Histomorphologic evaluation of extracorporeal shock wave therapy of the fourth metatarsal bone and the origin of the suspensory ligament in horses without lameness

OBJECTIVE: To determine via histologic examination and scintigraphy the effect of focused extracorporeal shock wave therapy (ESWT) on normal bone and the bone-ligament interface in horses. ANIMALS: 6 horses without lameness. PROCEDURE: Origins of the suspensory ligament at the metacarpus (35-mm probe depth) and fourth metatarsal bone (5-mm probe depth) were treated twice (days 0 and 16) with 2,000 shocks (energy flux density, 0.15 mJ/mm2). One forelimb and 1 hind limb were randomly treated, and the contralateral limbs served as nontreated controls. Bone scans were performed on days -1 (before ESWT), 3, 16, and 19. Histomorphologic studies of control and treated tissues were performed on day 30. RESULTS: ESWT significantly increased the number of osteoblasts but caused no damage to associated soft tissue structures and did not induce cortical microfractures. A significant correlation between osteoblast numbers and radiopharmaceutical uptake was noticed on lateral views of the hind limb on days 3 and 16 and on caudal views of the forelimb on day 3. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that ESWT has the potential to increase osteoblast numbers in horses. The correlation between increased osteoblast numbers and radio-pharmaceutical uptake 3 days and 16 days after the first ESWT suggested that stimulation of osteogenesis occurred soon after ESWT. No damage to bone or the bone-ligament interface should occur at the settings used in this study, and ESWT can therefore be administered safely in horses.     

Scanning electron microscopic examination of third metacarpal/third metatarsal bone failure surfaces in thoroughbred racehorses with condylar fracture

OBJECTIVE : To examine the fracture failure surfaces from Thoroughbred horses that had sustained a catastrophic condylar fracture. SAMPLE POPULATION : Bone specimens from the failure surface were obtained from 12 Thoroughbred racehorses with catastrophic injury and 2 non-racing horses with accidental long bone fracture. METHODS : Bone specimens from the failure surface of each fracture were incubated with gold microspheres to label microcracks before examination at x50 to x60,000 using scanning electron microscopy. Microcracking at the failure surface was assessed using a visual analog scale. RESULTS : Branching arrays or clusters of microcracks were seen over a range of magnifications in adapted subchondral bone in the distal end of the MC3/MT3 bone from racing Thoroughbreds with a catastrophic displaced condylar fracture. In the palmar/plantar region, microcracking was associated with the formation of an array of macroscopic cracks in the condylar groove. A different pattern of microcracking was seen in specimens of bone from distal metaphyseal and diaphyseal MC3/MT3 failure surfaces from Thoroughbred racehorses with catastrophic fracture and non-racing horses with an accidental diaphyseal long bone fracture. Few microcracks were seen and typically did not form branching arrays. CONCLUSION : These data suggest that propagation of condylar fracture in Thoroughbred racehorses is initiated by the formation of nanoscale microcracks in adapted subchondral bone that form during exercise-induced bone adaptation. CLINICAL RELEVANCE : Accumulation and coalescence of branching microcracks into arrays or clusters appears to eventually lead to the development of macroscopic subchondral cracks in the condylar groove and initiation of a condylar fracture.     

Investigation of the immediate analgesic effects of extracorporeal shock wave therapy for treatment of navicular disease in horses

OBJECTIVES: To measure the acute analgesic properties of extracorporeal shock wave therapy (ESWT) in horses with navicular disease using objective ground reaction forces (GRF). STUDY DESIGN: Prospective study. ANIMALS: Nine client-owned horses with unilateral forelimb lameness caused by navicular disease. METHODS: Horses were trotted at 3 m/s over a force plate to record pre-treatment GRF of the lame and contra-lateral forelimbs. After ESWT of the lame limb, applied with a radial unit to each of the frog and heel bulb areas with 1500 pulses at 4 bar and 10 Hz, GRF measurements were repeated at 15 minutes and 24-hour intervals for 7 days. From the 5 trials recorded at each time, peak vertical force (PVF) was calculated and averaged. Data were compared between limbs and over time using a 2-way repeated-measures ANOVA. RESULTS: Mean (+/-SD) PVF was significantly different between lame (day 1; 4339+/-626 N) and contra-lateral (day 1; 5236+/-515 N) limbs pre-treatment (P<.05). After ESWT treatment, this difference remained unchanged at 15 minutes and from days 1 to 7. To confirm navicular disease, palmar digital analgesia significantly reduced the lameness (lame 5144+/-430 N; contralateral 5082+/-586 N; P>.05). CONCLUSIONS: Single ESWT treatment applied in this manner does not influence lameness in horses with navicular disease. CLINICAL RELEVANCE: Although many equine regulatory commissions currently ban the use of ESWT before competition, our results suggest that such regulations may be unfounded. Further research is required to determine the long-term analgesic properties of this frequently used treatment modality in equine athletes.     

