Pathological fracture through a subchondral bone cyst in the proximal phalanx of a horse

A 12‐year‐old Morgan broodmare presented for a nonweightbearing right forelimb lameness. Radiography and computed tomography confirmed the presence of a pathological fracture of the proximal first phalanx through a large subchondral bone cyst (SBC) in the right forelimb and a large SBC in the proximal first phalanx of the left forelimb. Surgical repair of the large palmar medial eminence fracture of the proximal first phalanx fracture was performed using bone screws placed in lag fashion placed through stab incisions after debridement and bone grafting of the SBCs. Approximately 6 months after surgery the mare was ambulating comfortably at pasture. This case report describes a fracture through a large subchondral bone cyst in a horse despite chronicity and ongoing bone remodelling. Careful consideration regarding exercise or use should be considered in horses with large SBCs.     

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.     

Severe lameness associated with an impact fracture of the proximal phalanx in a filly

A 3‐year‐old filly was presented for severe lameness referable to the left front fetlock joint. Radiographs confirmed an osseous cyst‐like lesion and synovial fluid cytology ruled out sepsis. The filly responded poorly to medical management and was subsequently subjected to euthanasia. Post mortem examination confirmed an impact fracture of the proximal phalanx, previously undiagnosed in the horse.     

Osteitis of the axial border of the proximal sesamoid bones in horses: eight cases (1993-1999).

OBJECTIVE: To determine clinical, radiographic, and scintigraphic abnormalities in and outcome of horses with septic or nonseptic osteitis of the axial border of the proximal sesamoid bones. DESIGN: Retrospective study. ANIMALS: 8 horses. PROCEDURE: Data collected from medical records included signalment; history; horse use; severity and duration of lameness; results of perineural anesthesia, radiography, ultrasonography, and scintigraphy; and outcome following surgery. RESULTS: Five horses did not have any evidence of sepsis; the other 3 had sepsis of the metacarpophalangeal or metatarsophalangeal joint or the digital synovial sheath. All horses had a history of chronic unilateral lameness. Three of 5 horses improved after diagnostic anesthesia of the metacarpophalangeal or metatarsophalangeal joint; the other 2 improved only after diagnostic anesthesia of the digital synovial sheath. Nuclear scintigraphy was beneficial in localizing the source of the lameness to the proximal sesamoid bones in 4 horses. Arthroscopy of the palmar or plantar pouch of the joint or of the digital synovial sheath revealed intersesamoidean ligament damage and osteomalacia of the axial border of the proximal sesamoid bones in all horses. All 5 horses without sepsis and 1 horse with sepsis returned to their previous uses. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that osteitis of the axial border of the proximal sesamoid bones is a distinct entity in horses that typically is associated with inflammation of the associated metacarpointersesamoidean or metatarsointersesamoidean ligament and may be a result of sepsis or nonseptic inflammation. Arthroscopic debridement may allow horses without evidence of sepsis to return to their previous level of performance.     

A case of sesamoid bone fragmentation in the leg as the cause of lameness in a female Rottweiler

An eight-month-old female rottweiler was presented with a history of intermittent lameness of the right hindlimb of 4 weeks duration. Radiographs showed a fragmentation in two plantar sesamoid bones of the metatarsophalangeal joint. Based on these clinical and radiographic signs sesamoid disease of the 2nd and 7th sesamoid bone in the right hindpaw was diagnosed. The fragmented sesamoids were surgically removed and histologically examined. The treatment was successful and the dog became lamnessfree. Additional radiographs showed fragmentations of sesamoid bones VII of both the forepaws, but they did not cause any lameness.     

Subchondral cystic lesions (osteochondrosis) of the femoral heads in a horse

Bilateral subchondral cystic lesions of the femoral head in a horse resulted in lameness. The lesions had resulted in degenerative disease in the left coxofemoral joint. The cause of lameness was confirmed by use of intra-articular anesthesia, joint fluid analysis, and radiography. Subchondral cystic lesions involving the femoral head should be considered in the differential diagnosis of equine lameness localized in the upper portion of the hind limb.     

Computed tomography of proximal metatarsal and concurrent third tarsal bone fractures in a Thoroughbred racehorse

A 2‐year‐old Thoroughbred filly presented to the William R. Pritchard Veterinary Medical Teaching Hospital at the University of California at Davis for whole body nuclear scintigraphic evaluation after an acute onset of nonweightbearing right hindlimb lameness post race. The use of computed tomography (CT) enabled visualisation of additional pathology that was not initially appreciable using combined imaging modalities of nuclear scintigraphy and digital radiography, which ultimately altered the selected course of treatment. Computed tomography in horses with fractures of the cuboidal bones of the hock can provide valuable additional information regarding fracture configuration and radiographically occult pathology, which may help to guide clinical decisions about treatment.     

