Musculoskeletal responses of 2-year-old Thoroughbred horses to early training. 6. Bone parameters in the third metacarpal and third metatarsal bones

AIM: To determine the effect of a known training regimen on the size and mineral content of the third metacarpal (Mc3) and third metatarsal (Mt3) bones of 2-year-old Thoroughbred horses trained on racetracks. METHODS: Mc3 and Mt3 of seven horses trained on grass and sand tracks were scanned at several sites using conventional quantitative and peripheral computed tomography (CT). Bone dimensions and density in the diaphysis and epiphysis were compared with those from seven untrained horses. Calcein label was injected in two clusters, during Weeks 9 and 12. The extent and rate of diaphyseal modelling was determined by confocal fluorescent microscopic examination of thin plane parallel sections of the mid-metacarpal region. RESULTS: Volumetric bone mineral density (BMDv) of the epiphysis was markedly higher and of the diaphysis was slightly higher in trained compared with untrained horses, but greater bone size in the trained horses had the greatest effect on an index of bone strength. Active osteons, defined as Haversian systems containing calcein label, were fewer, of smaller diameter at the time of calcein injection, and had a greater bone apposition rate in trained than in untrained horses. CONCLUSIONS: Conventional training of 2-year-old Thoroughbred racehorses over a 13-week period had a significant effect on bone size, density and strength index when compared to untrained horses. CLINICAL RELEVANCE: Bone responded rapidly to early training. The data provide reference values and sites for use in longitudinal studies of commercial training regimens.     

Musculoskeletal responses of 2-year-old Thoroughbred horses to early training. 6. Bone parameters in the third metacarpal and third metatarsal bones

AIM: To determine the effect of a known training regimen on the size and mineral content of the third metacarpal (Mc3) and third metatarsal (Mt3) bones of 2-year-old Thoroughbred horses trained on racetracks.

METHODS: Mc3 and Mt3 of seven horses trained on grass and sand tracks were scanned at several sites using conventional quantitative and peripheral computed tomography (CT). Bone dimensions and density in the diaphysis and epiphysis were compared with those from seven untrained horses. Calcein label was injected in two clusters, during Weeks 9 and 12. The extent and rate of diaphyseal modelling was determined by confocal fl uorescent microscopic examination of thin plane parallel sections of the mid-metacarpal region.

RESULTS: Volumetric bone mineral density (BMDv) of the epiphysis was markedly higher and of the diaphysis was slightly higher in trained compared with untrained horses, but greater bone size in the trained horses had the greatest effect on an index of bone strength. Active osteons, defined as Haversian systems containing calcein label, were fewer, of smaller diameter at the time of calcein injection, and had a greater bone apposition rate in trained than in untrained horses.

CONCLUSIONS: Conventional training of 2-year-old Thoroughbred racehorses over a 13-week period had a significant effect on bone size, density and strength index when compared to untrained horses.

CLINICAL RELEVANCE: Bone responded rapidly to early training. The data provide reference values and sites for use in longitudinal studies of commercial training regimens.     

Evaluation of a new strategy to modulate skeletal development in Thoroughbred performance horses by imposing track-based exercise during growth

REASON FOR PERFORMING STUDY: No data exist on the intensity of exercise required or on possible harmful effects of increasing exercise in foals over the natural level when free at pasture. OBJECTIVES: To investigate whether an increase in workload over free pasture exercise in the period from directly after birth to the start of training is tolerated by Thoroughbred (TB) foals without increasing injury rate or producing other undesired side effects. METHODS: Thirty-three TB foals were allocated to one of 2 exercise groups directly after birth. One group (PASTEX) was raised on pasture and the other (CONDEX) kept under identical circumstances, but was additionally subjected to an exercise protocol of gradually increasing intensity. Foals were monitored periodically and scored for the presence of clinical signs related to the musculoskeletal system (joint effusion, pain at flexion, occurrence of physeal swelling), and radiographs taken at the end of the conditioning phase. Also, behavioural studies were performed to detect any changes in behaviour related to the exercise programme. Cortisol levels were measured in both groups, to assess the level of stress. RESULTS: Workload in the CONDEX group was significantly higher than in the PASTEX group (approximately 30%). Conditioning increased the likelihood for joint effusion in the antebrachiocarpal joint, but reduced tarsocrural effusion and physeal swelling at the lateral distal radius, the third metacarpal bone (medial aspect) and lateral and medial aspects of the third metatarsal bone. CONCLUSIONS: The 30% increase in workload did not affect the animals' welfare, effects of conditioning exercise on clinical musculoskeletal health were few and there were no adverse effects. POTENTIAL RELEVANCE: This study supports the feasibility of imposing early conditioning exercise in horses and is a benchmark for its effects on the development of equine musculoskeletal tissues.     

