Pathology of the distal condyles of the third metacarpal and third metatarsal bones of the horse

This study examined material from Thoroughbred horses, the majority of which had been in race training, for evidence of pathology in the third metacarpal (McIII) and third metatarsal (MtIII) bones which might be related to the occurrence of distal condylar fractures. Whole bone samples were studied and documented by macrophotography prior to macroradiography and computed tomographic (CT) imaging. Microradiographs were made from 100 microm thick mediolateral sections cut perpendicular to the dorsal and palmar/plantar articular surfaces of distal condylar regions of McIII and MtIII. Blocks were prepared for morphological imaging using the backscattered electron mode of scanning electron microscopy (BSE SEM). Linear defects in mineralised articular cartilage and subchondral bone were found in the palmar/plantar aspects of the condylar grooves adjacent to the sagittal ridge. These were closely related to the pattern of densification of the subchondral bone and were associated with intense focal remodelling of the immediately adjacent and subjacent bone. Parasagittal fractures of the condyles originated in similar defects. A unifying hypothesis for the aetiopathogenesis of these fractures is presented.     

Structural variation of the distal condyles of the third metacarpal and third metatarsal bones in the horse

This study examined 3-dimensional (3D) distribution of sectors with contrasting density in the equine third metacarpal (McIII) and third metatarsal (MtIII) bones with a view to explaining the aetiology of distal condylar fractures. Macroradiography and computed tomographic (CT) imaging were used in the nondestructive study of bones obtained from horses, most of which were Thoroughbreds in race training. Distal condylar regions of McIII and MtIII were also studied in microradiographs of 100 microm thick mediolateral sections cut perpendicular to the dorsal and palmar/plantar articular surfaces. Qualitative and quantitative results from all methods used (radiography, CT and microradiographic stereology) demonstrated a densification (sclerosis) of subchondral bone located in the palmar/plantar regions of the medial and lateral condyles of both McIII and MtIII. Substantial density gradients between the denser condyles and the subchondral bone of the sagittal groove were shown to equate with anatomical differences in loading intensity during locomotion. It is hypothesised that such differences in bone density results in stress concentration at the palmar/plantar aspect of the condylar grooves, which may predispose to fracture.     

Three dimensional structure of the distal condyles of the third metacarpal bone of the horse

This study examined the three-dimensional (3D) microarchitecture of regions of the equine third metacarpal bone (McIII) commonly involved in distal condylar fractures. Limbs were obtained from Thoroughbred horses (neonates to age 24 years) destroyed for inoperable fractures and a variety of other conditions. Beams, blocks and sections were cut in the principal axes, some embedded in PMMA and others examined unembedded. Several methods were used to study the 3D structure, including conventional and confocal optical microscopy, scanning electron microscopy (SEM) and radiography. The mineralised articular cartilage tends to cleave in the sagittal plane. Proximal to the subchondral bone, the main trabeculae are robust plates running in the sagittal direction with less significant mediolateral connections. Small blood vessel canals lie inside the sagittal plates. This structure gives maximum strength and protection in the sagittal plane in which the bone rotates, but offers minimal resistance to fracture propagation in this plane. The anatomical course of the common distal condylar fractures of the third metacarpal bones can be explained by underlying anisotropic structural features of the mineralised tissues.     

Advanced imaging of an incomplete fracture and exostosis of the third metacarpal bone in a young Warmblood horse

A 5-year-old Hanoverian gelding with acute moderate right forelimb lameness underwent nuclear scintigraphy, which identified marked increase in radiopharmaceutical uptake of the proximomedial aspect of the right metacarpus. Ultrasonography and radiography identified sclerosis and exostosis of the proximomedial aspect of the metacarpal bone III in-between the suspensory ligament and the second metacarpal bone, and presence of a suspected fracture. The owner requested euthanasia of the gelding, and post-mortem computed tomography and magnetic resonance imaging identified marked bone sclerosis and thickening of the palmar cortex of the metacarpal III (McIII), presence of an incomplete fracture in the palmar cortex of McIII and expansive exostosis from McIII extending in a palmar direction between the suspensory ligament and the second metacarpal bone. Histopathological examination confirmed the imaging findings of sclerosis and led to final diagnosis of a fracture of the palmar cortex of the McIII associated with an exostosis encroaching the medial aspect of the suspensory ligament. No abnormalities were present in the suspensory ligament or metacarpal bone II (McII).     

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.     

