Active tension‐extension splints: A novel technique for management of congenital flexural deformities affecting the distal limb in the foal

A variety of methods are described for managing distal limb flexural deformities in the foal, including intravenous oxytetracycline and splint or cast use. This case series describes a novel technique that creates an ‘active tension‐extension splint’ by wiring the toe into a custom‐made fibreglass splint and therefore into active extension. A dorsal fibreglass splint is made by halving a cast that is set around the affected leg with padding underneath it, so that it is sculpted to a more appropriate anatomical shape. Cerclage wire is placed through the toe and the dorsal aspect of the splint, then tightened to pull the limb into active extension. Foals with distal limb flexural deformities that were treated in this way were followed up by examination of hospital records and telephone questionnaire. Records were examined for 13 foals treated between 2004 and 2010. One foal developed septic osteitis of the distal phalanx due to suspected laminar penetration; other post operative complications seen were bandage sores and minor cosmetic scarring. Out of 10 foals where follow‐up by questionnaire was available, 8 had complete resolution of their deformity following active tension‐extension splinting, one required inferior check ligament desmotomy for complete correction and one had carpal flexural deformities that did not resolve. All that survived to adulthood are sound and have achieved their intended purpose. This previously unpublished technique using a wire through the toe to create an active tension‐extension splint has a high success rate for correction of congenital flexural deformities affecting the distal interphalangeal and metacarpo‐/metatarsophalangeal joints in the foal. The majority of post operative complications are minor and easily managed. This is a simple technique that can improve the management of neonatal distal limb deformities both in a hospital situation and for equine practitioners in the field.     

Congenital bilateral aplasia of the metacarpophalangeal joints in a foal

A 2‐day‐old Warmblood filly was presented for examination of an angular limb deformity of the left front limb and an upright conformation of both metacarpophalangeal joints. Radiological examination revealed bilateral absence of the metacarpophalangeal joint space with fusion of the third metacarpal bone and first phalanx (synostosis). No treatment was undertaken. The filly was readmitted to the clinic 10 weeks later for bilateral front limb lameness. On radiological examination, the synostosis of the front metacarpophalangeal joints was still present. Physitis of the distal growth plate of the right third metacarpal bone and proximal growth plate of the right proximal phalanx, and an avulsion fracture of the palmaromedial and proximal aspect of the left middle phalanx, with a cystic like lesion on the medial aspect of distal first phalanx and proximal middle phalanx were diagnosed. Given the poor prognosis, the foal was subjected to euthanasia. Post mortem examination confirmed the absence of the metacarpophalangeal joint space with a trabecular bony union between the third metacarpal bone and the first phalanx. A rudimentary joint capsule was present at the level of the absent joints as well as a small zone of articular cartilage, which invaginated over a short distance into the dorsal trabecular bone on the right front limb. On the medial aspect of the left proximal interphalangeal joint, a focal defect of articular cartilage with exposure of subchondral bone was observed. This is the first case report of a foal born with congenital aplasia of both metacarpophalangeal joints. Congenital malformations should be considered as differential diagnosis in lame foals or foals born with angular or flexural limb deformities.     

Periosteal transection of the proximal phalanx in foals with angular limb deformities of the metacarpo/metatarsophalangeal area

Bilateral angular limb deformities of the metacarpo/metatarsophalangeal regions in 2 foals are discussed. Periosteal transection was used to correct the deformity in both foals. In one foal, only the right forelimb was treated because the deformity in the left forelimb did not appear to warrant surgery. Subsequently, an angular limb deformity, which could have been prevented, developed in the left forelimb. A third foal developed a deformity in the proximal phalanx after periosteal transection of the distal third metatarsal bone.     