VALIDATION OF DELAYED GADOLINIUM‐ENHANCED MAGNETIC RESONANCE IMAGING OF CARTILAGE AND T2 MAPPING FOR QUANTIFYING DISTAL METACARPUS/METATARSUS CARTILAGE THICKNESS IN THOROUGHBRED RACEHORSES

The purpose of this study was to determine whether delayed gadolinium‐enhanced magnetic resonance imaging of cartilage (dGEMRIC) and T2 mapping are accurate techniques for measuring cartilage thickness in the metacarpus3/metatarsus3 (Mc3/Mt3) of Thoroughbred racehorses. Twenty‐four Mc3/Mt3 cadaver specimens were acquired from six healthy racehorses. Cartilage thickness was measured from postintra‐articular Gd‐DTPA^2? images acquired using short tau inversion recovery (STIR), and proton density weighted (PDw) sequences, and compared with cartilage thickness measured from corresponding histologic images. Two observers performed each histologic measurement twice at three different sites, with measurement times spaced at least 5 days apart. Histologic cartilage thickness was measured at each of the three sites from the articular surface to the bone–cartilage interface, and from the articular surface to the mineralized cartilage interface (tidemark ) . Intra‐observer repeatability was good to moderate for dGEMRIC where Mc3/Mt3 cartilage was not in contact with the proximal phalanx. Where the Mc3/Mt3 cartilage was in contact with the proximal phalanx cartilage, dGEMRIC STIR and T2 mapping PDw cartilage thicknesses of Mc3/Mt3 could not be measured reliably. When measured from the articular surface to the bone–cartilage interface, histologic cartilage thickness did not differ from STIR or PDw cartilage thickness at the site where the Mc3/Mt3 cartilage surface was separated from the proximal phalanx cartilage (P > 0.05). Findings indicated that dGEMRIC STIR and T2 mapping PDw are accurate techniques for measuring Mc3/Mt3 cartilage thickness at locations where the cartilage is not in direct contact with the proximal phalanx cartilage.     

Physeal form of the longbones of the foal

The possible relationship between physeal diseases and physeal form prompted investigation of change in steepness of the physis in young foals. The distal and proximal aspects of the longbones were sawn sagittally in the right and frontally in the left bones. The slabs were washed to remove saw debris, arranged in order and inspected. The proximal physes had a flat or gently arched form, without obvious inclination. In the distal physes there were distinct inclinations. Inspection of an identical slab from the medial aspect of the distal radius of two series of foals of different breeds showed that the degree of inclination of the physis with respect to the long axis of the bone increased with age. In a further series of foals, the angle of inclination was measured from radiographs of identical sagittal and frontal slabs of the distal radius. A line drawn through the secondary spongiosa was produced to intersect a line drawn along the physis where it was mostly steeply inclined, and the angle measured. The angle decreased (physeal inclination increased) with increasing age, up to 35–90 days. The steepness in the lateral aspect of the physis was similar to that in the medial aspect, although evident in a different plane.     