Surface strains around the midshaft of the third metacarpal bone during turning

REASONS FOR PERFORMING STUDY: Bone strains quantify skeletal effects of specific exercise and hence assist in designing training programmes to avoid bone injury. OBJECTIVE: To test whether compressive strains increase on the lateral surface of the inside third metacarpal bone (McIII) and the medial surface of the outside McIII in a turn. METHODS: Rosette strain gauges on dorsal, medial and lateral surfaces of the midshaft of the left McIII in 2 Thoroughbred geldings were recorded simultaneously during turning at the walk on a bitumen surface. RESULTS: Medial surface: Compression peaks were larger in the outside limb. Tension peaks were larger in the inside limb and in a tighter turn. On the lateral surface compression and tension peaks were larger on the inside limb, which showed the largest recorded strains (compression of -1400 microstrains). Dorsal compression strains were larger on the outside limb and on a larger circle. Tensile strains were similar in both directions and larger on a larger circle. CONCLUSIONS: Compressive strains increased on the lateral surface of the inside McIII and medial surface of the outside McIII in a turn. POTENTIAL RELEVANCE: Slow-speed turning exercise may be sufficient to maintain bone mechanical characteristics in the inside limb lateral McIII cortex. Further work is needed to confirm these findings and to determine whether faster gaits and/or tighter turns are sufficient to cause bone modelling levels of strain in the medial and lateral McIII cortex.     

Osteostixis for Incomplete Cortical Fracture of the Third Metacarpal Bone: Results in 11 Horses

Eleven horses with acute or chronic incomplete cortical fractures of the left or right third metacarpal bone (McIII) were treated with surgical puncture (osteostixis). The fractures were diagnosed by physical examination and radiography. Four to eight holes, 2.7 or 3.5 mm in diameter, were drilled in the fractured bone. Radiographically, the fractures were healed by month 3, and the drill holes were inapparent by month 7. Nine horses (82%) returned to race competition, and two horses were retired, one the result of a surgical complication. The mean time between surgery and the first race was 9.4 months. None of the bones refractured within 24 months of surgery. Osteostixis was not technically difficult and a second operation for implant removal was not necessary.     

Magnetic resonance imaging‐detected adaptation and pathology in the distal condyles of the third metacarpus,associated with lateral condylar fracture in Thoroughbred racehorses

Reasons for performing the study: Lateral condylar (LC) fractures of the third metacarpus (McIII) are a common reason for euthanasia in racehorses, and may be the result of repetitive overloading or cumulative pathological change. Magnetic resonance imaging (MRI) allows monitoring of bone and cartilage to detect pathological and adaptive changes that may be precursors of fracture. Objectives: To describe bone and cartilage MRI features in the distal condyles of McIII of Thoroughbred racehorses, with and without condylar fracture. Hypotheses: 1) A greater degree of bone and cartilage adaptation or pathology will be seen in fractured McIIIs compared with their respective contralateral McIIIs. 2) Contralateral McIIIs will have a greater degree of bone and cartilage adaptation or pathology than McIIIs from control horses that did not sustain a LC fracture. Methods: The McIIIs from 96 horses subjected to euthanasia at racecourses were divided into 3 groups: Group 1: nonfractured bones from horses without LC fracture; Group 2: nonfractured bones from horses with unilateral LC fracture; and Group 3: fractured bones from horses with unilateral LC fracture. The MR images were examined and graded for bone and cartilage changes. Results: Nine percent of Group 1 (n = 9) and 11% of Group 2 bones (n = 5) had incomplete LC fractures. Focal palmar necrosis was most frequently detected in bones from Group 1 (12%) compared with Groups 2 (9%) and 3 (4%). The prevalence of bone and/or cartilage abnormalities tended to increase from Group 1 to Group 2 to Group 3. Conclusions: Magnetic resonance imaging is able to detect cartilage and bone changes that may be associated with LC fracture. There was no significant difference in bone/cartilage changes between bones from Groups 1 and 2, despite increased pathology in Group 2 bones. Potential relevance: Periodic monitoring of bone and/or cartilage changes in distal McIII of Thoroughbred racehorses may help to prevent catastrophic LC fractures.     

Aetiopathogenesis of parasagittal fractures of the distal condyles of the third metacarpal and third metatarsal bones--review of the literature

Fractures are the cause of considerable morbidity and mortality among Thoroughbred racehorses. A significant proportion of these injuries occur in the absence of any particular traumatic incident. Evidence of prefracture pathology interpreted as fatigue damage has been identified in some such cases, but the aetiology of many of these so-called 'spontaneous' fractures remains obscure. Parasagittal fractures of the third metacarpal (McIII) and third metatarsal (MtIII) bones are one of the more common fractures to affect Thoroughbred racehorses. The configuration of each of these fracture types is highly consistent, suggesting a predisposition of the bones to these injuries. Several theories have been proposed to explain the aetiopathogenesis of these fractures although none has so far stood up to critical examination. The current paper reviews the literature relating to parasagittal fractures of McIII and MtIII.     