Race- and course-level risk factors for fatal distal limb fracture in racing Thoroughbreds

REASONS FOR PERFORMING STUDY: Considerable variation in the rates of equine fatality at different racecourses draws attention to probable risk factors at the level of course or race that might be partly responsible. Distal limb fractures are the most common cause of equine fatality on UK racecourses and identification of risk factors for such injuries and subsequent implementation of intervention strategies could significantly reduce the total number of racecourse fatalities. OBJECTIVES: To identify race- and course-level risk factors for fatal distal limb fracture in Thoroughbreds on UK racecourses. METHODS: A case-control study design was used. Case races were defined as those in which one or more horses sustained fatal fracture of the distal limb. Controls were selected in 2 different ways. Firstly, 3 races in which no fracture occurred were selected from all races of the same type held within 5 days of the case race (Analysis 1). Secondly, 3 control races were selected for each case race from all races of the same type held in the same year (Analysis 2). One hundred and nine cases were included in the study. Information about the race and the racecourses was collected from Computer Raceform. Conditional logistic regression was used to identify the relationship between a number of independent variables and the likelihood of fracture in a race. RESULTS: Longer races with a larger number of runners were more likely to contain a fracture. Firmer going and fewer days since the last race on the same course were associated with an increased risk of fracture. The going at the course at the previous race meeting was also associated with the likelihood of fracture. CONCLUSIONS: Modifications to the going on the day of a race and greater emphasis on ground maintenance between race meetings may have an impact on the risk of fatal distal limb fracture during racing. POTENTIAL RELEVANCE: Modification of risk factors such as the going and number of days since the last race meeting could reduce the number of equine fatalities on UK racecourses. The condition of the racecourse may be an important risk factor and future research should focus on the identification of course maintenance techniques that produce the safest possible racing surfaces.     

The Use of Radial Extracorporeal Shockwave Therapy in the Treatment of Urethral Urolithiasis in the Horse: A Preliminary Study

Background: Radial extracorporeal shockwave therapy (ESWT) is widely used in equine practice for the treatment of orthopedic problems. However, its original use as a lithotripsy device in human and canine urology led us to postulate that it could be used as an alternative to the surgical treatment of urethral calculi in horses. Hypothesis: Radial ESWT can easily and safely fragment calculi in the distal urethra of the horse. Animals: Two postmortem cases and 1 live case of obstructive urinary disease admitted at the Veterinary Teaching Hospital of Liege. Methods: A radial shockwave device was directly applied to the urethra in an attempt to fragment calculi. An ex vivo trial was performed on the same retrieved calculi to investigate pressure settings in order to obtain complete fragmentation of the calculus. Results: In all cases, radial ESWT was able to fragment the calculus partially, enabling retrieval of the remaining fragments via the urethra. Much higher pressure settings than those used for in vivo partial fragmentation were necessary to obtain complete destruction of the calculi ex vivo. Conclusions and Clinical Importance: This brief report suggests the use of radial ESWT as a safe and useful alternative to more invasive surgical management of urethral calculi in horses.     