Mild exercise early in life produces changes in bone size and strength but not density in proximal phalangeal, third metacarpal and third carpal bones of foals

Exercise or lack of it in early life affects chondro-osseous development. Two groups of horses were used to investigate the effects of age and exercise regimen on bone parameters of diaphyseal, metaphyseal, epiphyseal and cuboidal bones of the distal limb of Thoroughbreds. One group had exercised only spontaneously from an early age at pasture (PASTEX group), while the other group of horses were exposed to a 30% greater workload through additional defined exercise (CONDEX). Longitudinal data from peripheral quantitative computed tomography (pQCT) were obtained from eight scan sites of the left forelimb (proximal phalangeal (P_p; 1 site), third metacarpal (Mc3; six sites) and third carpal (C₃; one site) bones) of 32 Thoroughbred foals scanned five times from ∼3 weeks to 17 months of age. The primary outcome measures were bone mineral content (BMC), bone area (BA), and periosteal circumference (Peri C) in diaphyseal bone, with cortical thickness (CortTh), volumetric bone mineral density (BMD_v) and a bone strength index (SSI) also being analysed.At the P_p site within the model there was a significant effect (P = 0.00–0.025) of conditioning exercise increasing bone parameters, except endosteal circumference (Endo C) and BMD_v. The BMC, BA, and SSI of P_p were significantly greater in the CONDEX than PASTEX groups at 12 and 17 months (P = 0.015–0.042) and CortTh at 17 months (P = 0.033). At the M55 site of Mc3 BMC, BA and SSI (P = 0.02–0.04), and at the M33 site, SSI (P = 0.05) were higher in the CONDEX than PASTEX group. The adaptive responses, consistent with diaphyseal strengthening, were more marked in the diaphysis of P_p than Mc3. In the Mc3, metaphysis, trabecular BMD_v was less in the CONDEX than PASTEX group, associated with greater bone mineral accretion in the outer cortical-sub-cortical bone in the CONDEX group. There were no significant between-group differences in any epiphyseal or cuboidal bone parameter. Although the early imposed exercise regimen was not intensive, it had significant effects on diaphyseal bone strength, through change in size but not bone density.     

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.     

A SKELETAL OSSIFICATION INDEX FOR NEONATAL FOALS

A skeletal ossification index (SOI) was devised to standardize the radiographic evaluation of the carpal and tarsal regions of newborn foals (less than two weeks of age). This index was based on two radiographic views of a carpus and a tarsus. Four grades of cuboidal bone ossification were discerned: Grade 1 foals had some cuboidal bones with no ossification; Grade 2 was assigned when all cuboidal bones had radiographic evidence of some ossification; in Grade 3 the bones were small and round; in Grade 4 the cuboidal bones were shaped like the adult counterparts. Radiographs were taken of 24 neonatal foals of various gestational ages (range, 297–374 days). The relationships between the SOI and two measures of newborn foal developmental maturity, gestationai age and body weight, were assessed. There was no relationship between the sex of the foal and the SOI, but there was a relationship between the SOI and the gestational age (one-tailed Spearman's rank correlation coefficient, r = 0.748) and between the SOI and body weight (r = 0.77) for the 24 foals. For the ten foals with gestational ages less than 320 days, the relationship between body weight and the SOI was significant (r = 0.953), but the relationship between gestational age and the SOI was not significant (r = 0.605). The degree of ossification of the bones of neonatal foals that are born prematurely (< 320 days of gestation) or are "small-for-gestational age" at birth may be incomplete, and we suggest that radiographs of these regions should be made to assess ossification in foals in these two high risk groups.     

Severe bilateral physitis with instability and Salter‐Harris type 1 fractures in two foals

This Case Report describes the clinical, radiographic, computed tomographic and post mortem findings in 2 foals with severe bilateral physitis of the distal third metatarsal bones (MtIII). The foals were admitted because of bilateral hindlimb lameness of several weeks' duration. Initial examination revealed that the physeal regions of the distal MtIII were enlarged, warmer than normal and painful on palpation. Case 1 was treated conservatively and discharged but was readmitted 8 weeks later because of clinical deterioration. In both foals, radiographs showed plantar dislocation of both epiphyses through the physis and a Salter‐Harris type 1 fracture. The foals were subjected to euthanasia and a post mortem examination.     

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.     