Long bone failure after intraosseous regional perfusion

A 5-year-old Australian Stock Horse gelding was initially referred to the Charles Sturt University Veterinary Clinical Centre (CSUVCC) for assessment of a penetrating laceration over the medial splint bone (second metacarpal bone) of the left foreleg. Clinical examination failed to reveal a communication with a synovial structure, but radiographs showed a palisading bone reaction on the proximal aspect of the medial splint bone which was thought to be a characteristic of infection. Soft tissue swelling precluded access to a peripheral vein, so a decision was made to use intraosseous regional limb perfusion. This was achieved through an access portal in the lateral diaphysis of the third metacarpal bone (McIII). Subsequently, the horse developed lameness and further investigation revealed a nondisplaced longitudinal fracture of McIII propagating from the intraosseous regional perfusion access portal.     

Accessory Carpal Bone Fractures in the Racing Greyhound: Classification and Pathology

Fractures of the accessory carpal bone in 35 racing Greyhounds were classified into five types. Type I fractures (27 fractures) involved the distal articular surface of the accessory carpal bone, type II (6 fractures) were of the proximal articular margin, type III (1 fracture) were at the origin of the accessorometacarpal ligaments, type IV (6 fractures) were avulsion fractures at the tendon of insertion of the flexor carpi ulnaris muscle, and type V (3 fractures) were comminuted fractures.     

Long incomplete longitudinal fractures of the third metacarpal and metatarsal bone in horses

Five horses with long incomplete longitudinal fractures of the third metacarpal bone and three horses with similar fractures of the third metatarsal bone were examined. In three of the metacarpal fractures a long incomplete fissure extended proximomedially, in association with the more common lateral condylar fracture of the third metacarpal bone, and in the other two cases the fracture originated from the medial aspect of the distal articular surface. In the three horses with fractures of the third metatarsal bone the fractures had a consistent spiral configuration.     

Effect of beta-tricalcium phosphate in surgically created subchondral bone defects in male horses

beta-Tricalcium phosphate (TCP) was evaluated as a synthetic bone grafting material in horses. Sixteen horses were randomly assigned to 4 groups of 4 horses. In each horse, an 11-mm by 10-mm circular defect with a smooth margin was created surgically in the weight-bearing surface of both third metacarpal bones (McIII) and the left third metatarsal bone. The defect in the left McIII was filled with TCP, the defect in the right McIII was filled with a mixture of 50% autogenous cancellous bone (ACB) and 50% TCP, and the defect in the left third metatarsal bone was not filled to serve as a control. Nuclear imaging and radiographic evaluation of surgical sites were performed at postsurgical week (PSW) 4 and 13 in group-I horses and at PSW 26, 39, and 52 in groups-II, -III, and -IV horses, respectively. Horses in groups I, II, III, and IV were euthanatized at PSW 13, 26, 39, and 52, respectively, and specimens were harvested for histologic evaluation. Results were compared among treatment methods, as well as among time intervals. The greatest activity at defect sites was seen in group-I horses at PSW 4. Activity counts in limbs of group-I horses at PSW 13 and counts in limbs of group-II horses at PSW 26 were not significantly (P less than or equal to 0.05) different. Activity counts in groups-III and -IV horses at PSW 39 and 52, respectively, were less than those in groups I and II. However, there was no significant difference in activity counts between limbs implanted with TCP or ACB:TCP.(ABSTRACT TRUNCATED AT 250 WORDS)     

The effects of limb posture on relationships between in vitro radial hoof strain,load and joint angles

Reasons for performing study: Radial strain in normal hooves has been found to vary with strain gauge location, limb posture and sample limb but reported magnitudes were considered to be low. More accurate measurement of radial strain may enhance the understanding of hoof function. Objectives: To explore in vitro radial hoof strain in relation other kinetic and kinematic variables that may be related. Methods: Five normal forelimbs were removed at the proximal articular surface of the third metacarpal bone (McIII). The limbs were loaded using a modified Instron test machine. Six calibrated infrared cameras captured movement from markers on the hoof and bone fixed markers on the second and first phalanxes and McIII, whilst radial hoof strain was measured using a calibrated instrumented plug. Change in strain, joint angle and load were found at simulated walking postures and bivariate correlations were used to compare the relationships between them. Results: Radial strain was moderately correlated with proximal interphalangeal joint (PIPJ) rotation (r =?0.519). Large reductions in radial strain were found in loading and midstance with 10° of heel lift postures. Conclusions and potential relevance: PIPJ rotation has previously been linked to the magnitude of deep digital flexor tendon (DDFT) loads and it is therefore suspected that these loads may have the greatest influence on radial strain magnitudes. Further investigation of radial strain is needed to describe the patterns fully during the stance phase in vivo.     