Management of hydrops amnion in a mare resulting in birth of a live foal

CASE DESCRIPTION: A 19-year-old Thoroughbred mare was evaluated at 265 days of gestation with a markedly distended abdomen and edema of the ventral portion of the abdomen. CLINICAL FINDINGS: The uterus was distended over the pelvic rim, making transrectal palpation of the fetus impossible. Transabdominal ultrasonography revealed excessive amounts of fetal fluid. Results of analysis of fluid obtained via amnio- and allantocentesis confirmed that the amniotic cavity was large. TREATMENT AND OUTCOME: The mare was monitored for signs of weakness of the prepubic tendon and abdominal wall. The fetus and placenta were monitored for signs of stress and pending abortion. Flunixin meglumine and altrenogest were administered to the mare. Parturition was attended and occurred at 321 days' gestation. Postpartum complications in the mare included hypovolemic shock and cardiac arrhythmias. Both conditions were treated, and the mare recovered. The foal was considered small, had bilateral angular limb deformities, and was unable to nurse. The foal was given plasma for failure of passive transfer of immunity. Ten months later, the foal underwent procedures to correct limb deformities. CONCLUSIONS AND CLINICAL RELEVANCE: Hydrops conditions are rare in horses, with hydrops allantois occurring more frequently than hydrops amnion; reportedly result in fetal or neonatal death; and may result in death of or injury to the mare. Close monitoring of maternal and fetal health in combination with supportive treatment of the mare can result in the safe progression of a hydrops pregnancy and the birth of a live foal.     

Anaphylaxis and systemic inflammatory response syndrome induced by inadvertent intravenous administration of mare's milk in a neonatal foal

Objective – To describe the diagnostic procedures, therapeutic management and successful outcome of a case of anaphylaxis induced by the inadvertent intravenous (IV) administration of mare's milk to a neonatal foal. Case Summary – A 3‐day‐old Thoroughbred colt was presented for treatment of bilateral flexural limb deformities of the forelimbs. Because the foal was unable to ambulate initially, mare's milk was administered via nasoesophageal tube feedings during treatment of the musculoskeletal disorder. Anaphylaxis resulted after unintentional administration of a bolus of 150 mL of mare's milk through a jugular catheter. Aggressive therapy for anaphylaxis and careful monitoring resulted in the successful recovery of the foal after 9 days of intensive care. New or Unique Information Provided – This case is the first published report to describe the effects of accidental IV administration of mare's milk to a neonatal foal. Medical errors are commonly reported in pediatric medicine; the intent of this report is to raise awareness of medical errors and student education in equine medicine as well as describe the therapy and outcome of anaphylaxis induced by IV administration of mare's milk in a neonatal foal.     

Fractures of the distal phalanx of the forelimb in eight foals

Fractures of the distal phalanx of the forelimb were diagnosed in 5 colts and 3 fillies ranging in age from 2 weeks to 5 1/2 months at the time of fracture. Three fractures entered the distal interphalangeal joint and 6 fractures (one foal had bilateral fractures) were nonarticular. All foals with articular fractures became sound with conservative treatment. Four of 5 foals with nonarticular fractures became sound with conservative treatment and 1 foal developed separation of the hoof at the coronary band after application of acrylic around the hoof. On the basis of our observations in these foals, sagittal articular and nonarticular distal phalangeal fractures in foals should be treated conservatively. Foals so treated would have an excellent prognosis for return to soundness.     

Traumatic disruption of the suspensory apparatus in foals

Traumatic disruption of the suspensory apparatus is a catastrophic injury in the horse. Although this injury has been described in the adult, little information is available in the foal. This paper describes 3 foals with metacarpophalangeal joint instability caused by traumatic disruption of the suspensory apparatus. Two foals had biaxial proximal sesamoid fractures in a single forelimb, and 1 foal had avulsion of the distal sesamoidean ligaments in 1 forelimb plus biaxial proximal sesamoid fractures in the other forelimb. The foals with single forelimb involvement were managed with splints, and the foal with bilateral disruption of the suspensory apparatus was euthanatized. Both treated foals resumed natural exercise at pasture. Both continue to be pasture sound 2 and 3 years after injury and are to be used for breeding. Management of disruption of the suspensory apparatus causing metacarpophalangeal joint instability using external support was effective for salvage of these 2 valuable foals for breeding.     

ULTRASOUND-ASSISTED DIAGNOSIS OF RENAL DYSPLASIA IN A 3-MONTH-OLD QUARTER HORSE COLT

A 3-month-old foal was presented for correction of bilateral angular limb deformities. Azotemia was detected as an incidental finding. Small, misshapened, hyperechoic kidneys with decreased corticomedullary demarcation were noted with ultrasonography. Additionally, the internal renal architecture was abnormal in that the intrarenal vessels and distant collecting system were not clearly seen in either kidney. Ultrasound-guided renal biopsy was suggestive of congenital renal dysplasia, which was later confirmed at necropsy. Clinical, sonographic, and pathologic features of equine renal dysplasia are discussed.     