Retrospective study of 108 foals with septic osteomyelitis

Objective   To determine the clinical characteristics, short-term outcome and future athletic performance of foals with septic osteomyelitis.
Design   Retrospective clinical study of 108 Thoroughbred foals with radiographic evidence of bone infection that were presented at the Scone Veterinary Hospital between August 1995 and December 2001. Medical records were reviewed and information concerning signalment, the clinical, laboratory and radiographic findings, treatment and outcome was obtained. Racing records were obtained and evaluated for surviving foals that had reached racing age.
Results   Mean age of foals at initial evaluation was 39 days (range 1–180 days); 21 foals had multiple radiographic bone lesions (19.4%), and 76 had concurrent septic arthritis (70.4%). The most frequently affected bones were the femur, tibia and distal phalanx. In total, 87 foals were discharged from the hospital (80.6%), 79 survived long-term to reach racing age and 52 raced (65.8%). Overall, 48% (52/108) of the foals treated for osteomyelitis raced. Foals less than 30 days of age at the time of diagnosis, critically ill foals and those with multiple bones or joints affected were significantly less likely to be discharged from hospital. Multiple septic joints, but not multiple bone involvement, had an unfavourable prognosis for racing.
Conclusions   The prognosis for survival of foals with septic osteomyelitis or osteitis is favourable. Multiple bone or joint involvement is an important short-term prognostic indicator; however, the involvement of multiple joints, but not multiple infected bones, is associated with an unfavourable prognosis for racing.     

Changes in mineralised tissue at the site of origin of condylar fracture are present before athletic training in Thoroughbred horses

Abstract

AIM: To show that changes are present at the site of origin of metacarpal condylar fracture in young Thoroughbred horses before they enter race training.

METHOD: Bone slices, 2 mm thick, in three mediolateral planes through the centre of rotation of the metacarpo-phalangeal joint (MCPJ) of both distal third metacarpal bones (Mc3) of 12 Thoroughbred horses aged 17 months, were imaged using point-projection digital X-ray imaging (µXR).

RESULTS: In some horses, linear or ovoid radiolucency was found in articular calcified cartilage (ACC) and subchondral bone of the palmaro-distal aspect of the sagittal groove, exactly at the site of more advanced stages of condylar fatigue fracture. An incidental finding was ovoid radiolucency in the apex of the dorso-distal aspect of the sagittal ridge, with or without fragmentation or disturbance of the subchondral mineralised tissue line, resembling equine osteochondrosis.

CONCLUSIONS AND CLINICAL RELEVANCE: The findings imply that the aetiology of condylar fatigue fracture in young Thoroughbred horses includes abnormality in development of the bone and joint that is present before athletic activity occurs.     

Quantitative analysis of long-bone growth in the horse

Long-bone growth at the distal ends of the radial bones, the distal ends of the 3rd metacarpal bones, the distal ends of the 3rd metatarsal bones, and the proximal ends of the proximal phalangeal bones (of thoracic and pelvic limbs) was quantitatively analyzed in 9 Thoroughbred-Quarter Horse foals from birth to 2 years of age. Metal growth markers were surgically implanted in the bones of the animals at 2 to 4 days of age. Radiographs of the bones were made on the day of surgical manipulation, the next day, and then once a week for 8 months, and once a month thereafter for an additional 18 months. On each radiograph, the intervals between the growth markers were measured and plotted, and these accumulated growth data were subjected to statistical analyses. Growth curves, cumulative growth, and relative growth rates were determined. The ages of radiographic growth plate closure also were determined. Total bone growth observed in these foals was proportionately greater than that observed in a similar study of Shetland-Welsh ponies, probably indicating a breed difference. The most rapid growth rate at the 5 anatomic sites in the foals occurred from birth to 10 weeks of age; however, in the distal part of the radius, there was a continuous, though declining growth rate until 60 weeks of age, whereas in the distal ends of the 3rd metacarpal and metatarsal bones and the proximal end of the proximal phalanges growth ceased abruptly and nearly plateaued after 10 weeks of age.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

BIPARTITE PROXIMAL SESAMOID BONES IN YOUNG THOROUGHBRED HORSES

Twelve foals with unusual sesamoid development were found in a population of 107 Thoroughbred foals (60 males, 47 females) over a three year period. Radiographic examination was done at 14 days of age and at 42 day intervals thereafter. The routine administration was of a dorsopalmar view of the proximal sesamoid bones in the left forelimb. Changes of the proximal sesamoid bones were found in 11% of the foals between 14 and 56 days of age. The change was a radiolucent line at the junction of the middle and proximal third of the sesamoid bone. Of those which were observed with sesamoid bone changes, 8 had a normal radiographic appearance at 60 days. In most foals at least 2 or 3 sesamoid bones of the forelegs were affected. In some only 1 sesamoid bone was affected. The changes did not correlate with a clinical joint disorder. However, females seemed to be affected more than males. This condition may be similar to bipartite sesamoid bones described by others and probably a manifestation of secondary ossification centers.     

