initial injury due to the benign presenting signs. Recurrence of lameness after rest is common. The prognosis for a successful return to racing would appear to be good following fragment fixation in both acute and chronic cases without dorsal tarsal collapse. Centrodistal joint arthrodesis may encourage bone union. The prognosis for conconservatively treated cases is guarded. Fragment removal is not recommended as a treatment.     

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.     

Tarsometatarsal subluxation in dogs: partial arthrodesis by plate fixation

In a retrospective study of tarsometatarsal joint subluxation in eight dogs, secondary fractures were identified in six dogs, particularly of the fourth tarsal bone and the proximal fifth metatarsal bone. Common causes of tarsometatarsal joint injury included jumping or falling and direct trauma to the foot. Partial tarsal arthrodesis, with the use of bone-plate stabilization and cancellous bone grafting of joint spaces after removal of articular cartilage, led to progressive bone healing in all dogs. Implant breakage did not occur in any dog.     

Anastomosis of the medial digital artery in a mare following traumatic laceration

A 7‐year‐old Warmblood mare presented with blood loss from a laceration of the medial digital artery sustained in the field. The mare was initially managed conservatively by pressure bandaging but the bleeding did not stop. After a blood transfusion the mare underwent arterial repair under general anaesthesia and was initially managed in a cast post operatively. Doppler ultrasonography 4 days post operatively confirmed effective blood flow distal to the arterial anastomosis and the mare was discharged from the hospital. At 6 months follow‐up the owner reported that the mare was sound at the trot with an excellent cosmetic outcome of the surgical site.     

Pathological fracture through a subchondral bone cyst in the proximal phalanx of a horse

A 12‐year‐old Morgan broodmare presented for a nonweightbearing right forelimb lameness. Radiography and computed tomography confirmed the presence of a pathological fracture of the proximal first phalanx through a large subchondral bone cyst (SBC) in the right forelimb and a large SBC in the proximal first phalanx of the left forelimb. Surgical repair of the large palmar medial eminence fracture of the proximal first phalanx fracture was performed using bone screws placed in lag fashion placed through stab incisions after debridement and bone grafting of the SBCs. Approximately 6 months after surgery the mare was ambulating comfortably at pasture. This case report describes a fracture through a large subchondral bone cyst in a horse despite chronicity and ongoing bone remodelling. Careful consideration regarding exercise or use should be considered in horses with large SBCs.