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.     

Retrospective study of 38 cases of femur fractures in horses less than one year of age.

Medical records of 38 horses less than 1 year of age and diagnosed as having a fracture of the femoral diaphysis, metaphysis or distal physis were evaluated. Twenty-six foals had fractures of the femoral diaphysis or metaphysis with the most common fracture configuration being comminuted. Twelve foals had distal physeal fractures with the most common fracture configuration being a Salter-Harris type II. Twenty-one foals with fractures of the capital femoral physis, neck or greater trochanter during the same time period were excluded from this study. Surgical repair was attempted in 16 diaphyseal and 2 distal physeal fractures. Most of the diaphyseal fractures were repaired by placing plates on the lateral and cranial surfaces of the bone. Dynamic condylar screw plates or angle blade plates were used for increased bone purchase in 4 foals with short distal fragments. Five foals with distal physeal fractures were treated; 2 were surgically treated by placing an angle blade plate on the lateral cortex, and 3 foals with minimally displaced distal physeal fractures were managed with stall confinement. Eight of the 16 surgically repaired diaphyseal fractures healed. Fracture location and configuration was not a determinant of outcome, but the mean age of foals with successfully repaired diaphyseal fractures was 2 months compared with 4 months for the unsuccessful cases, indicating that the age and size of the foal was important. Long-term follow up revealed that 6 of the 8 successfully repaired diaphyseal fractures had no residual effects of the fracture observed during performance of the horse for its intended use. Only 1 of the 2 surgically repaired distal physeal fractures healed, but this horse was eventually killed because of unthriftiness related to a malabsorption syndrome. Some form of complication developed in 13 of the 18 surgically repaired fractures. Infection was the primary cause of failure. The greatest determinant associated with infection was the inability to control post-surgical seroma formation.     

Arthroscopy of the Coxofemoral Joint of Foals

An arthroscopic procedure for examination of the coxofemoral joint was developed in nine foals (four cadavers, five anesthetized) to determine if access was sufficient for evaluation and surgical treatment of intra-articular lesions. The joint was distended and the arthroscope inserted through the notch (incisura trochanterica) between the cranial and caudal parts of the greater trochanter. This portal allowed examination of the cranial, lateral, and caudal aspects of the joint. Mechanical distraction of the joint through an instrument portal located 2 to 4 cm cranial and 1 to 2 cm ventral to the arthroscope portal allowed examination of the ligament of the head of the femur, the femoral head, and articular and nonarticular surfaces of the acetabulum. Adduction and rotation of the limb improved visualization of the craniomedial and caudomedial portions of the femoral head. Traction applied to the distal limb allowed visualization of the same structures that were observed when mechanical distraction was used. Traction also created space for placement of surgical instruments into the joint through the instrument portal. Access to most regions of the joint was adequate, but access to the caudal and medial aspects of the joint was limited. Three foals were killed while they were anesthetized, and their coxofemoral joints were dissected. Two foals were allowed to recover from anesthesia and were observed for 30 days after surgery. One foal was mildly lame for 2 days after surgery. The other foal was not lame after surgery. The incisions healed, and the coxofemoral joints were radiographically normal by postoperative day 30.     

Repair of physeal fractures of the tuber olecranon in the horse, using a tension band method

Physeal fractures of the tuber olecranon of 4 horses were treated, using the tension band method of compression fracture repair. A cortical bone screw and Steinmann pin were placed through the proximal fragment into the distal parent bone parallel to the palmar border of the olecranon. The tension band was placed dorsal to the Steinmann pin and anchored in a hole through the shaft of the ulna 10 cm distal to the tuber olecranon. Of the 4 foals, 2 became pasture sound, 1 is now being worked under saddle, and the 4th showed no signs of lameness 5 months after surgery.     

