Computed tomography assisted diagnosis and treatment of a comminuted fracture of the plantar aspect of the medial trochlear ridge and the proximal tubercle of the talus in a foal

Isolated fractures of the proximal tubercle of the talus and the medial trochlear ridge of the talus have been reported in the equine literature. A comminuted, intra-articular fracture of the plantar medial trochlear ridge and proximal tubercle of the talus has not been previously reported. The current case report describes this unique comminuted fracture in a 6-week-old Thoroughbred foal with acute onset lameness. The diagnosis was achieved by a combination of radiography, ultrasonography and computed tomography (CT) followed by CT arthrography. Surgical removal of the fracture fragments was recommended; the intra-articular fracture fragments were removed under arthroscopic visualisation of the plantar pouch of the tarsocrural joint; due to ligamentous attachments and partial extra-articular nature, the fracture fragment of the proximal tubercle of the talus was removed via an arthrotomy extension of the medial arthroscopy portal. On follow-up examination 12 months post-operatively, the yearling showed no clinical evidence of lameness or radiographic evidence of secondary degenerative joint disease.     

Osteochondritis dissecans of the medial trochlear ridge of the talus in a calf

Osteochondritis dissecans of the proximal aspect of the medial trochlear ridge of the talus was found to be causing lameness and tarsocrural joint effusion in a male Limousin calf. Arthroscopy via a dorsolateral approach was unsuccessful in revealing the lesion in this calf. A caudomedial arthrotomy or medial malleolar osteotomy, which can be used to gain access to lesions of the medial trochlear ridge in dogs, was not attempted. The lameness gradually worsened, and the calf was slaughtered.     

Arthrotomy,curettage and medical management of septic arthritis and osteomyelitis of the temporomandibular joint in a horse

Osteomyelitis and/or bone sequestra are commonly reported in equids following traumatic wounds. This report describes the clinical management and outcome following an arthrotomy of the temporomandibular joint of a 1-year-old Quarter Horse gelding with septic osteomyelitis and arthritis. Computed tomography was used for further assessment of the lesions within the temporomandibular joint and helped guide surgical planning.     

Septic arthritis,navicular bursitis and osseous cyst‐like lesion in a foal

The purpose of this report is to describe the clinical, imaging and pathological findings in a Quarter Horse colt admitted to the Texas A&M University Veterinary Medical Teaching Hospital for lameness of the left forelimb and left hindlimb. A presumptive diagnosis of left forelimb septic navicular bursitis was made ultrasonographically. A cyst‐like lesion of the calcaneus was diagnosed radiographically and better characterised with computed tomography. The cyst‐like lesion of the calcaneus was caused by infection with Actinobacillus sp. and extended into the adjacent tarsocrural, proximal intertarsal and talocalcaneal joints causing septic arthritis. The owner elected for euthanasia due to the poor prognosis. The diagnoses were confirmed on histopathology.     

Arthroscopic treatment of temporomandibular joint sepsis in a horse

OBJECTIVE: To report arthroscopic debridement and lavage of a septic temporomandibular joint (TMJ) in a horse. DESIGN: Clinical case report. ANIMALS: A 12-year-old Thoroughbred mare. METHODS: Arthroscopic investigation of the dorsal joint pouch of the right TMJ was made through a stab incision into the dorsocaudal compartment. Mechanized resection of synovium and fibrinous debris combined with copious lavage, and intra-articular and systemic antibiotic administration was used to treat the septic TMJ. RESULTS: Arthroscopic debridement and lavage of the TMJ, in combination with intra-articular and systemic antimicrobials resulted in resolution of sepsis. Eight months post-operatively, there was no clinical evidence of degenerative joint disease or ankylosis of the TMJ. CONCLUSION: TMJ sepsis is rare in horses, however, standard arthroscopic equipment can be used in the management of this condition with minimal complications. CLINICAL RELEVANCE: Arthroscopic debridement and lavage should be considered for evaluation and initial treatment of TMJ sepsis in horses.     