Bilateral distal radial epiphysectomy and pancarpal arthrodesis for correction of complex carpal deformities in an American Miniature horse

A 9‐day‐old American Miniature horse was referred for evaluation and treatment of congenital bilateral carpal deformities. Clinical examination revealed a combination of flexural, angular and rotational deformities affecting both carpi. Radiographic evaluation of both forelimbs revealed malformation of the distal radial epiphysis accompanied by flexural contracture and external rotation of the limb distal to the antebrachial carpal joint. Conservative therapy was attempted with splints and bandages and failed to result in improvement. Surgical intervention was elected and a bilateral distal radial epiphysectomy and pancarpal arthrodesis performed. Fourteen months later the mare was turned out to pasture and ambulating well.     

A lag-screw technique for bridging of the medial aspect of the distal tibial physis in horses

A lag-screw technique for transphyseal bridging of the medial aspect of the distal tibial physis in foals with tarsal valgus deformities and results of the technique in 11 foals (6 with bilateral tarsal valgus deformities and 5 with unilateral tarsal valgus deformities) are described. Briefly, horses were anesthetized, and a single stab incision was made through the skin to the underlying bone over the most distal aspect of the medial malleolus. A 20-gauge needle was placed in the incision to guide screw placement, and a lag screw was inserted parallel to the medial cortex of the tibia under radiographic guidance. Screws were removed when the tarsal valgus deformity was clinically assessed to have improved by at least 80%. Clinically, all horses had evidence of a tarsal valgus deformity of > 7 degrees prior to surgery. Mean age at the time of lag-screw implanation was 220 days (range, 116 to 364 days). Mean time the implant was in place was 62 days (range, 39 to 89 days). The tarsal valgus deformity resolved in all 11 horses with excellent cosmetic results.     

Morphology and correction of distal tibial valgus deformities

OBJECTIVES: To characterise distal tibial valgus deformities in dogs through physical examination and radiographic evaluation. Methods: In a clinical study of 16 client-owned dogs, twelve unilateral and four bilateral distal tibial valgus deformities were evaluated using palpation and radiographs. The origin and amplitude of angulation, rotation and length deficits if present were measured. Radiographically, fibular length and position in relation to the tibia was compared in affected and clinically normal limbs. The dimensions of the fibular physes were also compared between clinically normal and affected limbs. RESULTS: Rottweilers and Shetland sheepdogs were overrepresented. Valgus deformities ranged from 16 degrees to 48 degrees (median, 32 degrees ) in affected and from 0 degrees to 13 degrees (median, 6 degrees ) in contralateral, clinically normal limbs. Fibular length, fibular position relative to the tibia or physeal dimensions were not statistically different between affected and clinically normal limbs. CONCLUSION AND CLINICAL RELEVANCE: Many distal tibial valgus deformities in dogs are a uniplanar deformity without concurrent craniocaudal or rotational changes or length deficits. A growth cessation in the fibula does not appear to be responsible for the development of the deformity.     

Platelet-Rich Plasma as an Adjunctive Therapy for the Management of a Severe Chronic Distal Limb Wound in a Foal

Distal limb wounds are frequent in horses after traumatic events. The use of platelet-rich plasma (PRP) represents a simple method of treating wounds in equines. A case of a chronic severely contaminated distal limb wound in an 8-month-old foal is presented. The patient was managed with the combination of standard wound therapy (debridement and bandages), surgery, and PRP obtained by a manual tube protocol. No complications were observed with the PRP treatment, and the foal was fully recovered 2 months later. The results from this case report indicate that PRP and its by-products (platelet-poor plasma) could be used as an adjunctive treatment in severe distal limb wounds in horses. A clinical controlled study should be performed to test this hypothesis.     

