Prevalence of osseous fragments in distal and proximal interphalangeal, metacarpo- and metatarsophalangeal and tarsocrural joints of Hanoverian Warmblood horses

The prevalence of osseous fragments in different limb joints was analysed in 3749 young Warmblood riding horses, which were pre-selected for sale at auction from 1991 to 1998 by the Association of Hanoverian Warmblood Breeders (Verband hannoverscher Warmblutzüchter e.V.) in Verden (Aller), Germany. The evaluation of these horses was based on a standardized radiological examination, including the distal interphalangeal (DIJ), the proximal interphalangeal (PIJ), the metacarpo- and metatarsophalangeal (MC/MTJ) and the tarsocrural joints (TCJ). In 32% of all horses at least one osseous fragment was found on these radiographs. TCJ were affected in 9.6% of the horses and MC/MTJ in 20.7%. The percentage of horses affected in the MTJ was significantly higher (13.7%) than that of horses affected in the MCJ (9.5%). The prevalences of osseous fragments were considerably lower in DIJ (4.5%) and PIJ (0.9%). Osseous fragments only occurred either in DIJ or PIJ or MC/MTJ or TCJ in 87% of the affected horses. Depending on the joint type, osseous fragments were found in analogous joints in the front and the hind limbs in up to 26% of the affected horses, whilst bilateral affection occurred in between 10% and 46% of the horses. Distribution of osseous fragments in the limb joints investigated here did not differ significantly between male and female horses. There was a significant increase in the percentage of horses with osseous fragments in MC/MTJ during the study period. The results of this study indicate the need to act against the high prevalences of osseous fragments in the limb joints of young Warmblood riding horses.     

Arthroscopic surgery for osteochondral fractures of the proximal phalanx of the metacarpophalangeal and metatarsophalangeal (fetlock) joints in horses

Arthroscopic surgery for osteochondral fractures of the proximal phalanx was performed on 74 fetlock joints of 63 horses for a total of 87 fractures during a 2-year period. The medial dorsal proximal aspect of the proximal phalanx of the forelimbs was most commonly involved (59 fractures), followed by the lateral aspect (26 fractures), and 2 fractures occurred in the fetlock joint of the right hindlimb. At surgery, 82 fragments were removed and 5 fragments that had healed or were embedded in the joint capsule were not removed. Of the fragments removed, 15 were fixed firmly to the proximal phalanx, 63 were easily movable by arthroscopic instruments (but had soft tissue attachments to the proximal phalanx), and 4 were floating free within the joint. Arthroscopic surgery allowed excellent visualization and appreciation of the attachments of fragments and their stage of healing. Horses returned to full race training at an average of 11 1/2 weeks (range, 6 to 24 weeks). Thirty eight of 46 horses (82.6%) with adequate postoperative follow-up returned to athletic performance at least equal to that before fetlock injury.     

Conditions of the interphalangeal joints

The various conditions of the interphalangeal joint are presented; these include degenerative joint disease and osteochondral chip fractures of the proximal interphalangeal joint, fractures of the middle phalanx affecting proximal and/or distal interphalangeal joints, subluxation and osteochondrosis of the proximal interphalangeal joint, and arthrosis of the distal interphalangeal joint.     

A phalangeal fusion defect and osteochondrosis dissecans with subluxation of the distal interphalangeal joints in a foal

A fusion defect of the proximal and middle phalanges of both hindlimbs, osteochondrosis dissecans of the distal interphalangeal joints of the forelimbs, and subluxation of all 4 distal interphalangeal joints occurred in a Standardbred filly. Lameness was the first abnormality noted and was observed at one week of age in the left forelimb and progressed until all 4 limbs were affected by 5 weeks of age. On radiographs of both forelimbs, the distal interphalangeal joints were subluxated with irregularity and lucency of subchondral bone. On radiographs of the distal hindlimbs, there was a subluxation of both distal interphalangeal joints and loss of the proximal interphalangeal joint spaces with fusion of the proximal and middle phalanges. The foal was euthanised. On necropsy, there were focal areas of erosion of articular cartilage in the distal interphalangeal joint of both forelimbs. The proximal and middle phalanges of both hindlimbs were fused. Histopathological examination of the distal interphalangeal joint of the right foreleg showed loss of articular cartilage and degenerative changes in the exposed subchondral bone.     