Idiopathic infectious arthritis of the coxofemoral joint in a mature horse

The authors are aware of only one previously described case of idiopathic infectious arthritis of the coxofemoral joint in a mature horse. The case described herein presented with clinical signs that localised pain to the proximal limb, subtle increased radiopharmaceutical uptake at the coxofemoral joint and an increase of the major acute phase protein, serum amyloid A in the horse's blood biochemistry. The latter finding led the authors to search initially for an infective process. Ultrasound guided aspiration of the coxofemoral joint yielded infected synovial fluid. Despite the duration of the condition, nonsurgical treatment allowed the horse to return to its previous, relatively modest, level of activity. This case is presented to supplement the single previously published case report of idiopathic adult coxofemoral infectious arthritis in the horse.     

Haematogenous septic arthritis,physitis and osteomyelitis in foals: A tutorial review on pathogenesis,diagnosis, treatment and prognosis. Part 1

Haematogenous septic arthritis, physitis and osteomyelitis (SAPO) is a potentially debilitating or even life-threatening disease entity encountered in foals of all ages between birth and approximately 7 months old. Correct, and complete, diagnosis and successful treatment require collaboration between specialties including medicine, anaesthesia, diagnostic imaging, surgery and rehabilitation services. However, in order to succeed, it is important that all specialties have an overall knowledge of all aspects of the disease complex. Therefore, the aim of this review is to give an overview of aetiology, presenting complaints, clinical findings, diagnostic imaging, treatment, rehabilitation and prognosis. Part one deals with all aspects of aetiology and how to make a diagnosis. Part two deals with all aspects of treatment, rehabilitation and prognosis.     

Free chondral fragment involving the lateral trochlear ridge of the talus in a dog

A saucer-shaped defect involving the lateral trochlear ridge of the talus and a radiopaque joint fragment were evident on radiographs of the left tarsus in a 6-month-old Rottweiler. Surgical treatment involved removal of the joint fragment and debridement of the defect. Histologic interpretation of the specimen was a chondral fragment. It is important to realize the possibility of a lesion in the location described, as this may be an additional site for osteochondrosis dissecans of the canine tarsus.     

Subchondral cyst‐like lesions in the talus of four horses

Subchondral cyst‐like lesions (SCLs) of horses have been found in various locations, but SCLs of the talus have been reported rarely. In this report, we describe 4 horses affected with a SCL of the talus. Each SCL was identified using digital radiography, and each horse was treated by intralesional injection of triamcinolone acetonide. Case details, history, findings during clinical and radiographic examination, treatment, and outcome of each horse are discussed.     

Septic tendonitis of the deep digital flexor tendon in a Thoroughbred horse referred for weight loss and intermittent fever

This case report describes the history, clinical and diagnostic findings, treatment and outcome of a 3‐year‐old Thoroughbred gelding. The horse was examined for chronic weight loss, intermittent fever of 4 months' duration and acute lameness of 2 weeks' duration, and was finally diagnosed with septic tendonitis of the deep digital flexor tendon and digital flexor tendon sheath caused by Streptococcus equi ssp. zooepidemicus. Investigation of the lower respiratory tract also allowed isolation of S. equi ssp. zooepidemicus. Although surgical treatment was recommended, because of the severity of the lesion and the guarded prognosis for a return to full athletic function, the owner declined surgery. The horse was therefore treated aggressively with antimicrobials using systemic, local and regional approaches, and with anti‐inflammatory drugs. At 20 months after discharge, the horse was able to race, and he is now in full work with 20 races finished successfully.     

Osteomyelitis of the scapulohumeral joint associated with Rhodococcus equi and unresponsive to antibiotherapy in a foal

This case report describes the treatment and outcome of a 3.5-month-old lame foal, with a history of pneumonia associated with Rhodococcus equi. Clinical examination identified osteomyelitis of the scapulohumeral joint. The unusual location of the Rhodococcus equi osteomyelitis unresponsive to prevention and adequate treatment led to euthanasia of the patient. Post-mortem findings confirmed bronchopneumonia due to Rhodococcus equi as well as the osteomyelitis of the scapulohumeral joint. This case highlights that Rhodococcus equi should be considered as a pathogen in extrapulmonary locations such as septic arthritis and osteomyelitis in foals with history of bronchopneumonia. Early and aggressive treatment should be considered.     

