Surgical management of complete diaphyseal third metacarpal and metatarsal bone fractures: Clinical outcome in 10 mature horses and 11 foals

Reasons for performing study: Osteosynthesis of third metacarpal (McIII) and third metatarsal (MtIII) bone fractures in horses is a surgical challenge and complications surrounding the repair are common. Retrospective studies evaluating surgical repair, complications and outcome are necessary to increase knowledge and improve success of long bone fracture repair in the horse. Objectives: To evaluate clinical findings, surgical repair, post operative complications and outcome of 10 mature horses and 11 foals with McIII or MtIII fractures that were treated with open reduction and internal fixation (ORIF). Methods: Medical records were reviewed and follow‐up information obtained by means of radiographs and/or telephone questionnaire. Results: Survival was achieved in 62% of the horses (3 mature/10 foals). On long‐term evaluation (>6 months) 11 horses (2 mature/9 foals) were fit for their intended activity, one mature horse had a chronic low grade lameness, and one foal was lost to follow‐up because it was sold. The main fracture types were simple transverse (33.3%) or simple oblique (28.6%) and 71.4% of the fractures were open, 3 Type I (one mature/2 foals) and 12 type II (7 mature/5 foals). The preoperative assessment revealed inadequate emergency treatment in 10 horses (5 mature/5 foals; 47.6%). Survival rate of horses with open fractures was 12.5% (1/8) in mature and 85.7% (6/7) in foals. Post operative incisional infection (4 mature, 3 foals) was only managed successfully in 2 foals. Fracture instability related to inadequate fracture fixation technique occurred in 4 horses (all mature) and was always associated with unsuccessful outcome. Conclusions: Age, bodyweight and infection are strongly associated with outcome in treatment of complete McIII/MtIII fractures. Clinical relevance: Rigid fixation using plates and screws can be successful in treatment of closed or open, complete diaphyseal McIII/MtIII fractures in mature horses and foals. Instable fixation, infection and a bodyweight >320 kg are major risk factors for unsuccessful outcome.     

Hydranencephaly in a foal

Hydranencephaly is well recognised in several domestic animals, especially ruminants, but is virtually unknown in the horse. This case report describes a premature filly foal that on the day of delivery was found with a severe neurological disorder that initially improved but then progressively worsened. The foal was subjected to euthanasia on humane grounds and post mortem examination revealed somewhat asymmetric but bilateral destruction of the telencephalon identified as hydranencephaly. The possible causes of hydranencephaly in foals are discussed.     

Simultaneous presence of a seminoma and a leiomyoma in the testes of a horse

An 18‐year‐old stallion was presented for castration because of insidious, bilateral scrotal enlargement of one year's duration. The left testis was firm, while the right was soft and lobulated; both were larger than normal. Palpation of the scrotum and its contents did not cause the horse to show signs of discomfort. Ultrasonography of scrotal contents revealed abnormal, heterogeneous tissue with ill defined regions of hyper‐ and hypoechogenity throughout both testes. Several hours after admission the horse developed severe signs of colic. On the basis of anamnesis, clinical findings, and results of ultrasonography and transrectal palpation bilateral testicular neoplasia and incarcerated inguinal hernia were tentatively diagnosed. Because the horse's owner did not consent to surgical treatment, the stallion was subjected to euthanasia. Histological and immunohistochemical examination of the testicular tissue collected post mortem revealed a seminoma in the left testis and a leiomyoma in the right testis. The post mortem examination also revealed incarceration of the small intestine in addition to the testicular tumours. To our knowledge, this is the first report of the simultaneous presence of bilateral, yet different testicular tumour types in a stallion.     

Clinical significance of osseous spurs on the dorsoproximal aspect of the third metatarsal bone