Is there a characteristic distal tarsal subchondral bone plate thickness pattern in horses with no history of hindlimb lameness?

REASONS FOR PERFORMING STUDY: Osteoarthritis (OA) is a common cause of distal tarsal pain, but disease development is poorly understood. Awareness of normal tarsal structure and function is important in order to understand the pathogenesis of OA. Thickening of the subchondral bone (SCB) plate has been related to the development of OA, but SCB plate patterns in the equine tarsus have not been documented. HYPOTHESES: There is a repeatable pattern of SCB thickness across the distal tarsal joints, and specifically that thickness would be greatest dorsally and laterally. METHODS: Twenty cadaver tarsi were collected from mature horses that had undertaken low-level exercise only with no history of hindlimb lameness. Magnetic resonance images were acquired using a high-resolution sagittal 3-dimensional T1-weighted spoiled gradient echo sequence. Subchondral bone thickness was measured on sagittal images at dorsal and plantar locations on the proximal and distal aspects of the central (CT) and third (T3) tarsal bones and proximal aspect of the third metatarsal bone (Mt3). RESULTS: On the proximal aspect of CT, medial and lateral SCB thickness were significantly greater than midline. On the distal aspect of CT and T3 and proximal Mt3, lateral SCB thickness was significantly greater than medial and midline sites. Dorsal SCB thickness was greatest on the proximal and distal aspects of CT and proximal Mt3. Subchondral bone accounted for a greater proportion of CT and T3 on the dorsal aspect than the plantar. CONCLUSIONS: There is a repeatable pattern of SCB thickness in the distal tarsal bones of horses with no history of hindlimb lameness. This reflects the pattern of loading across the joints. POTENTIAL RELEVANCE: This study provides evidence of a consistent osteochondral pattern in the equine tarsus for reference in identification of osteoarticular pathologies.     

Musculoskeletal responses of 2-year-old Thoroughbred horses to early training. 8. Quantitative back-scattered electron scanning electron microscopy and confocal fluorescence microscopy of the epiphysis of the third metacarpal bone

AIM: To characterise and explain the increase in density evident by computerised tomography (CT) and radiography in companion studies as a response to training, in bone in the palmar and dorsal regions of the condyles of the third metacarpal bone (Mc3) of 2-year-old Thoroughbred horses. METHODS: Compositional back-scattered electron (BSE) imaging in scanning electron microscopy (SEM) and confocal scanning laser microscopy (CSLM) were conducted on polymethyl methacrylate (PMMA)-embedded mediolateral slices of the right distal Mc3 from seven 2-year-old Thoroughbred horses trained on a racetrack and seven untrained horses kept at pasture. One left Mc3 from each group was studied in transverse section planes. This study focussed on regions of Mc3 found to differ in density between the trained and untrained horses in companion studies using CT and radiography. RESULTS: The increase of bone density in the condyles of Mc3 in trained horses compared with untrained horses occurred, without prior osteoclastic resorption, via the deposition of new bone on pre-existing internal surfaces. Within prior marrow spaces of cancellous bone, there was also rapid formation of immature strands and fronds of bone which were more cellular and mineralised, and more lamellar bone tissue was deposited on these new scaffolding elements in the trained horses. Both resulted in increased bone volume fraction (BVF). The microscopic mineralisation density of the bulk of the new tissue was lower than in pre-existing bone, and CT and radiography underestimated the increase in BVF. The new tissue was thus probably less stiff at the microscopic scale than pre-existing bone, though its addition would stiffen the global structure. CONCLUSIONS: In Mc3 of all the trained horses, there were obvious differences in microscopic structure compared with those from the untrained horses. Moderate, industry-standard levels of exercise used to prepare young horses for racing induced the formation of new bone in non-bone spaces in bone tissue, such that the bone organ should better withstand later increased levels of exercise.