Surgical correction of carpal valgus deformity in three alpacas

Two alpaca crias and one 14-month-old alpaca were referred for treatment of bilateral carpal valgus. In one cria, hemi-circumferential periosteal transection and elevation combined with an ulna osteotomy was performed initially without success, however transphyseal bridging with screws and wires was used successfully in both crias to straighten the limbs. As the distal radial and ulna growth plates had closed in the 14-month-old alpaca, bilateral wedge ostectomies of the distal radius and transfixation casts were used to straighten and stabilise the limbs. The ostectomy sites healed and the alpaca is ambulatory, although carpal flexion is significantly reduced. Until the relationship between the growth rate of crias and the success of hemicircumferential periosteal transection and elevation and ulna osteotomy is established, transphyseal bridging may provide a more reliable result in crias with carpal valgus deformity and open physes. Wedge ostectomy and application of a transfixation cast can be used to correct severe carpal valgus deformities in alpacas with closed physes.     

Complete ulnas and fibulas in a pony foal

Complete ulnas and fibulas were found in a 10-month-old Welsh Pony examined because of severe flexural deformity, with carpal and tarsal valgus deformities, in all limbs. Presence of these normally vestigial structures is considered a form of atavism. At one week of age, periosteal transection was performed for the angular deformity, resulting in no improvement. When performing this procedure, the authors recommend transection of these vestigial structures if present.     

Musculoskeletal disorders in neonatal foals

Angular limb deformities are not uncommon in foals. Mild angular deviation due to laxity of supporting soft tissues often resolves spontaneously. However, external splinting or casting may be needed in severe cases or in those that do not resolve. When incomplete ossification of carpal or tarsal bones is the cause of the limb deformity, external support is mandatory to prevent further deformation and abnormal development of the bones. When epiphyseal and metaphyseal abnormalities cause axial deviation, surgical intervention is usually necessary. Circumferential periosteal transection and/or transphyseal bridging are methods used. The choice is dictated by the type and severity of the deformity. Flexor contractures of the forelimb vary greatly in degree and joints affected. Physical therapy combined with intermittent splint application is often successful, but surgical intervention may be necessary in unresponsive cases. Flexor tendon laxity is usually self-correcting but physical therapy, restricted exercise, and splinting may be needed. Rotational abnormalities are easier to correct in the forelimbs than in the hind limbs. Correction is usually accomplished by frequent corrective hoof trimming. Miscellaneous anomalies of the musculoskeletal system may sometimes be amenable to surgical correction, although the potential disadvantages must be carefully considered. Septic arthritis is a frequent sequela to neonatal septicemia and must be treated aggressively and early in its development. Appropriate systemic antibiotics, joint lavage, and rest are indicated. Neonatal osteomyelitis has a poor prognosis and requires prompt, vigorous therapy; even then, growth anomalies of the limb or contiguous septic arthritis may develop and further worsen the prognosis. Early accurate diagnosis and prompt appropriate therapy are vital in treating musculoskeletal disorders in foals, especially when a successful outcome is judged by the animal becoming a functional athlete.     

Desmotomy of the Accessory Ligament of the Superficial Digital Flexor Muscle in Equine Cadaver Limbs

Effects of longitudinal compression before and after transection of the accessory ligament of the superficial digital flexor (SDF) muscle were measured in eight equine cadaver forelimbs. When compression was increased from 890 N to 3115 N, the metacarpophalangeal (MCP) and carpal joints hyperextended 20 degrees and 4 degrees, respectively, and strain in the SDF and deep digital flexor tendons was increased 3.5% and 1.4%, respectively. The accessory ligament did not elongate. Immediately after transection of the accessory ligament at 3115 N load, a 2.8 mm gap formed between the transected ends of the accessory ligament, and the muscle belly of the SDF elongated and moved distad. The MCP joint hyperextended 15.8% further and strain of the SDF tendon increased 11.2% further. These results show that the accessory ligament transferred load in the SDF musculotendinous unit away from the muscle belly and that desmotomy altered this function. Decrease in the MCP joint angle indicated that the accessory ligament contributed to the support of the MCP joint under load. Increase in SDF strain after desmotomy was probably influenced by the change in the moment about the MCP joint and increased length of the SDF musculotendinous unit.     