Reasons for performing study: Osseous spurs on the dorsoproximal aspect of the third metatarsal bone (MtIII) are common, but their clinical significance is unknown. Objectives: To verify the sites of insertion of the dorsal metatarsal ligament and the tendons of tibialis cranialis and fibularis tertius in order to determine if periarticular osteophytes and entheseophytes could be differentiated radiologically; and to determine the frequency of occurrence of osseous spurs on the dorsoproximal aspect of MtIII. Hypotheses: The frequency of osseous spurs on the dorsoproximal aspect of MtIII would be higher in lame than in clinically normal horses and higher in horses with distal hock joint pain or proximal suspensory desmitis than in horses with other causes of hindlimb lameness. Methods: A retrospective study of data from the clinical work up and tarsal radiographs of 455 horses was performed. Horses were divided into: Group 1, clinically normal horses; Groups 2–5, according to the diagnosis of hindlimb lameness. Radiographs were examined for the presence of an osseous spur on the dorsoproximal aspect of MtIII; pathology of the distal tarsal joints was graded. The associations between the presence of a spur and lameness, diagnosis group and the grade of distal tarsal joint abnormalities were analysed statistically using Chi‐squared tests. Results: An osseous spur was present in 25% of horses; 13% of horses with bilateral radiographs had bilateral spurs. There was no significant difference in frequency of the presence of a spur between lame and nonlame horses, or between horses with other causes of hindlimb lameness and horses with proximal suspensory desmitis and/or distal tarsal joint pain. The presence of an osseous spur was significantly associated with the grade of radiological abnormality in the distal tarsal joints (tarsometatarsal joint P = 0.018: centrodistal joint P = 0.027). In many horses it was not possible to differentiate accurately between osteophytes and entheseophytes. Conclusions and potential relevance: The presence of an osseous spur on the dorsoproximal aspect of MtIII in the absence of other radiological abnormalities may be an incidental finding. Osseous spurs occur more frequently in hocks with radiological abnormalities in the distal tarsal joints and may be an indicator of distal tarsal joint osteoarthritis. The clinical significance must be established by intra‐articular analgesia.     

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.     

Aortic rupture and aorto‐pulmonary fistulation in the Friesian horse: Characterisation of the clinical and gross post mortem findings in 24 cases

Reasons for performing study: In horses, aortic sinus of Valsalva aneurysms or tears in the aortic root are well‐recognised conditions in breeding stallions, often leading to sudden death. A more uncommon form of aortic rupture, located proximal to the ligamentum arteriosum has been reported in 3 Friesian horses. Objectives: The purpose of this study was to phenotypically characterise aortic rupture and aorto‐pulmonary fistulation in Friesian horses in terms of clinical and post mortem data based on 24 cases. Methods: Friesian horses that were diagnosed with aortic rupture and aorto‐pulmonary fistulation over a period of 13 years (1997–2010) at the Department of Equine Sciences of Utrecht University (n = 15) and Wolvega Equine Hospital (n = 9), were included in this study. Case history, results of clinical examination and gross post mortem findings were screened and analysed. Results: Some cases were found dead without prior symptoms, but in several cases signs such as recurrent colic, peripheral oedema and sustained tachycardia were present for several weeks prior to cardiac failure. Clinical examination during hospitalisation revealed increased rectal temperature, peripheral oedema and increased jugular pulse with a bounding arterial pulse. In the majority of horses an aortic rupture of the aortic arch near the ligamentum arteriosum, concurrent with a circumferential cuff of perivascular haemorrhage and aorto‐pulmonary fistulation, was found at post mortem examination. Conclusions: Aorto‐pulmonary fistulation in conjunction with aortic rupture is more common in Friesians than previously estimated. In some cases findings demonstrate a progressive pathology rather than acute cardiac failure and sudden death. An appropriate approach is necessary during post mortem examination of the heart in order not to overlook the diagnosis. Potential relevance: Equine practitioners should realise that in Friesian horses presented with a history of recurrent false colic, coughing, sustained tachycardia and/or peripheral oedema, aortic rupture and aorto‐pulmonary fistulation should be included in the differential diagnosis.     

Bullous emphysema with haemorrhage in a premature foal

A Warmblood foal was admitted at one day of age because of prematurity and seizures. Clinical and clinical pathology abnormalities were consistent with prematurity and suspected hypoxic seizures that responded to anti‐convulsive therapy. The foal stabilised after several days of intensive care but then developed an airway infection. Thoracic radiographs showed multiple cavitary lesions and ultrasound examination suggested intra‐cavital haemorrhage. The foal went on to develop septicaemia and was subjected to euthanasia. Post mortem examination revealed multiple bullous emphysema with haemorrhage. This disorder should be considered in the differential diagnosis of foals having air‐fluid filled cavities on thoracic radiographs.     

Safety of multiple,submucosal inoculations of a live attenuated strangles vaccine in pregnant mares

A live attenuated vaccine against Streptococcus equi was administered submucosally in the upper lip to 224 pregnant and healthy mares to evaluate its safety. After a primary immunisation the mares were inoculated every 3 months until foaling. As control group, 206 mares of the same breeding farm were administered the solvent of the vaccine submucosally. None of the 430 mares presented any clinical evidence of strangles and neither local nor systemic reactions to vaccination were noticed. There was no association between abortion and vaccination. Furthermore no case of S. equi infection was revealed at post mortem examinations of aborted foals.     