Myopathy with central cores in a foal

Central core disease is a nonprogressive or slowly progressive congenital myopathy with a variable degree of hypotonia and axial and proximal muscle weakness that is histologically characterized by areas devoid of oxidative enzyme activity, resulting from an absence or low numbers of mitochondria in these regions (central core). A 10-month-old, male, pony foal was examined because of stiff gait, marked contractures of the distal portion of the limbs, flexion deformities of the hooves, and moderate hypotonia that had been present from birth. The foal had increased creatine kinase (282 U/liter; reference interval 10-135 U/liter), lactate dehydrogenase (1,188 U/liter; reference interval 150-450 U/liter), and aspartate transaminase (377 U/liter; reference interval <290 U/liter) activities, suggesting muscle disease. Muscle biopsy was performed. In cytochrome oxidase-, succinate dehydrogenase-, and reduced nicotinamide adenine dinucleotide tetrazolium reductase-reacted sections, the dominant morphologic feature was the absence of oxidative enzyme activity in the cores. By use of immunohistochemical technique with a monoclonal antibody against desmin, the cores were clearly delineated and a desmin network was present within the cores. Ultrastructurally, the core areas were characterized by preserved sarcomeres with irregular Z-lines, with some streaming or zigzag appearance and abnormal sarcoplasmic reticulum profiles and T-tubules. Lack of mitochrondria within central cores was observed. Diagnosis of myopathy with central cores was made.     

Surgical correction of carpal valgus deformity in three alpacas

Two alpaca crias and one 14-month-old alpaca were referred for treatment of bilateral carpal valgus. In one cria, hemi-circumferential periosteal transection and elevation combined with an ulna osteotomy was performed initially without success, however transphyseal bridging with screws and wires was used successfully in both crias to straighten the limbs. As the distal radial and ulna growth plates had closed in the 14-month-old alpaca, bilateral wedge ostectomies of the distal radius and transfixation casts were used to straighten and stabilise the limbs. The ostectomy sites healed and the alpaca is ambulatory, although carpal flexion is significantly reduced. Until the relationship between the growth rate of crias and the success of hemicircumferential periosteal transection and elevation and ulna osteotomy is established, transphyseal bridging may provide a more reliable result in crias with carpal valgus deformity and open physes. Wedge ostectomy and application of a transfixation cast can be used to correct severe carpal valgus deformities in alpacas with closed physes.     

The use of an absorbable bone screw as a transphyseal bridge for the correction of fetlock varus deviations in six foals

This report describes and evaluates the use of a single‐positional absorbable screw (Smart Screw) ¹ as a temporary transphyseal bridge of the lateral aspect of the distal metacarpus in 6 foals with fetlock varus deformities. Using radiographic and visual assessments, an improvement in the severity of the deviation was identified in all cases. There were no complications encountered during screw placement or post operatively. The use of absorbable screws in the treatment of angular limb deformities in foals has potential and offers several advantages over the use of traditional stainless steel implants.     

Farriery for the foal: A review part 2: Therapeutic farriery

The extensive nature of this topic warrants this review paper to be divided into two parts: ‘Basic trimming in foals’ and ‘Therapeutic farriery in foals’. Management of the feet and limbs during this juvenile period will often dictate the success of the foal as a sales yearling or mature sound athlete. Overall hoof care in the foal is often a joint venture between the veterinarian and the farrier. The orthopaedic disorders discussed in this paper that require input from the two professions are flexural limb deformities (FLD) and angular limb deformities (ALD). The concept of protecting the foot from the deleterious effects of mal-loading created by many FLDs and ALDs is just as important as using the symptomatology as an instrument to correct the deformity. This paper presents a review of the current information regarding the farriery for these two limb deformities while dispelling some of the anecdotal methodology, such as the use of toe extensions to treat flexural deformities, that presently exists. Considering the deficiency of information in the literature, segments of this text will be based on the author's extensive clinical practice, comprehensive clinical records and comparisons of case outcomes.     