Femoral Capital Physeal Fractures in 25 Foals

The medical records of 25 horses 1 year of age or younger affected with femoral head and neck fractures during an 18 year period were reviewed. Each fracture involved the capital physis. The foals were 11 days to 12 months of age (mean, 5 months). No femoral capital physeal fractures occurred in horses older than 1 year of age during the same period. The history in each case included acute onset of severe unilateral hindlimb lameness, 3 hours to 2 months (mean, 12 days) before presentation. Injuries observed were violent falls, struggles, and kicks. Crepitation, swelling, pain with manipulation or palpation or both, and apparent fracture fragment displacement were inconsistently noted. Tentative clinical diagnoses were confirmed by radiography in 24 foals and by necropsy alone in one foal. Twenty-one foals were euthanatized due to poor prognosis. One foal sent home for stall rest was lost to follow-up. Surgical repair was attempted in three foals. Two fractures were repaired with multiple intramedullary pins and the foals were euthanatized within 2 weeks due to surgical failure and, in one case, contralateral limb breakdown. The third fracture was repaired with a compressing screw and plate device; the animal was pasture sound at month 20.     

Evaluation of an Interfragmentary Compression System for the Repair of Equine Femoral Capital Physeal Fractures

Femoral neck and proximal epiphyseal lengths were measured in 37 femurs from 19 cadaver foals that were 1 day to 12 months old to determine the applicability of a human interfragmentary compression system to equine femoral capital physeal fractures. Because components of the implant system are available only in fixed sizes, its use was possible in foals older than 5 weeks of age, but not in younger foals. The 135 degree angle plate conformed best to the equine femur. Femoral capital physeal fractures were created surgically and repaired with the implant system in three foals. Fracture stability was evident clinically and radiographically in all three foals until euthanasia at month 3. At necropsy, the treated femurs were 4, 8, and 27 mm shorter than their mates. Epiphyseal viability was verified in all three foals by tetracycline deposition and new appositional bone growth comparable with that in the contralateral control epiphyses. The treated capital physis was open but reduced in thickness in one foal, disorganized in one foal, and closed in one foal. Fixation by compression with the implant system resulted in stability sufficient for fracture healing and maintenance of epiphyseal viability, although it was associated with reduced longitudinal femoral growth.     

Farriery for the foal: A review part 1: Basic trimming

The extensive nature of this topic warrants this review paper to be divided into two parts: ‘Routine basic trimming in foals’ and ‘Therapeutic farriery in foals’. Hoof care in the first few months of life is serious business and should never be taken lightly. Good farriery is vital for the development of the hoof capsule and the conformation of the limb. Management of the feet and limbs during the juvenile period will often dictate the success of the foal as a sales yearling or mature sound athlete. Overall hoof care of a foal is often a joint venture between the veterinarian and the farrier. Part 1 of this paper will outline the concept of a footcare programme, examination of the foal's feet and limbs along with what constitutes good basic farriery to properly apply the trim. It will also emphasise the importance of maintaining a good veterinarian-farrier relationship - the farrier being responsible for basic trimming with veterinary oversight when necessary, and if orthopaedic disorders develop, the farrier will have significant input with therapeutic farriery.     

Long-term effects of desmotomy of the accessory ligament of the deep digital flexor muscle in standardbreds: 23 cases (1979-1989).

Desmotomy of the accessory ligament of the deep digital flexor muscle (inferior check desmotomy) permitted Standardbred foals affected with flexural deformities to reach their full athletic potential. Long-term effects of inferior check desmotomy were examined in 23 Standardbreds over a 10-year period. Six of 11 foals that were treated surgically either raced 6 times and obtained a race record or were training sound (if yearlings). All 12 horses with flexural deformity that did not receive an inferior check desmotomy had an unfavorable outcome (no race record). Foals that had surgery performed at a younger age apparently had a better chance of racing or training sound because no foals treated surgically after 8 months of age had a favorable outcome and only 1 foal that was older than 5 months at the time of surgery had a favorable outcome. In 5 foals that had surgery with an unsuccessful outcome, 3 were greater than or equal to 1 year old at the time of surgery and were lame when training was started on the limb(s) with the desmotomy.     