Effects of extracorporeal shock wave therapy and radial pressure wave therapy on elasticity and microstructure of equine cortical bone

OBJECTIVE: To measure changes in the modulus of elasticity (E) and describe histologic findings after extracorporeal shock wave therapy and radial pressure wave therapy on equine cortical bone specimens. SAMPLE POPULATION: 16 bone specimens from the proximodorsal cortex of an equine third metacarpal or metatarsal bone. PROCEDURE: Baseline E was determined by the density (p) and unidirectional ultrasound transmission velocity (C) of each specimen according to the equation E = pC2. Eight specimens were treated with 500 pulses of 0.15 mJ/mm2 of extracorporeal shock wave therapy, and 8 specimens were treated with 500 pulses of 0.16 mJ/mm2of radial pressure wave therapy. After treatment, C was determined again. Four treatment sessions resulted in 2,000 pulses and 5 C measurements. The p of each sample was measured again. Mean post-treatment E was calculated for each group. Nondecalcified sections of all specimens were stained with toluidine blue or basic fuchsin for histologic evaluation. RESULTS: Overall treatment group effect was not significant for C or E. Final E was not different from baseline values for extracorporeal shock wave therapy and radial pressure wave therapy. No histologic changes could be attributed to either treatment modality. CONCLUSIONS AND CLINICAL RELEVANCE: Extracorporeal shock wave therapy and radial pressure wave therapy did not affect the material properties of equine bone at the energy and pulse values used in this study.     

Assessment of scintigraphic and thermographic changes after focused extracorporeal shock wave therapy on the origin of the suspensory ligament and the fourth metatarsal bone in horses without lameness

OBJECTIVE: To monitor the effect of focused extra-corporeal shock wave therapy (ESWT) on bone and bone-tendon junction of horses without lameness by use of nuclear scintigraphy and thermography. ANIMALS: 6 warmblood horses without lameness. PROCEDURE: The origin of the suspensory ligament at the metacarpus (OSL-MC) and the fourth metatarsal bone were treated at 2 time points (days 0 and 16) with 2,000 shocks applied by a focused ESWT device at an energy flux density of 0.15 mJ/mm2. One forelimb and 1 hind limb were treated, and the contralateral limbs served as controls. To document the effect of focused ESWT, nuclear scintigraphy was performed on days -1, 3, 16 (before second ESWT), and 19. Thermography was performed on days -1, 0 (1 hour after first ESWT), 1, 3, 8, 16 (twice; before and 1 hour after second ESWT), and 19. On days 3, 16 (first scans), and 19, thermography was performed before scintigraphy. RESULTS: Scintigraphically, significant variations in radiopharmaceutical activity at the OSL-MC were detected in treatment and control limbs. No significant differences, however, in mean temperature or radiopharmaceutical activity could be detected by use of thermography or nuclear scintigraphy, respectively, between the treatment and control limbs at any time point in response to ESWT. CONCLUSIONS AND CLINICAL RELEVANCE: After 2 treatments of focused ESWT, no physiologic effect on the studied structures could be demonstrated by use of nuclear scintigraphy or thermography. Results of this study indicate that at currently used ESWT settings, no damage to the bone or bone-tendon junction should occur.     

Frequency distribution of carpal osteochondral fragmentation in a population of flat racing Thoroughbreds in the UK

Lameness associated with osteochondral fragmentation of the carpus is a common injury in racing horses. Frequency distributions of sites of fragmentation have previously been published in racehorses in the USA, Australia, New Zealand and Japan but not in racing Thoroughbreds in the UK. The objectives of the study were to document sites of osteochondral fragmentation in the carpus of a population of Thoroughbred flat racehorses in the UK and compare these with other Thoroughbred populations globally and other flat racing breeds. This study was a single centre retrospective observational study; case records of flat racing Thoroughbreds with sites of carpal bone fragmentation that underwent arthroscopic surgery at Newmarket Equine Hospital between 2008 and 2013 were reviewed. A total of 291 sites of fragmentation were identified arthroscopically within the carpal joints of 174 horses. This involved 135 (75%) middle carpal (MCj) and 44 (25%) antebrachiocarpal joints (ABCj), which differs from other populations reported. The most common sites of fragmentation were dorsodistal radial carpal bone (DDiCr) (49%), dorsoproximal third carpal bone (DPrC3) (22%), dorsodistal radius (DDiR) (15%), dorsoproximal radial carpal bone (DPrCr) (5%) and dorsoproximal intermediate carpal bone (DPrCi) (4%). The dorsodistal radial carpal bone is also the most common site in American (US) Quarter Horses (QHs) and Thoroughbreds (TBs) and Australian (AUS) TBs, while DPrC3 has a greater prevalence in US Standardbreds (SBs). Thereafter the frequency distribution differs between the reported study groups. Although all horses underwent bilateral radiographic examination, 45% of the total population had unilateral arthroscopic evaluation. This may therefore underestimate the total number of sites of fragmentation reported. In summary the frequency distribution of carpal fragmentation in flat racing Thoroughbreds in the UK appears to differ from other populations of racehorses.     