Putative intestinal hyperammonaemia in horses: 36 cases

Reasons for performing the study: Intestinal hyperammonaemia (HA) has been infrequently reported in individual horses; however, there have been no studies describing clinical and laboratory data as well as short‐ and long‐term outcome in a larger number of cases. Objectives: To describe clinical and laboratory data and short‐ and long‐term outcome in a large group of horses with intestinal HA. Methods: Multi‐centred, retrospective study; case records of horses with HA were reviewed and any horse with a clinical or post mortem diagnosis of intestinal HA was included. Hyperammonaemia was defined as a blood ammonium (NH₄⁺) concentration ≥60 µmol/l and horses with a diagnosis of primary hepatic disease were excluded. Relevant data were recorded and, if appropriate, data from survivors were compared to nonsurvivors to identify potential prognostic indicators. Results: Thirty‐six cases, 26 mature horses and 10 foals with intestinal HA were identified. Case histories included diarrhoea, colic and neurological signs and the most common clinical diagnosis was colitis and/or enteritis. The most common clinical and laboratory abnormalities included tachycardia, increased packed cell volume, hyperlactataemia and hyperglycaemia. Fourteen horses (39%) survived to discharge; NH₄⁺ concentration on admission was the only parameter significantly associated with survival. All surviving horses and foals for which follow‐up information was available recovered completely and returned to their intended use without further complications. Conclusions and potential relevance: Intestinal HA occurs in mature horses and foals and can be associated with severe clinical and laboratory abnormalities; further studies are required to investigate predisposing factors and delineate possible differences in aetiologies.     

Clinically significant,nontraumatic, degenerative joint disease of the temporomandibular joints in a horse

Horses with degenerative joint disease (DJD) of the temporomandibular joint (TMJ) have been reported infrequently, with the majority of cases describing the disease as a consequence of an earlier traumatic event. A case of clinically significant TMJ‐DJD due to a nontraumatic event has not been published. This retrospective case report describes a case of bilateral, DJD of the TMJ. Case management, subsequent review and interpretation of the clinical records, tangential radiographic views of each TMJ, computed tomography and magnetic resonance imaging of the head, and post mortem histological examination of the TMJs were performed. The horse exhibited both quidding and a ‘clicking’ sound during mastication; episodes of intermittent colic were also prevalent in the horse's history. Computed tomography illustrated bilateral mineralisation of the rostral aspect of both intra‐articular discs. Treatment, by intra‐articular injection of corticosteroid, resulted in temporary resolution of both the quidding and the ‘clicking’ sound, as well as the recurrent episodes of colic. Repeated treatment over time was required. Ultimately the horse was subjected to euthanasia for reasons other than disease of the TMJ. The development of TMJ‐DJD may not be confined to traumatic events. Age‐related degeneration of this joint may occur and manifest through quidding and abnormal sounds noted during mastication.     

Ethmoid adenocarcinoma: Severe neurological complications after combined laser ablation and intralesional formalin injection

An 11‐year‐old Warmblood gelding with chronic bilateral epistaxis was diagnosed with an adenocarcinoma of the right ethmoid, based on transendoscopic biopsy. On computed tomography images, the cribriform plate was considered intact and the tumour was minimally invasive in surrounding tissue. The palliative treatment included a combination of surgical exploration and laser ablation. Following recurrence of the clinical signs one month later, intralesional formalin injection was performed. In the immediate post injection period, the horse developed severe neurological signs. Because of the overall poor prognosis, the horse was subjected to euthanasia. On post mortem examination, changes were seen in the frontal lobe consistent with diffusion of formalin through the cribriform plate. Care is needed when treating horses with intralesional formalin because macroscopic appearance of the cribriform plate may not relate to its functionality.     

Equine laryngeal dysplasia as a cause of acute respiratory distress in a neonatal foal

Equine laryngeal dysplasia (ELD) is a congenital disorder caused by hypoplasia or aplasia of the structures derived from the fourth and possibly sixth branchial arches. The severity of the clinical signs varies widely, and depends on which structures are involved and the extent of the defect. In most cases, affected horses present with abnormal respiratory noise during exercise and poor performance. Manifestation of the disease in foals is very rare. This case report describes an unusual presentation of ELD in a neonatal foal. The foal presented with severe respiratory distress and weakness. Equine laryngeal dysplasia was suspected on endoscopy and later confirmed on post mortem examination of the larynx. To the best of our knowledge, this is the first report describing ELD as a cause of respiratory distress in a neonatal foal.     