Fractures of the proximal sesamoid bones in thoroughbred foals.

Eighteen cases of fractures of the proximal sesamoid bones in Thoroughbred foals are described. Most of the fractures were in foals under 2 months old and all but one occurred in the forelegs. The bones commonly fractured when the foal galloped to exhaustion trying to keep up with its dam in the paddock. The types of fracture varied but a simple fracture of the medial sesamoid was most frequent and the majority were towards the base of the bone. Six foals sustained a fracture of more than one sesamoid bone and one foal fractured all 4 proximal sesamoid bones in its front legs. Treatment included box rest and the surgical removal of the separated piece of sesamoid bone. Only 3 of the foals treated have raced. One of these was treated surgically.     

The effects of copper supplementation on the prevalence of cartilage lesions in foals

The potential role of dietary copper in the development of cartilage defects in foals was investigated. Twenty-one mares were fed rations containing 13 ppm copper (CuC, control) or 32 ppm copper (CuS, supplemented) during the last three to six months of gestation and first three months of lactation. Their foals were fed pelleted concentrate containing 15 or 55 ppm Cu and were destroyed at 90 (5 CuC and 5 CuS foals) or 180 (6 CuC and 5 CuS foals) days. Focal cartilage lesions were found at multiple sites on necropsy. In foals killed at 90 days, there were over twice (9 versus 4) as many lesions of osteochondrosis and more than four times (9 versus 2) as many articular lesions of osteophyte formation or thinning in CuC foals compared with CuS foals. These differences were due predominantly to a higher number of lesions in one CuC foal. Two 90-day CuC foals had osteochondrosis of articular-epiphyseal (A-E) complex, one with thickenings and separation from subchondral bone and one with subchondral fibrosis. One 90-day CuS foal had a cartilage thickening of the A-E complex in the tibiotarsal joint with separation from subchondral bone. In foals killed at 180 days, there were seven times more articular lesions (21 versus 3) of osteophyte formation or thinning, nearly twice as many lesions of osteochondrosis (13 versus 8) [corrected] in the physis and over five times as many involving the A-E complex (11 versus 2) in six CuC foals compared with five CuS foals.(ABSTRACT TRUNCATED AT 250 WORDS)     

Palmar/Plantar Process Fractures of the Proximal Phalanx In 15 Horses

Fifteen fractures of the palmar or plantar process of the proximal phalanx in 15 horses are described. Ten were articular and five were nonarticular. Two modes of therapy were used depending on the location of the fracture. Nonarticular fractures were treated with stall rest or reduction in exercise, and articular fractures were treated with either surgical removal or internal fixation of the fragment. All horses that were operated on were sound within 6 months after surgery. Follow-up information was obtained on all horses through client questionnaire and race records in the racing breeds (Standardbred and Thoroughbred) and client questionnaire alone is the nonracing breeds (Quarterhorse and Arabian). Fourteen horses returned to an equal or better level of performance than before injury; one horse returned to a lower level of performance.     

Mechanical ventilation in foals with botulism: 9 cases (1989-2002)

"Shaker foal" disease, toxicoinfectious botulism of foals, was 1st described as a clinical entity in 1967. The reported mortality rate was 90%, with death occurring within 24-72 hours of the onset of the characteristic clinical signs. The mortality rate decreased when equine-origin botulism antitoxin became available; however, a certain percentage of foals continued to die of respiratory failure. Mechanical ventilation is an important part of the treatment of infant botulism and is essential to the survival of many affected infants. We report a retrospective study of 9 foals with toxicoinfectious botulism where early mechanical ventilation was employed as part of the treatment. Foals receiving mechanical ventilation were progressively acidemic and had increased PaCO2 tensions before mechanical ventilation. These arterial blood gas abnormalities were ameliorated with mechanical ventilation. One foal was euthanized for economic reasons; survival in treated foals was 87.5%. Mechanical ventilation of foals with botulism and respiratory failure appears to be an effective therapy.     