Sesamoid disease as a cause of lameness in young dogs

A degenerative disease of the volar sesamoid bones of the metacarpophalangeal and metatarsophalangeal joints is described in young dogs of the larger breeds. It is characterized by degenerative changes in the articular cartilage of the sesamoid bones and by calcification within their ligamentous attachments. The lesion can be associated with lameness although it can also be asymptomatic. In many cases, other orthopaedic lesions are present in the dog which makes clinical assessment difficult. Treatment is by surgical removal of the affected sesamoid bone. This is the first report of this particular clinical entity which has been designated sesamoid disease.     

Minimally‐invasive plate osteosynthesis of a Salter‐Harris type 2 fracture of the proximal phalanx in a filly

A 7‐month‐old Warmblood filly was referred to the equine hospital because of a Salter‐Harris type 2 fracture of the proximal physis of the right hind P1. On admission, the filly had acute grade 3/5 lameness at the walk and diffuse swelling in the area of the right hind proximal phalanx. Radiographs were taken to assess the fracture and plan treatment. Surgical treatment using two 4.5 mm narrow locking compression plates (PIP‐LCPs) resulted in fracture stabilisation and rapid healing. This case report suggests that internal fixation using PIP‐LCPs is useful for the treatment of Salter‐Harris type 2 fractures of the proximal physis of P1 in large foals.     

Arthroscopic autologous osteochondral mosaicplasty for the treatment of subchondral cystic lesion in the medial femoral condyle in a horse

An 11-year-old, Hungarian half-bred stallion was presented with a history of mixed left hindlimb lameness of 6 months duration. Subchondral bone cyst of the medial femoral condyle and injury of the medial meniscus were diagnosed. Osteochondral autograft transplantation (mosaic arthroplasty) was performed, taking grafts from the less weight-bearing medial border of the medial femoral trochlea of the affected limb, and transplanting them into the cyst during arthroscopy. The lameness was evaluated prior to and one year after the operation with a motion analysis system during treadmill exercise. Considerable improvement of the lameness and the clinical signs as well as successful transplantation of the grafts, and a new hard joint cartilage surface of the medial femoral condyle could be detected during follow-up arthroscopy. Osteochondral autograft transplantation seems to bee a possible alternative for treating subchondral cystic lesions of the medial femoral condyle in horses. A new technique for the surgical treatment of a subchondral cystic lesion of the medial femoral condyle in the horse is described.     

Surgical Approach for Removal of Nonarticular Base Sesamoid Fragments of the Proximal Sesamoid Bones in Horses

Objectives— To describe a surgical approach for the removal of nonarticular base sesamoid fragments in performance horses and to report the outcome. Study Design— Retrospective study. Animals— Horses (n=11), 7 months to 10 years of age, with lameness because of nonarticular base sesamoid fragments. Methods— Lameness was localized to the metacarpophalangeal/metatarsophalangeal region by clinical examination or response to diagnostic local anesthesia. Radiographs confirmed the diagnosis of a nonarticular base sesamoid fragment. Surgical removal was performed with an incision over the base of the affected sesamoid through the digital flexor tendon sheath. After identifying the fragment with the aid of needles, a small vertical incision was made in the straight distal sesamoidean ligament (SDSL) and the fragment was freed from its attachments and removed. Six months convalescence and rehabilitation was prescribed for all horses. Results— Eleven horses had 16 nonarticular fragments of the base of the proximal sesamoid bones. Eleven (69%) fragments occurred in the forelimbs with the right front (82%) and medial sesamoid (73%) more commonly affected. Horses were treated by surgical fragment removal. In horses with follow‐up, 9 of 10 returned to their intended use. Conclusions— Surgical removal of nonarticular base sesamoid fragments can be accomplished through a palmar/plantar approach through the digital flexor tendon sheath and SDSL. This “keyhole” approach minimizes damage to the distal sesamoidean ligament attachments to the sesamoid base and allows some horses to return to their intended use. Clinical Relevance— Surgical removal of nonarticular base sesamoid fragments should be considered in horses with performance‐limiting lameness as a result of the fragment.     