Complex stifle injury in a foal

A 130 kg, 60-day-old Quarter Horse male foal presented with bilateral stifle effusion and severe left hindlimb lameness. Clinical examination and imaging including radiography, ultrasound and computed tomography revealed bilateral stifle trauma. Specifically, disruption of the left medial meniscus and deep bone injury to the left medial femoral condyle (MFC) were detected, and bilateral injury to the origin of the cranial cruciate ligaments was suspected. Treatment consisted of stall rest and joint injection with corticosteroids, however there was little improvement in lameness. Due to the poor prognosis for soundness, the foal was subject to euthanasia 10 weeks after initial presentation. Post-mortem examination supported the left medial meniscus and MFC injuries and revealed avulsions of the origin of the cranial cruciate ligaments (complete on the left and partial on the right) from the lateral femoral condyle. Histopathology of the left stifle joint revealed varying depths of MFC osteochondral injury and severe left medial meniscus damage.     

Congenital Glossocheilognathoschisis and Persistent Frenula Linguae in a Foal: A Case Report

This paper describes clinical findings and surgical treatment of a foal with multiple craniofacial defects (glossocheilognathoschisis; congenital midline cleft of the lower lip, mandible and tongue combined with bilateral persistent frenula linguae) admitted to the Surgery Clinics of Faculty of Veterinary Medicine, University of Kafkas, Turkey. A thorough clinical examination revealed cleft of the lower lip and mandible combined with glossoschisis (glossocheilognathoschisis) and bilateral extensive and restrictive membranous band (frenula) of tissue at the base of the tongue. Physical examination and radiography of the other organs and tissues of the foal were within normal limits. After sedation and general anesthesia, the persistent frenulas on the right and left parts of the tongue were transected, starting from normal tongue tissue, with the scissors. The tongue was completely freed after the transection of the remaining part of the frenulum, where right and left frenulas united, and the accompanying mucosal tissue on the mandibular symphysis was removed and underlying bone tissue was superficially curetted. Cerclage wire was placed under the mucosa of the mandible and was then passed among two drilled holes below the two incisors. These two pieces of wire were twisted together and anchored over the labial surface of the mandibular symphysis junction. The mandibular symphysis was then stabilized after cerclage wire tensing. A nasogastric tube was placed to permit enteral feeding. The foal was discharged 5 days after surgery. Telephone follow-up revealed that the foal had died 15 days after the surgical intervention.     

Single transphyseal screws for the correction of moderate to severe angular limb deformities in 28 Thoroughbred foals

This study reports on the effective use of a single transphyseal screw for the treatment of moderate to severe angular limb deformities (ALDs) of the fetlocks and carpi of 28 young Thoroughbred foals. The objective was to evaluate the surgical management of foals with moderate to severe ALDs treated with single transphyseal screws. Evaluation of medical records of 28 Thoroughbred foals treated with single transphyseal screws placed across the distal radial, metacarpal and metatarsal physes was undertaken. The angle of joint deviation was measured prior to implantation and at removal of the implants, and the degree of improvement was calculated. A total of 39 screws were placed: 24 in the distal metacarpus or metatarsus and 15 in the distal radial physis. Varus or valgus deformities in the fetlock improved by 4–5° over a period of 15–30 days. Varus or valgus deformities in the carpi improved by 8–11° in 11–56 days. One case failed to improve adequately due to implant infection. Single transphyseal screws were effective in treating moderate to severe varus and valgus ALD of the fetlocks and carpi in young Thoroughbred foals. Further investigation into their use in the distal radius in young foals is needed. While single transphyseal screws are almost exclusively used by some clinics in the distal metatarsal and metacarpal physes, many clinicians do not use them in the distal radial physis of young foals due to fear of over‐correction, physitis and metaphyseal collapse. This was not observed in any of our cases.     

Intraosseous regional perfusion for treatment of septic physitis in a two-week-old foal

A 2-week-old Morgan filly examined because of lameness of 5 days' duration was found, on the basis of clinical and radiographic findings, to have septic physitis of the distal end of the radius. The foal was treated by means of intraosseous regional perfusion with penicillin and amikacin and systemic administration of antimicrobials. Intraosseous regional perfusion was performed 3 times. The foal was anesthetized for the first episode of intraosseous regional perfusion, but was only sedated for the subsequent 2 episodes. Antimicrobials were administered systemically for 22 days. Foals with septic physitis are typically considered to have a guarded to poor prognosis for recovery; however, this treatment regimen resulted in relatively fast and uncomplicated resolution of the infection in this foal.