Respiratory stridor associated with polymyopathy suspected to be hyperkalemic periodic paralysis in four quarter horse foals.

Four Quarter Horse foals ranging in age from 6 days to 2 months were determined to have upper airway stridor secondary to polymyopathy suspected to be hyperkalemic periodic paralysis. Electromyography revealed spontaneous muscle activity in all muscles examined. Electromyographic findings were similar in the dams of 3 foals (No. 1, 3 and 4). Hyperkalemia was found in foals 1 and 4. Endoscopically, the upper airway stridor in foals 1 and 3 was confirmed to be attributable to laryngeal and pharyngeal collapse or spasm. Foals 1, 2, and 3 were treated with acetazolamide. Foal 4 was not treated, at the owner's request. Foals 2 and 3 improved with treatment, foal 4's condition was static, and foal 1 required a tracheostomy and laryngeal surgery to manage its upper airway stridor.     

Detection of rib trauma in newborn foals in an equine critical care unit: a comparison of ultrasonography, radiography and physical examination

REASONS FOR PERFORMING STUDY: Previous studies have shown that in man ultrasonography is more accurate than radiography for detecting rib fractures. OBJECTIVES: To describe clinical, radiographic and ultrasonographic findings related with rib fractures in newborn foals in an equine critical care unit; and to compare diagnostic accuracy of ultrasonography to radiography. METHODS: A prospective ultrasonographic study was performed on 29 foals presented to the emergency unit. This study was performed at the Centre Hospitalier Universitaire Vétérinaire (CHUV), University of Montreal. Physical examination as well as radiographic and ultrasonographic examinations were performed. RESULTS: Thoracic radiographs revealed 10 rib fractures in 5 of 26 (19%) foals. Ultrasonography revealed 49 fractures in 19 of 29 (65%) foals of which fillies (n = 13; 68%) were significantly over represented as were fractures to the left thorax (n = 15; 78%). Seventeen of 19 foals (90%) had rib fractures located 3 cm or less from the costochondral junction, the distal part of the rib being displaced laterally in all cases. In 2 foals, where both thoracic radiographs and ultrasonography detected rib fractures, the site of fractures was located on the mid portion of the rib. Rib fractures were detected only by thoracic radiographs in one foal. Sixty-five percent (32/49) of fractured ribs had a moderate displacement (1-4 mm). CONCLUSIONS: Rib fractures are seen frequently in newborn foals in equine critical care units. Ultrasonography is more accurate than radiography and reveals fractures in most patients presented in emergency. The position (costochondral junction) of rib fractures and of the fragments suggest that most thoracic trauma probably occurs during parturition. POTENTIAL RELEVANCE: Ultrasound imaging increases awareness and improves the diagnosis of rib fractures in newborn foals.     

Epiphyseal cartilage canal blood supply to the distal femur of foals

REASONS FOR PERFORMING STUDY: The developmental pattern of the cartilage canal blood supply to epiphyseal growth cartilage has been linked to osteochondrosis (OC) in the tarsus of foals. This pattern has not yet been described in the distal femur, another site frequently affected by OC. OBJECTIVE: To describe the developmental pattern of the blood supply to the distal femoral epiphyseal growth cartilage in 8 Standardbred foals age 0-7 weeks. METHODS: One foal was sacrificed weekly from birth to age 7 weeks (n=8) to undergo a barium perfusion procedure to demonstrate vessels within cartilage canals of one hindlimb. The distal end of the femur was cleared in methyl salicylate and perfused vessels were studied in the intact bones. Each distal femur was then sawed into 5 mm thick slabs in the transverse plane, and the slabs decalcified and radiographed. Finally, the lateral trochlear ridge was separated from each slab and examined histologically. RESULTS: The cartilage canal blood supply regressed with increasing age, but several regions remained vascularised in the oldest foal at age 7 weeks. Vessels arose from perichondrial and subchondral arterial sources, and coursed perpendicular or parallel to the ossification front. The midsection of parallel vessels became incorporated into the ossification front during growth. Anastomoses formed and vessels within the distal portion of canals with an original perichondrial source shifted to use subchondral vessels as their arterial source. Both parallel and perpendicular vessels therefore traversed the ossification front to enter cartilage canals. No histological lesions were observed in sections from any of the foals. CONCLUSION: The same anatomical feature (traversing the ossification front to enter cartilage canals) reported to render vessels vulnerable to failure in the tarsus was also present in the distal femur of foals. POTENTIAL RELEVANCE: OC may occur by the same pathogenetic mechanism in the distal femur as in the tarsus of foals.     