Long-term outcome of horses with a slab fracture of the central or third tarsal bone treated conservatively: 25 cases (1976-1993)

OBJECTIVE: To determine clinical features of horses with a slab fracture of the central or third tarsal bone and to report outcome of horses in which treatment did not include surgery. DESIGN: Retrospective study. ANIMALS: 25 horses (14 Standardbreds, 6 Thoroughbreds, 5 Quarter Horses). PROCEDURE: Medical records of horses with a slab fracture of the central (n = 9) or third (16) tarsal bone were reviewed. Only horses for which treatment consisted of confinement to a stall were included in this study. Clinical features and radiographic findings were recorded and summarized. Outcome was determined for racing breeds by obtaining official lifetime race results. Outcome for Quarter Horses was determined by phone survey of the owners. RESULTS: 16 (64%) horses had a successful outcome. Ten of 14 (71%) Standardbreds and 2 of 6 Thoroughbreds returned to racing and started at least 5 races after injury. Four of 5 Quarter Horses for which follow-up information was available successfully returned to their previous activity. Sex, age, limb affected, or gait was not associated with final outcome. Percentage of racehorses with central tarsal bone fractures that had a successful outcome (2/7) was significantly less than percentage with third tarsal bone fractures that did (10/13). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that enforced rest without surgical fixation can be an effective therapeutic option for horses with a slab fracture of the central or third tarsal bone, even if athletic function is expected.     

Disease-specific changes in equine ground reaction force data documented by use of principal component analysis.

OBJECTIVE: To assess the force plate as a diagnostic aid in equine locomotor abnormalities, particularly for abnormalities such as navicular disease that do not have specific diagnostic criteria. ANIMALS: 17 Thoroughbreds without observable locomotor abnormalities (group A), 6 Thoroughbreds with superficial digital flexor tendon injury (group B), and 8 Thoroughbreds with navicular disease (group C). PROCEDURE: Using a force plate, ground reaction force patterns were recorded at the trot. Peak limb vertical force and force/time curve parameters were derived from 4 identifiable points at the beginning and end of vertical and craniocaudal horizontal plots. Principal component analysis (PCA) of group-A data was undertaken on beginning and end of stride data, and the first 2 components were represented graphically. The PCA rotation matrices were applied to equivalent data for horses of groups B and C. RESULTS: Asymmetry of peak vertical force (PVF) could not be differentiated among groups A, B, and C. Values for group-B horses, however, were significantly outside mean group-A values on the PCA plot for beginning of stride phase variables. Group-B data were within the group-A range for end of stride phase variables. Values for group-C horses were significantly outside the group-A range for beginning of stride phase variables and were outside mean group-A values for end of stride phase variables. CONCLUSIONS: PCA of force/time data provides a sensitive method to evaluate the force/time curve associated with 2 specific injury/disease processes. CLINICAL RELEVANCE: Horses alter weight-bearing in biomechanically distinct ways, thus creating potential for the force plate to become an important diagnostic and prognostic tool.     

Scintigraphic, radiographic, and thermographic appearance of the metacarpal and metatarsal regions of adult healthy horses treated with nonfocused extracorporeal shock wave therapy--a pilot study

Nonfocused extracorporeal shock wave therapy (ESWT) treatment protocol is commonly used in veterinary practice. This study investigated the effects of four nonfocused ESWT treatments, given 2 weeks apart, on bone radiopharmaceutical uptake and radiographic and thermographic appearance in the metacarpal and metatarsal regions in six adult untrained horses. There were no measurable treatment effects determined by thermography (daily), scintigraphy (at 2-week intervals), and radiography (before study initiation and at study completion) between treated and control limbs. It was concluded that no gross evidence of bone remodeling is detectable by conventional clinical assessment when nonfocused ESWT is applied to healthy equine metacarpal or metatarsal bone.     