Use of magnetic resonance imaging to diagnose distal sesamoid bone injury in a horse

CASE DESCRIPTION: A 5-year-old Appaloosa mare was examined for severe left forelimb lameness of 4 months' duration. CLINICAL FINDINGS: Lameness was evident at the walk and trot and was exacerbated when the horse circled to the left. Signs of pain were elicited in response to hoof testers placed over the frog of the left front hoof, and a palmar digital nerve block eliminated the lameness. Radiographs revealed no abnormalities, but magnetic resonance imaging (MRI) revealed increased bone density in the medullary cavity of the distal sesamoid (navicular) bone in the proton density and T2-weighted images and a defect in the fibrocartilage and subchondral bone of the flexor cortex. TREATMENT AND OUTCOME: Because of the absence of improvement after 4 months and the poor prognosis for return to soundness, the mare was euthanatized. An adhesion between the deep digital flexor tendon and the flexor cortex defect on the navicular bone was grossly evident, and histologic evaluation revealed diffuse replacement of marrow trabecular bone with compact lamellar bone. Changes were consistent with blunt traumatic injury to the navicular bone that resulted in bone proliferation in the medullary cavity. CLINICAL RELEVANCE: Use of MRI enabled detection of changes that were not radiographically evident and enabled accurate diagnosis of the cause of lameness. Navicular bone injury may occur without fracture and should be considered as a differential diagnosis in horses with an acute onset of severe unilateral forelimb lameness originating from the heel portion of the foot.     

Primary ossifying fibroma of the proximal phalanx in a horse

A primary ossifying fibroma was found at necropsy in a 5-year-old Welsh pony cross mare that was humanely subjected to euthanasia for an intractable severe left hindlimb lameness. Antemortem radiographs of the left hind pastern were characterised by articular, subchondral and cortical areas of lysis. Primary ossifying fibroma is a rare lesion of the distal limb but should be considered when there is extensive lysis extending into the medulla and proximal cortical bone.     

Fibro‐osseous tumour of the second metacarpal bone in a Thoroughbred filly

A 7‐month‐old Thoroughbred filly was evaluated because of an enlarging mass present on the proximomedial aspect of the left metacarpus. The mass was first noticed at age 2 months and had continued to increase in size. The mass was firm, nonpainful to palpation, covered with normal haired skin and had never been associated with lameness. Radiographs obtained at ages 2 and 7 months revealed an enlarging and partially mineralised mass associated with the second metacarpal bone. Based on the clinical and radiographic progression, as well as the location of the mass, a poor prognosis for future athletic soundness was given and the filly was subjected to euthanasia. The mass had histological features of both an ossifying fibroma and osteoma.     

Ankylosis of the distal interphalangeal joint in a horse after septic arthritis and septic navicular bursitis.

A 6-month-old 300-kg Quarter Horse filly was treated for septic arthritis of the distal interphalangeal joint and septic navicular bursitis that developed as a result of a deep puncture to the foot. Initial treatment consisted of establishing ventral drainage for the navicular bursa, lavage of the distal interphalangeal joint, and administration of broad-spectrum antimicrobial drugs and non-steroidal anti-inflammatory drugs. Because of continuing sepsis in the distal interphalangeal joint, subsequent treatment included packing the defect in the bottom of the foot with cancellous bone in an attempt to prevent ascending contamination of the joint, placing the limb in a short limb cast, and inserting a Penrose drain into the joint for passive drainage of septic exudate. The goal of treatment was to encourage ankylosis of the distal interphalangeal joint. Because of the filly's persistent lameness and laxity of the lateral collateral ligament in the contralateral carpus, the palmar nerves of the affected foot were injected with a long-acting local anesthetic at the level of the proximal sesamoid bones to encourage weight-bearing. Ankylosis of the distal interphalangeal joint was complete 9 months after the puncture, but a grade-2 lameness remained and the horse had a varus deformity resulting from ligamentous laxity of the lateral collateral ligament in the contralateral carpus.     

Polyostotic cystic bone lesions in a dog

The clinical, radiological, and pathological features of a polyostotic cystic bone lesion in a 9-month-old Doberman Pinscher are described. The patient was diagnosed as having nutritional secondary hyperparathyroidism at 6 weeks of age and after dietary correction it remained clinically normal until 9 months when there was sudden left hind-limb lameness due to a pathological fracture through a cystic lesion in the distal femur. Radiography revealed additional cystic structures in the metaphyses of the left radius, and left and right tibia. Pseudofractures were associated with two of the cystic lesions.
In some areas the cysts were crossed by trabeculae and in others there were bony ridges on the inner cystic wall. The cavities were lined with flesh-coloured fibrillar material which formed a lacy network extending into cavities. Histologically, multiple small cysts were present adjacent to the larger cavities noted radiographically. The secondary spongiosa and the metaphyseal periosteum were the major abnormal tissue sites. The small cysts appeared to arise in an oedematous and congested metaphyseal spongiosa. The cysts were accompanied by small foci of intense osteoclasis but unattended by compensatory bone production, and the consequent possibility of pseudofractures is an important clinical consideration. Earlier reports demonstrated that resolution of the lesions will follow surgical drainage and curettage of the cystic cavity. Of six cases of polyostotic cystic bone lesions observed in the dog, five were in the Doberman Pinscher breed.     