Septic arthritis of the first and second cervical vertebral articulations with vertebral osteomyelitis in a foal caused by Salmonella

A case of infectious arthritis of a cervical vertebral articulation and vertebral osteomyelitis in a foal caused by Salmonella is described. Ultrasound images of the cervical facet joints were suggestive of septic arthritis and ultrasound facilitated needle placement for arthrocentesis and joint lavage. Due to the uncommon location of the infection, diagnosis of septic arthritis was not immediate and, despite aggressive intra‐articular lavage and instillation of appropriate intra‐articular antibiotics after hospitalisation, we were unable to resolve the infection in this foal. Radiographs did not show evidence of osseous involvement until later in the course of the infection. Septic arthritis should be suspected in cases with similar clinical and laboratory findings and radiographic changes may not be present early in the course of infection. Ultrasound imaging provided the most useful diagnostic information regarding infection of the cervical joints, facilitating both diagnosis and treatment.     

Diffuse osteomyelitis of the fourth metacarpal bone in a horse caused by Clostridium perfringens

Osteomyelitis in adult horses, often associated with trauma or iatrogenic infection following surgery, usually presents as a focal area of infected bone. Diffuse osteomyelitis, affecting both the cortex and medulla, along the full length of a bone is encountered less frequently and treatment of such infections is not well reported in horses. The 2-year-old Warmblood mare in this case was diagnosed with diffuse osteomyelitis affecting the 4th metacarpal bone with concurrent unicortical fracture of the third metacarpal bone following traumatic injury. Computed tomography (CT) aided diagnosis in this case, providing critical additional detail to that obtained with radiography and ultrasound. This case highlights the value of CT in the diagnosis of diffuse osteomyelitis. This is the first reported case of diffuse osteomyelitis caused by Clostridium perfringens in horses. Successful treatment in this case consisted of surgical debridement of the associated abscess, followed by systemic and locoregional antimicrobial therapies.     

MAGNETIC RESONANCE IMAGING IN FOALS WITH INFECTIOUS ARTHRITIS

The magnetic resonance (MR) imaging findings of foals with infectious and noninfectious arthritis are described. Six foals with infectious arthritis and three foals with noninfectious arthritis were grouped based on synovial fluid analysis results and examined with radiography and MR imaging. Four out of six foals with infectious arthritis had osseous lesions in MR images indicative of osteomyelitis and only 4/19 lesions were detected on digital radiographs. The three foals with noninfectious arthritis had no osseous lesions in MR images or radiographically. Of the six joints that had osseous lesions detected with MR imaging, three had at least one lytic lesion detected radiographically. Osseous lesions in the epiphysis, metaphysis, and physis appeared in MR images as T2W, short tau inversion recovery, and proton density hyperintense foci with a hypointense halo. The same lesions appeared hyperintense in the 3D RSSG water excitation pulse sequence but lacked a surrounding hypointense halo. Most joints of foals with infectious arthritis had heterogenous signals within the synovial fluid whereas all of the nonseptic joints had homogenous synovial fluid signals. MR imaging appears to be better than radiography in the detection of osseous lesions in foals diagnosed with infectious arthritis and may be a valuable screening test for the presence of osteomyelitis.     

SEPTIC COXOFEMORAL ARTHRITIS AND OSTEOMYELITIS IN A DOG

An 8-year-old male Labrador retriever presented with a rear limb lameness cased by an osteolytic lesion of the left acetabulum and femoral head and neck. Initial bone biopsy study was nondiagnostic. Histopathologic study and culture of the subsequently excised femoral head and neck revealed a Staphyloccocus intermedial arthritis and osteomyelitis. Neoplash was ruled out on the basis of histopathologic analysis.     

Anaesthesia and ventilation strategy in a horse undergoing pulmonectomy

A 7‐year‐old, 430 kg Standardbred gelding was presented to the hospital with severe bilateral purulent pleuropneumonia requiring partial pulmonectomy. Prior to surgery the trachea was intubated through a tracheotomy site using a customised tube (10 mm internal diameter)‐in‐tube (26 mm internal diameter) endotracheal tube, similar to a bronchial blocker tube in design. The left lung was selectively mechanically ventilated. Thoracotomy was performed and a major lung abscess and surrounding lung tissue were resected. Arterial PO₂ and PCO₂ remained 79–305 and 43–72 mmHg, respectively, and haemodynamic variables within a range acceptable for general anaesthesia in the horse. A 5 month follow‐up revealed complete resolution of the pleuropneumonia without signs of recurrence.     

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.