Morphometrical variations of the carpal bones in thoroughbreds and ponies

There is scant morphological data for equine carpal bones despite the frequent pathology in Thoroughbreds (TB). This study aimed to identify morphological and morphometrical variations and similarities in carpal bones between and within TB and Ponies (Po). Carpal bones from nine TB and 13 Po were prepared by boiling and drying. Lateromedial width, dorsopalmar depth, proximodistal height, relative density and volume of each bone were measured. Normalized measurements of the radial (Cr) and third (C3) carpal bones were significantly different in all dimensions, and there were significant variations in relative sizes of articular facets of the ulnar (Cu), C3 and fourth (C4) carpal bones between the groups. Bilaterally, the proportionate volume of the intermediate carpal bone (Ci) was significantly greater in Po while that of Cu and C4 were significantly greater in TB. Relative density of most bones was greater in Po. The palmar tuberosity of the proximal surface of Ci and palmar tubercle on the palmar surface of Cu were more prominent and relatively larger in TB. In the second carpal bone (C2), the distal extent of the proximal articular surface on the palmar surface was greater in Po. The inconsistent first carpal bone (C1) was relatively larger in Po. Morphometrical similarities and differences in carpal bones between TB and Po indicate potential effects of selection for body size or fast exercise.     

Equine carpal articular cartilage fibronectin distribution associated with training, joint location and cartilage deterioration

Processes involved in equine carpal osteochondral injury have not been established. In other species, fibronectin appears important in chondrocyte-matrix interactions, and levels are increased in osteoarthritis. This investigation aimed to (a) describe fibronectin immunoreactivity in the middle carpal joint of 2-year-old Thoroughbreds, (b) determine topographical variations, (c) compare strenuously trained (Group 1) or gently exercised horses (Group 2) and (d) describe sites with early osteoarthritis. Group 1 (n = 6) underwent a 19 week high intensity treadmill training programme. Group 2 (n = 6) underwent 40 min walking until euthanasia. Dorsal and palmar sites on radial, intermediate and third carpal articular surfaces were prepared. Immunohistochemistry was performed using a biotin-streptavidin/peroxidase method. Cross-reactivity of rabbit antihuman fibronectin antiserum with equine fibronectin was confirmed using Western blotting. Results showed: (a) fibronectin was present primarily in pericellular and interterritorial matrix locations, (b) dorsal sites had zonal immunoreactivity compared to palmar sites, (c) Group 1 dorsal radial carpal cartilage had increased superficial staining compared to Group 2 and (d) fibrillated cartilage showed increased intracellular and local matrical immunoreactivity (superficial zone). These findings suggest topographical and exercise-related variations in fibronectin distribution, and indicate equine fibronectin is localised at sites of cartilage degeneration and released into the matrix by chondrocytes in the local area.     

Race-start characteristics and risk of catastrophic musculoskeletal injury in Thoroughbred racehorses

OBJECTIVE: To identify race-start characteristics associated with catastrophic musculoskeletal (MS) injury in Thoroughbred racehorses at 2 racetracks in Florida during 1995 through 1998. DESIGN: Matched case-control study. ANIMALS: 97 Thoroughbreds (case horses) that incurred a catastrophic MS injury during racing and 388 Thoroughbreds (control horses) randomly selected from noninjured participants and matched on the basis of racetrack and year. PROCEDURE: Incidence of MS injury was calculated for all race meets at 2 racetracks in Florida from 1995 through 1998. Race-start characteristics were compared among case and control horses, using conditional logistic regression. RESULTS: Overall incidence of MS injury was 1.2/1,000 race starts (97/79,416 starts). Incidence of injury was significantly higher for turf races (2.3/1,000 starts) than for dirt races (0.9/1,000 starts). Sex, number of days since last race, and racing surface were associated with risk of injury; geldings, > or = 33 days since the last race, and turf racing surface were associated with a higher risk of injury. CONCLUSIONS AND CLINICAL RELEVANCE: Incidence of injury among Thoroughbreds in Florida was associated with sex, number of days since last race, and racing surface. Days since last race may have been an indicator of previous health and lameness problems. Racing surface may have been a risk factor for MS injury because turf races tended to be more competitive than dirt races. Horses running in turf races were more likely to participate in races with a large field, handicap races, long races, and races with high purses.     