Field technique for the resection of the distal interphalangeal joint and proximal resection of the deep digital flexor tendon in cows

A modified technique for the resection of the distal interphalangeal joint and the proximal resection of the deep digital flexor tendon in cows is described. Septic arthritis of the joint was diagnosed in eight Holstein cows and treated in the field. Four of the cows were diagnosed with ascending tendonitis during the resection of the joint and their tendons were also resected. All the animals remained moderately to severely lame for two weeks postoperatively but quickly recovered and were sound within five months. Eight months after the last surgery only one cow had been culled, 321 days after its surgery, for reproductive failure. The other seven cows had survived for a mean period of 308 days, with a range from 235 to 392 days.     

Resection of the distal/proximal interphalangeal joint and digit amputation in 21 breeding bulls--indications, clinical findings and longterm outcome

Case records of 21 breeding bulls suffering from advanced septic claw disorders and treated with resection of the distal interphalangeal (= DIP) joint (n = 14), resection of the proximal interphalangeal joint (n = 1) and digit amputation (n = 6) were evaluated retrospectively (1992-2005) regarding the following parameters: breed, age, body mass, pre-treatment, localisation of disease, lameness degree, diagnosis, surgical method, outcome, postoperative survival time and return to breeding use. The mean age of the bulls was 3.6+/-1.7 years and the mean body mass 840.7 + 200.8 kg; range: 500-1200 kg), Surgery was carried out to treat the following conditions: white line infection (n = 9), sole ulcers (n = 5) with osteolysis of the distal sesamoid bone, the tuberculum flexorium, infection of the deep digital flexor tendon at insertion and the DIP-joint; osteomyelitis of the distal and middle phalanx with septic arthritis of the DIP-joint following deep penetrating wounds (n = 3); open fracture of the coffin bone with severe osteolysis/osteomyelitis and septic fibrino-purulent arthritis of the DIP-joint (n = 2); purulent arthritis of the proximal interphalangeal joint after a penetrating wound (n = 1) and a severe osteolysis/osteomyelitis of the coffin bone originating from a toe ulcer (n = 1). Three bulls were culled within 2-12 weeks after surgery due to postsurgical complications. In three bulls which were treated successfully six years ago, long-term follow-up information could not be obtained. Complete recovery was considered in 15 bulls.They returned to full breeding use three to four months after surgery, with a mean postoperative survival time of 24.1 months:21.2 months after joint resection and 27.2 months after amputation. At the time of this survey three bulls were still alive with 4,7 and 84 months after surgery, respectively. Both surgical methods were successful in breeding bulls, the resection of the distal interphalangeal joint is recommended as first option.     

Anatomical considerations of the distal interphalangeal joint of sheep

The ligamentous attachments and the extent of the capsule of the distal interphalangeal joint of sheep was studied using both dissection and radiographic techniques. The distal interphalangeal joint was considered to be most vulnerable to infection and trauma on the axial, or interdigital, aspect where the joint capsule protrudes above the coronary border. In sheep the interdigital ligament and each proximal collateral sesamoidean ligament help to unite the two digits: a role performed in cattle by the cruciate ligament.     