Comparisons of computed tomography, contrast-enhanced computed tomography and standing low-field magnetic resonance imaging in horses with lameness localised to the foot. Part 2: Lesion identification

Reasons for performing study: No previous study compares computed tomography (CT), contrast‐enhanced computed tomography (CECT) and standing low‐field magnetic resonance imaging (LFMRI) to detect lesions in horses with lameness localised to the foot. This study will help clinicians understand the limitations of these techniques. Objectives: To determine if CT, CECT and LFMRI would identify lesions within the distal limb and document discrepancies with lesion distribution and lesion classification. Methods: Lesions in specific structures identified on CT and MR images of feet (31 limbs) from the same horse were reviewed and compared. Distributions of lesions were compared using a Chi‐squared test and techniques analysed using the paired marginal homogeneity test for concordance. Results: Lesions of the deep digital flexor tendon (DDFT) were most common and CT/CECT identified more lesions than LFMRI. Deep digital flexor tendon lesions seen on LFMRI only were frequently distal to the proximal extent of the distal sesamoid and DDFT lesions seen on CT/CECT only were frequently proximal to the distal sesamoid. Lesions identified on LFMRI only were core (23.3%) or splits (43.3%), whereas lesions identified only on CT were abrasions (29.8%), core (15.8%), enlargement (15.8%) or mineralisation (12.3%). Contrast‐enhanced CT improved lesion identification at the DDFT insertion compared to CT and resulted in distal sesamoidean impar ligament and collateral sesamoidean ligament vascular enhancement in 75% of cases. Low‐field MRI and CT/CECT failed to identify soft tissue mineralisation and bone oedema, respectively. Conclusions and potential relevance: Multiple lesions are detected with CT, CECT and LFMRI but there is variability in lesion detection and classification. LFMRI centred only on the podotrochlear apparatus may fail to identify lesions of the pastern or soft tissue mineralisation. Computed tomography may fail to identify DDFT lesions distal to the proximal border of the distal sesamoid.     

Subchondral osseous cystic lesions of the elbow of horses: conservative versus surgical treatment

Subchondral osseous cystic lesion of the elbow was diagnosed as a cause of lameness in 6 horses. Persistent lameness and signs of degenerative joint disease developed in the first 3 horses treated conservatively with confinement. Subsequently, 3 horses were each treated by extra-articular enucleation of the cystic cavity via the proximal-medial aspect of the radius. Compared with conservative management, better long-term success (determined by return of athletic soundness and less evidence of degenerative joint disease) was achieved with surgical curettage of elbow subchondral cystic lesions.     

Developmental orthopaedic disease and early osteoarthritis of the temporomandibular joint in a 15-month-old Quarter Horse filly

A 15-month-old Quarter Horse filly presented for evaluation of hard swellings over the left temporomandibular joint (TMJ) and the right metatarsophalangeal joint (MTPJ). The TMJ swelling had been noted since she was weaned at 4 months of age and had slowly enlarged since then. Radiographs of both TMJs and the right MTPJ were performed, which revealed severe osteoarthrosis associated with osteochondrosis-like lesions. The filly was subjected to euthanasia due to the poor prognosis for performance. Computed tomography and post-mortem examination, including histopathology of the left TMJ, revealed early osteoarthritis (OA) associated with osteochondrosis-like lesions of the left TMJ and the right MTPJ, while the right hind proximal interphalangeal joint (PIPJ) was diagnosed with early OA.     

Septicemia, atrial fibrillation, cardiomegaly, left atrial mass, and Rhodococcus equi septic osteoarthritis in a foal

A foal with vegetative bacterial endocarditis affecting the wall of the left atrium was treated successfully with cefotaxime, erythromycin, and rifampin. Bacterial isolates included Escherichia coli from blood and Rhodococcus equi from a P-type osteomyelitic lesion of the left third metatarsal bone and from synovial fluid from the left metatarsophalangeal joint. Cardiac complications included cardiomegaly and atrial fibrillation, which responded to treatment with digoxin and quinidine sulfate. Cardiac function was considered normal 18 months after treatment. Bacteriologic cure of osteoarthritis was achieved by use of surgical debridement, lavage, and local and systemic antimicrobial treatment; however, lameness developed 18 months after treatment when training for flat racing was begun. Radiography revealed chronic degenerative joint disease.