Factors associated with racing performance of Thoroughbreds undergoing lag screw repair of condylar fractures of the third metacarpal or metatarsal bone

OBJECTIVE: To evaluate effects of sex, fracture configuration, affected limb, and screw placement on outcome of Thoroughbreds with condylar fractures involving the third metacarpal or metatarsal bone. DESIGN: Cohort study. Animals-56 horses. PROCEDURE: Age, sex, affected limb, fracture configuration, fracture length, fracture fragment width, and distance of the most distal screw from the articular surface were analyzed in logistic regression models. RESULTS: Females were more likely to have displaced fractures and race in fewer races after surgery than males. Sex and fracture configuration were associated with number of postoperative races. Among horses that returned to racing, those with thicker fracture fragments were 11 times as likely as horses with thinner fracture fragments to win a race after surgery. Horses with longer fractures and older horses had fewer postoperative races. Horses in which the most distal screw had been placed further from the joint surface had more races. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that female horses with displaced condylar fractures and male horses with nondisplaced condylar fractures are more likely to be referred for treatment. The effect of sex on outcome for these horses cannot be clearly separated from the effect of fracture configuration. When adjusted for fracture configuration, males were 6 times as likely as females to race after surgery. When adjusted for sex, horses with nondisplaced fractures were 17 times as likely as horses with displaced fractures to race after surgery. Results suggest that the most distal screw should be placed above the epicondylar fossa.     

Analysis of horse race videos to identify intra-race risk factors for fatal distal limb fracture

The objective of this study was to identify risk factors, during racing, associated with imminent fatal distal limb fracture in Thoroughbreds. One hundred and nine cases of fatal distal limb fracture were identified from all 59 UK racecourses over a 2-year period (February 1999-January 2001). Three uninjured control horses were randomly selected from the same race as the case horse. Videos of races in which fractures occurred were viewed using a defined protocol. Fractures in flat races occurred at any time during the race, whereas 74% (45/61) of cases in national hunt type races occurred in the second half of races. More than 75% (79/103) of cases were spontaneous, i.e. there was no obvious external influence such as a fall at a fence or collision with another horse. Sixty-six percent (44/67) of horses, sustaining a forelimb fracture, fractured the forelimb they were using as lead leg at the time of fracture. When case and control horses were compared, horses that were: (a) making good progress through the race, (b) reluctant to start and (c) received encouragement in the final 10s before the time of fracture, were more likely to sustain a fracture.     

Effects of extracorporeal shock wave therapy on desmitis of the accessory ligament of the deep digital flexor tendon in the horse

Objective: To evaluate the effects of extracorporeal shock wave therapy (ESWT) on collagenase‐induced lesions in the accessory ligament of the deep digital flexor tendon (ALDDFT) of horses. Study Design: Paired, blinded controlled study. Animals: Eight Thoroughbred horses (3 mares, 5 geldings; mean±SD weight, 464±26 kg, mean age, 8±1.7 years). Methods: Lesions were created in both ALDDFTs of all horses by injection of 2 × 10³ IU of collagenase type I. Percent lesion and structure (fiber alignment and echogenicity) were quantified with ultrasonographic imaging 3, 6, and 9 weeks after collagenase injection. After ultrasound examinations, ESWT (1000 shocks at 0.15 mJ/mm²) was applied to 1 ALDDFT in each horse. ALDDFT were harvested 15 weeks after collagenase injection and the microstructure, mRNA levels of collagen types I and III, and collagen and glycosaminoglycan content were evaluated. Results: There were no differences in percent lesion, echogenicity, or fiber alignment between control‐ and ESWT‐treated ligaments at each evaluation time; however, compared with 3‐week values, there was a significant increase in percent lesion and echogenicity for EWST treated ligaments at 6 weeks and significant decrease in both variables for treated and control ligaments at 12 weeks. Fiber alignment improved significantly at 9 weeks in controls and at 12 weeks in treated and control ligaments. Collagen type I mRNA levels were significantly higher in the ESWT treatment group compared with the control group 15 weeks after collagenase injection though differences in other mRNA levels, microstructure, and composition were not significant. Conclusions: Our results do not support an effect of ESWT on collagenase‐induced lesions in the equine ALDDFT.     