Arthroscopic surgery in the management of contamination and infection of joints,tendon sheaths,and bursae

Arthroscopic surgery has been reported to provide advantages in the management of infected joints in man and the use of endoscopy (arthroscopy) is now common in treating infected synovial structures in horses. It is proposed that the objectives in managing contaminated and infected joints, tendon sheaths, and bursae are optimized by inclusion of arthroscopy in their evaluation and treatment. This requires no additional equipment over and above that commonly used for equine arthroscopy, although motorized apparati are highly advantageous. This paper describes the author's current protocol in managing such cases and discusses the role of arthroscopy and its relationship with other concurrently employed treatment modalities. Its principal contributions to case management are considered to be comprehensive evaluation of the cavity, identification and removal of foreign material and contaminated or infected tissues, and by concurrent directed high-pressure lavage. These produce efficient mechanical cleansing of the cavity, which is combined with minimal tissue trauma and uncomplicated postoperative care.     

Facilitated ankylosis of the distal interphalangeal joint in a foal

A 3-month-old Quarter Horse colt sustained a penetrating injury over the coronary band on the right forelimb resulting in an articular bone sequestrum and septic arthritis of the distal interphalangeal joint. Despite aggressive treatment for septic arthritis, severe osteoarthritis and ongoing sepsis resulted in persistent lameness. Facilitated ankylosis of the distal interphalangeal joint was performed using a combination of open surgical debridement, placement of an autogenous cancellous bone graft and stabilisation within a transfixation cast. Bony ankylosis of the joint was observed radiographically 7 weeks following surgery. Evaluation of the horse 30 months following surgery revealed complete fusion of the middle and distal phalanges, and the distal sesamoid bone. The horse is pasture sound and is used as a breeding stallion. This report describes the surgical approach and case management employed to achieve facilitated ankylosis as a treatment for unresolved septic arthritis of the distal interphalangeal joint. This is the first report of successful facilitated ankylosis of the distal interphalangeal joint in a foal.     

Flexural deformities of the distal interphalangeal joint (clubfeet)

A true clubfoot results from a flexural deformity of the distal interphalangeal joint that is characterised by a shortening of the deep digital flexor tendon musculotendinous unit. Flexural deformities are a problem not only in foals but are also responsible for the clubfoot conformation seen in mature horses. Treatment is most successful when the cause is investigated and therapy initiated as early as possible, and when the biomechanical properties of the foot are thoroughly understood. Flexural deformities in foals and mature horses are addressed through appropriate farriery, often combined with surgery.     

Arthroscopic anatomy of the intercarpal and radiocarpal joints of the horse

Arthroscopic anatomy of the equine intercarpal and radiocarpal joints was documented in six cadaver limbs and on observations made during surgical treatment of horses with carpal osteochondral fractures. Instrument positions and arthroscopic visualisation were recorded. The cadaver limbs were dissected and iatrogenic lesions recorded. A single arthroscopic portal examination was adequate in both joints; however, a second arthroscopic portal improved visualisation. The intercarpal joint was more easily examined than the radiocarpal joint because of anatomical differences. Iatrogenic lesions were associated with failure of joint capsule distention during penetration.     

Laser-Facilitated arthrodesis of the distal tarsal joints

Arthritis of the distal tarsal joints is a common cause of lameness in performance horses. Clinical signs of distal tarsal arthritis are variable and may include gait abnormalities typical for tarsal lameness, including accentuated elevation of the affected limb, shortened cranial phase of the stride, and decreased arc of the foot. Affected horses frequently resent palpation of the lumbar and gluteal musculature. The lameness is usually increased after a hind limb flexion test. This condition is most commonly treated with intra-articular injections of sodium hyaluronate and corticosteroids in conjunction with controlled exercise and systemic nonsteroidal anti-inflammatory medication. Horses that are refractory to this form of treatment have traditionally been treated by cunean tenectomy with inconsistent results. Various surgical techniques have been used to achieve arthrodesis of these joints in an effort to eliminate the lameness associated with arthritic changes in these joints. Laser-assisted arthrodesis offers a minimally invasive surgical procedure with a relatively short convalescent period that eliminates the clinical signs of lameness in a high number of cases.