NAVICULAR BONE FRACTURE IN THE PELVIC LIMB IN TWO HORSES

The case history, radiographic and scintigraphic findings of two horses with pelvic limb navicular bone fractures are presented. In both cases the fractures were of traumatic origin. One horse had a bilateral fracture of the navicular bone, distal border, the other horse had a fracture of the proximal articular border in one pelvic limb navicular bone.     

Pedal bone fractures

Fractures of the pedal bone are usually the result of direct trauma, and are relatively commonly encountered in equine practice. Either front or hind feet may be affected. Seven distinct fracture types are recognised. Type I fractures involve the palmar/plantar process and do not enter the distal interphalangeal (DIP) joint. Type II fractures are oblique or parasagittal fractures that are articular but are not on the midline. Type III fractures are midline articular fractures that bisect the pedal bone into 2 equal halves. Type IV fractures involve the extensor (pyramidal) process of the pedal bone. Type V fractures are comminuted and split the pedal bone into multiple fragments. Type VI fractures are solar margin fractures. Type VII fractures are exclusive to foals and are also fractures of the solar margin. In most cases the onset of clinical signs is acute. The diagnosis is usually achieved by radiography, although computed tomography or magnetic resonance imaging can be helpful in some cases. Treatment options include surgical and nonsurgical therapies. The prognosis for articular fractures (Types II and III) is worse than for nonarticular fractures (Types I, IV, VI and VII) because of the likelihood of osteoarthritis within the DIP joint. Nonarticular fractures carry a good prognosis if a long enough convalescence is undertaken. Comminuted fractures (Type V) carry a poor, but not hopeless, prognosis.     

Arthroscopic removal of fracture fragments involving a portion of the base of the proximal sesamoid bone in horses: 26 cases (1984-1997)

OBJECTIVE: To determine the outcome of horses with basal fractures of the proximal sesamoid bone from which a fracture fragment involving a portion of the base of the bone was removed arthroscopically and to determine whether fragment size was associated with outcome. DESIGN: Retrospective study. ANIMALS: 26 horses. PROCEDURE: Dorsopalmar and axial-abaxial lengths of the fracture fragment were measured on the dorsopalmar and mediolateral radiographic views, respectively, and percentage of the base of the sesamoid bone involved was estimated. Fractures were classified as grade 1 (< or = 25% of the base involved) or grade 2 (> 25% but < 100% of the base involved). Outcome was classified as successful if the horse started at least 2 races or unsuccessful if the horse started only 1 race or failed to return to racing. RESULTS: There were 24 racehorses and 2 nonracehorses. Twelve (50%) of the racehorses returned to racing and started at least 2 races. Eight of 14 horses with grade-1 fractures and 4 of 10 horses with grade-2 fractures had a successful outcome. Ten of 16 horses without associated articular disease had successful outcomes, compared with 2 of 8 horses with associated articular disease. However, fragment size and presence of associated articular disease were not significantly associated with outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Horses with basal fractures of the proximal sesamoid bone from which a fracture fragment involving a portion of the base of the bone is removed arthroscopically have a fair prognosis for return to racing.     

Criteria to evaluate bone mineralization in cattle: II. Noninvasive techniques

An experiment was conducted to evaluate the capabilities of dual photon absorptiometry (PA), radiographic photometry (RP), and ultrasound (U) to estimate bone mineral content (BMC) and bone strength of a group of bovine third metacarpals (McIII). Metacarpals were chosen for evaluating BMC and bone strength because of their accessibility and susceptibility to biomechanical stress. The right and left McIII of 14 Angus heifers (24 to 32 mo of age) were collected at slaughter and all soft tissues (including periosteum) were removed. The BMC was estimated at both the midpoint and 3 cm proximal to the midpoint on the McIII diaphysis. Metacarpals then were tested by three-point bending to determine breaking load (BL) and breaking strength (BS). Bones were reassembled and two 2-cm sections were removed, one at the midpoint and one 1 cm proximal to the midpoint section. Sections then were ashed and ash content was expressed as grams per 2-cm slice and defined as BMC. Correlation coefficients (r) between BMC vs PA, RP, and U were .908 (P less than .0001), .967 (P less than .0001), and .565 (P less than .0001), respectively; r values between BS vs PA, RP, and U were .406 (P less than .05), .429 (P less than .05), and .499 (P less than .01), respectively, and r values between BL vs PA, RP, and U were .870 (P less than .0001), .865 (P less than .0001), and .588 (P less than .001), respectively. These data indicate that noninvasive techniques are useful in predicting BMC and BL in the bovine.