Severe hyperkalaemia associated with renal dysplasia in a 2-day-old foal

A 2-day-old filly foal presented with signs of depression, recumbency and inappetence. Blood analyses revealed hypoalbuminaemia, hyperfibrinogenaemia, hyperglycaemia and hyperkalaemia. The foal deteriorated despite intensive treatment and was subjected to euthanasia. At post mortem examination, the urinary bladder, ureters and kidneys appeared normal grossly. Histologically both kidneys showed disorganised development with the presence of structures inappropriate for a foal of this age, including primitive glomeruli, immature renal tubules and persistent metanephric ducts. Based on these findings a diagnosis of bilateral renal dysplasia was made.     

Imaging diagnosis and clinical presentation of a Chiari malformation in a Thoroughbred foal

A newborn Thoroughbred foal was presented to the clinic with ambiguous neurological deficits, spinal anomalies and a soft tissue swelling dorsal to the lumbar vertebral column. The foal was alert but unable to rise and stand. With radiography, ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) a lumbar dysraphic anomaly, cerebellar herniation and coincidental skeletal abnormalities were documented. Finally, a meningomyelocele was defined and, in context with the cerebellar herniation through the foramen magnum, the foal was diagnosed to have a Chiari malformation. The MRI examination corresponded best with the post mortem findings. Although 3‐dimensional imaging methods have been considered superior regarding full and detailed assessment of the congenital malformation, radiography and ultrasonography also provide essential information to diagnose dysraphic lesions at reduced costs and efforts. A Chiari malformation should be considered as a differential diagnosis in foals with neurological deficits.     

Small colon stenosis secondary to ulcerative colitis in three Standardbred foals

Three Standardbred foals, a colt approximately one month old and 2 fillies approximately 4.5 months old, from the same farm, presented to University of Pennsylvania's New Bolton Centre over the course of 3 months for further evaluation due to acute onset of colic. All foals had a history of diarrhoea prior to presentation. On presentation, the foals had abdominal distension, dull demeanour and repeatedly lay down and rolled. Exploratory celiotomy revealed a segment of stenotic (lumen diameter 1–4 mm) small colon with marked distension of the colon proximal to the stenotic segment. Post mortem examination of the foals confirmed stenosis of the small colon with a segment of ulcerative colitis associated with the stenotic region. An aetiological agent was not identified.     

Post mortem evaluation of palmar osteochondral disease (traumatic osteochondrosis) of the metacarpo/metatarsophalangeal joint in Thoroughbred racehorses

Reasons for performing study: Thoroughbred racehorses are commonly affected by subchondral bone injury, but the exact prevalence and the distribution of palmar/plantar osteochondral disease (POD) lesions are unknown. The relationship between pathologies has not been elucidated, although it is widely accepted that POD is a manifestation of traumatic overload arthrosis. Hypothesis: There is an association between grade of POD and other pathologies affecting the third metacarpal and metatarsal (MC/MTIII) condyles (wear lines, cartilage loss, marginal remodelling, dorsal impact injuries and linear fissures). Objectives: To evaluate the pathology found affecting the distal MC/MTIII condyles of Thoroughbred racehorses at post mortem examination, to describe the prevalence and distribution of POD lesions within a population of racing Thoroughbreds and to determine relationships between pathologies of the distal condyles of the third metacarpal and metatarsal bones. Methods: The metacarpo/metatarsophalangeal joints of 64 Thoroughbred racehorses were examined at routine post mortem examination and graded for third metacarpal and metatarsal condylar pathology. Associations between pathologies were determined. Results: POD had a within horse prevalence of 67%. There was a significant linear relationship between grade of POD and grades of wear lines, cartilage ulceration and dorsal impact injuries. There was a significant relationship, but this was not linear, between grade of POD and grade of linear fissures. Using ordinal logistic regression, compared to condyles with grade 0 or grade 2 linear fissures, condyles with grade 1 linear fissures were found to be more likely to have a lower POD grade. Potential relevance: POD can be considered to be a manifestation of traumatic overload arthrosis, but the role of subchondral bone adaptation is complex and warrants further investigation.     