In vitro cyclic biomechanical properties of an interlocking equine tibial nail

OBJECTIVE: To determine cyclic biomechanical properties of gap osteotomized adult equine tibiae stabilized with an equine interlocking nail (EIN). STUDY DESIGN: In vitro experimental biomechanical investigation. SAMPLE POPULATION: Thirteen adult equine cadaveric tibiae. METHODS: Adult equine tibiae with transverse, midshaft, 1-cm gap osteotomies, stabilized with an equine interlocking nail, underwent cyclic biomechanical testing in vitro under axial compression, 4-point bending, and torsion. Different specimens were subjected to different load levels that represented estimated in vivo loads at 2 Hz for 740,000 cycles. Fatigue life and gap strain were calculated. RESULTS: Compression and bending, but not torsional, fatigue life were longer than time necessary for bone healing. Compressive, but not bending or torsional, gap strains were small enough to be compatible with fracture healing by primary bone formation. Gap strains for compressive, bending, and torsional loads were compatible with indirect, or secondary, bone formation. CONCLUSIONS: Further modification should be made to the equine interlocking nail to increase bending stiffness and torsional fatigue life. CLINICAL RELEVANCE: The stainless steel equine intramedullary interlocking nail is unlikely to provide appropriate long-term stability for fracture healing in adult equine tibiae without modifications in the nail design and material.     

Evaluation of lipopolysaccharide-induced activation of equine neutrophils

OBJECTIVE: To evaluate lipopolysaccharide (LPS)-induced activation of equine neutrophils in blood. SAMPLE POPULATION: Blood samples from 5 healthy adult Thoroughbreds. PROCEDURES: Neutrophil integrin (CD11/CD18) expression, size variation, degranulation, and deformability were measured with and without incubation with LPS. Time and concentration studies were done. The mechanism of endotoxin-induced neutrophil activation was investigated by inactivating complement or preincubating neutrophils with inhibitors of tumor necrosis factor-alpha (TNF-alpha) synthesis, prostaglandin-leukotriene synthesis, or platelet-activating factor. RESULTS: Incubation of equine neutrophils with LPS increased cell surface expression of CD11/CD18, decreased neutrophil deformability, increased and decreased neutrophil size, and induced neutrophil degranulation. The LPS-induced neutrophil activation was attenuated by addition of inhibitors of TNF-alpha and prostaglandin-leukotriene synthesis. CONCLUSIONS AND CLINICAL RELEVANCE: Equine neutrophils are readily activated in vitro by LPS, resulting in increased expression of integrin adhesion molecules, decreased deformability, variation in neutrophil size, and degranulation. The tests used to detect activated neutrophils in this study may be useful in detecting in vivo neutrophil activation in horses with sepsis and endotoxemia.     

The effect of focused extracorporeal shock wave therapy on collagen matrix and gene expression in normal tendons and ligaments

Reasons for performing study: Extracorporeal shock wave therapy (ESWT) is frequently used in equine practice, but little is known about its biological action. Objectives: To study the effects of ESWT on matrix structure and gene expression levels in normal, physiologically loaded tendinous structures in ponies. Methods: Six Shetland ponies, free of lameness and with ultrasonographically normal flexor and extensor tendons and suspensory ligaments (SL), were used. ESWT was applied at the origin of the suspensory ligament and the mid‐metacarpal region of the superficial digital flexor tendon (SDFT) 6 weeks prior to sample taking, and at the mid‐metacarpal region (ET) and the insertion on the extensor process of the distal phalanx (EP) of the common digital extensor tendon 3 h prior to tendon sampling. In all animals one forelimb was treated and the other limb was used as control. After euthanasia, tendon tissue was harvested for real‐time PCR to determine gene expression levels and additional samples were taken for histological evaluation and biochemical analyses Results: Histologically a disorganisation of the normal collagen structure was observed 3 h after ESWT, remnants of which were still visible after 6 weeks. While degraded collagen levels showed an increase at 3 h post treatment (P = 0.012) they were reduced at 6 weeks post ESWT (P = 0.039). Gene expression for both COL1 (P = 0.004) and MMP14 (P = 0.020) was upregulated at 6 weeks after treatment. Conclusions: Exposure of normal tendinous tissue to ESWT is not uneventful; it leads to a disorganisation of matrix structure and changes in degraded collagen levels. The upregulation of COL1 expression 6 weeks after ESWT may be indicative for repair. Potential relevance: The observed disorganisation of the collagen network warrants caution when using ESWT. Exposing noninjured tissue to ESWT should be avoided and it may be advisable to restrict exercise in recently treated patients. However, the induced tissue disorganisation might also be a trigger for repair in chronic tendinopathies.