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.     

Crosspin Fixation of Fractures of the Proximal Tibia in Three Foals

Three foals, each less than 1 month of age, were presented with Salter Type II fractures of the proximal tibial physis. Reduction of the fractures was accomplished manually and maintained by crosspin fixation. Fracture healing in two of the foals was uncomplicated. The third foal developed an infection around the implants, which responded to periodic local antiseptic flushing and administration of penicillin and gentamicin. Follow-up information ranging from 11 to 22 months after surgery revealed satisfactory results in two of three foals; premature closure of the proximal tibial physis was found in the other foal, resulting in the development of an angular limb deformity.     

Effects of repeated Strongylus vulgaris inoculations and concurrent ivermectin treatments on mesenteric arterial lesions in pony foals

Eight of 10 pony foals reared under helminth-free conditions were inoculated PO with 50 Strongylus vulgaris infective larvae/week for 4 weeks, at which time 1 foal died of acute verminous arteritis. Inoculation of 7 remaining foals continued at 2-week intervals for 20 weeks. Of the 7 foals, 3 were treated with ivermectin (0.2 mg/kg of body weight) in an oral paste formulation at experiment weeks 8, 16, 24; 4 foals were not treated. Two foals were not inoculated or treated and served as controls. After the first ivermectin treatment, ivermectin-treated foals had fewer days (12 +/- 2.9) with rectal temperatures greater than 38.6 C than did nontreated foals (23.3 +/- 3.8). Mean baseline rectal temperatures were 38 +/- 0.2 C. Adverse clinical reactions to ivermectin treatment were not observed in foals. Foals were euthanatized and necropsied 3 weeks after the last ivermectin treatment (week 24). Ivermectin was effective in reducing S vulgaris arterial larval and intestinal adult parasite numbers by 100% in 3 treated foals. Strongylus vulgaris arterial larvae and/or adults were recovered from all 4 nontreated inoculated foals. One nontreated inoculated foal lacked arterial larvae or active arterial lesions, indicating that protective resistance had developed in this individual. Marked gross and histopathologic lesions typical of chronic S vulgaris infection were observed in the 3 nontreated inoculated foals with arterial larvae. Repeated killing of intra-arterial S vulgaris fourth-stage larvae in ivermectin-treated foals did not exacerbate lesions associated with verminous arteritis or induce unique lesions associated with repeated destruction of arterial larvae.(ABSTRACT TRUNCATED AT 250 WORDS)     

Conservative Management of a Distal Epiphyseal Metacarpal Fracture in a Skyros Pony

Epiphyseal fracture, also known as epiphysiolysis, is the loosening or separation, either partial or complete, of an epiphysis from the shaft of a long bone. Distal epiphyseal fractures in foals pose a substantial challenge due to their guarded prognosis. This report describes the clinical signs, diagnosis, successful conservative treatment of an 1-month-old, male Skyros pony with an epiphyseal fracture of the right third metacarpal bone (type II Salter-Harris). The owner declined surgical treatment because of financial considerations along with the unfavorable prognosis. Conservative fracture treatment was pursued through external reduction and coaptation. The total duration of the conservative treatment was eighteen weeks and the foal returned to complete health.