Disseminated alimentary mycobacteriosis in the horse: a retrospective study of nine cases

This paper summarises the clinical findings of 9 cases of disseminated alimentary mycobacteriosis in horses presented at a Finnish referral equine hospital 2009–2014. Four of 9 horses were Standardbreds and 8/9 horses were male. The median age was 2 years, ranging from 6 months to 15 years. The duration of clinical signs before admission ranged from 2 weeks to 6 months. All horses demonstrated deterioration of the clinical signs after a protracted period of the disease and were finally subjected to euthanasia after poor response to multiple medical therapies. The most common complaints on admission were weight loss and diarrhoea (9/9), pyrexia (7/9), ventral oedema (7/9), lethargy (7/9) and inappetance (6/9). The most common clinicopathological abnormalities were hypoalbuminaemia and hyperfibrinogenaemia, which were present in all horses. Rectal biopsy specimens were examined from 5/9 horses and specimens were stained with Ziehl‐Nielsen (ZN). At rectal biopsy, mild multifocal neutrophilic or mild granulomatous proctitis was recognised in all 5 horses, but the ZN stain for mycobacteria was positive in only one biopsy. A liver biopsy was taken from one horse in which hepatomegaly was observed clinically and revealed marked granulomatous hepatitis with the presence of mycobacteria. The rectal biopsy from this horse was ZN negative. At post mortem examination, chronic, multifocal to coalescing granulomatous typhlocolitis and lymphadenitis were found in all horses with the small intestine less frequently involved. At histopathological examination of post mortem samples, a ZN stain was performed and intracellular acid‐fast bacilli were identified in macrophages and multinucleated giant cells in the large intestine, liver and lymph nodes in 9/9 horses and in the small intestine in 5/9 horses. Mycobacterium avium ssp. hominissuis was isolated in 5/9 horses from post mortem samples.     

Carcinoma of an accessory genital gland in a 23‐year‐old Camargue gelding

This report describes the case management, histopathological and post mortem findings in a 23‐year‐old gelding with a peri‐rectal mass. The mass was debulked surgically and submitted samples revealed it to be a poorly differentiated carcinoma. In the post operative period the horse developed signs of abdominal pain and dysuria and was subjected to euthanasia. Post mortem examination revealed a large infiltrative mass located between the rectum and urethra, consistent with a carcinoma of an accessory genital gland, most likely the seminal vesicle.     

Can distal border fragments of the navicular bone be a primary cause of lameness?

A horse with unilateral forelimb lameness and pain localised to the palmar aspect of the foot was evaluated using radiography and low field magnetic resonance (MR) imaging. A distal border fragment of the navicular bone, an osseous cyst‐like lesion (OCLL) in the distal third of the navicular bone and focal distal sesamoidean impar desmitis were identified as the most likely causes of pain and lameness. No other lesions likely to contribute to pain and lameness were identified on MR images or gross post mortem examination. The OCLL was characterised histologically by enlarged bone lacunae containing proliferative fibrovascular tissue. Focal lesions of the distal aspect of the navicular bone are rarely found in isolation but can be causes of pain and lameness in horses.     

Diagnostic utility of computed tomography imaging in equine intracranial conditions

Reasons for performing study: The use of computer tomography (CT) and contrast‐enhanced CT (CCT) to image the head is common. However, the validity of CT as a neurodiagnostic indicator of intracranial diseases in horses is unknown. Objective: To define the validity of CT and CCT in horses with suspected intracranial disorders. Methods: The validity of CT imaging was estimated by comparing clinical, clinicopathological and histopathological findings to CT findings in 15 horses presented for intracranial disorders, for which pre‐ and post contrast CT images and post mortem examination of the brain and skull were reviewed. Post mortem examination (gross and histopathological examination) was considered as the gold standard; and sensitivity, specificity, predictive values, likelihood ratios, and pre‐ and post test probabilities were calculated. Results: All horses had abnormal neurological examinations on admission. Computer tomography imaging identified intracranial lesions in 8 horses, and included masses (oligodendroglioma, adenocarcinoma and cholesterinic granulomas), acute haemorrhage and skull fractures. Computer tomography imaging failed to identify intracranial lesions in 6 cases, which included meningitis, meningoencephalitis and nonacute haemorrhage. Lesions not recognised by CT were also not evident on gross examination but were identified by histopathological examination of the brain. Post mortem examination of the brain and skull was unremarkable in one horse, for which cranial CT imaging was normal (specificity, 100%). Therefore, the odds of having an intracranial lesion after an abnormal CT were very high. In contrast, there was a moderate sensitivity (57.1%, 95% confidence interval: 29.6–81.2). Conclusions and potential relevance: CT was an excellent neurodiagnostic tool in identifying skull fractures, intracranial space‐occupying lesions (e.g. neoplasia) and acute haemorrhage and allows to rule in intracranial disorders. However, CT showed limited sensitivity in identifying inflammatory disorders and small parenchymal lesions in the equine brain, which was not further detectable after contrast administration.