Ultrasound-Guided Transection of the Accessory Ligament of the Deep Digital Flexor Muscle (Distal Check Ligament Desmotomy) in Horses

Transection of the accessory ligament of the deep digital flexor muscle (distal check ligament desmotomy) was completed in 44 horses using an ultrasound-guided technique. The technique used real-time ultrasound with a 7.5 MHz transducer to observe the dissection and isolation of the check ligament through a 1 to 1.5 cm incision and to check for complete transection of the check ligament. The technique was effective in correcting flexural deformity of the distal inter-phalangeal joint and the metacarpophalangeal joint in all but three horses. Check ligament desmotomy at a young age (median, 6 months) resulted in more horses with normal foot conformation than when surgery was completed at an older age (median, 12 months). Age at surgery had no effect on subsequent appearance of the surgical site. Based on the authors experience this technique reduced immediate postoperative wound morbidity.     

Acquired flexural deformity of the metacarpophalangeal joint in five horses associated with tendonous damage in the palmar metacarpus.

Five cases of acquired flexural deformity of the metacarpophalangeal joint (MCPJ) in older horses and ponies were studied. The mean age of affected horses was 14-8 years. Four deformities developed following desmitis of the accessory ligament of the deep digital flexor tendon (ALDDFT) and superficial digital flexor tendon (SDFT) and one following tendonitis of the SDFT alone. All cases were markedly lame and demonstrated variable degrees of flexural deformity. Ultrasonographic examination was performed on all cases which revealed extensive adhesion formation between the ALDDFT and SDFT and reduced cross-sectional area of the deep digital flexor tendon in each case. A variety of treatments were unsuccessfully employed to treat this condition. The prognosis for acquired flexural deformity of the MCPJ in old horses following tendonous damage in the palmar metacarpus is likely to be poor.     

Retrospective analysis of distal limb conformation and lameness in mature horses after desmotomy of the accessory ligament of the deep digital flexor tendon for management of a flexural deformity

Mature horses that present with flexural deformity of the distal interphalangeal joint and lameness isolated to the foot may obtain long‐term benefits from desmotomy of the accessory ligament of the deep digital flexor tendon (ALDDFT). This retrospective analysis of medical records and radiographs included 13 horses, aged ≥2 years, presented for lameness isolated to the hoof region and diagnosed with flexural deformity of the distal interphalangeal joint. Radiographic angles of the hoof and distal interphalangeal joint and lameness scores were compared before and after desmotomy of the ALDDFT. Follow‐up data including the ability to perform the intended use were obtained at least one year after surgery. There was improvement in the angle between the dorsal aspect of the third phalanx and the weightbearing surface of the hoof, improved alignment between the dorsal hoof wall and dorsal aspect of the third phalanx, and improved alignment of the distal interphalangeal joint. Lameness was decreased in 9/13 horses and 10/13 horses were performing at their level of intended use. Evidence of improved hoof conformation and lameness following desmotomy of the ALDDFT in lame horses with flexural deformity of the distal interphalangeal joint would indicate this procedure should be considered in mature horses.     

Cryptosporidiosis in 20 alpaca crias

CASE DESCRIPTION: 20 alpaca crias (13 females and 7 males) were examined for diarrhea (n=20), weight loss (15), and poor appetite (5). Fourteen crias were between 8 and 18 days of age at time of admission. CLINICAL FINDINGS: Cryptosporidiosis was diagnosed in all crias. Common biochemical abnormalities included acidemia, hyperlactemia, azotemia, and hyperglycemia and increases in aspartate transaminase and gamma-glutamyltransferase activities. Serum sodium and chloride concentrations were high or low. Other potential gastrointestinal tract pathogens were identified in only 7 crias. TREATMENT AND OUTCOME: Supportive care was instituted, including i.v. administration of fluids with partial parenteral administration of nutrients (n=19 crias), antimicrobials (19), supplemental orally administered nutrients (11), administration of plasma (10), and insulin treatment (9). Other palliative treatments used by attending clinicians were sucralfate, flunixin meglumine, vitamin A/D/E/B complex, antiparasitic agents, antidiarrheal agents, and azithromycin. Three crias with inadequate urine production and severe azotemia were treated with furosemide administered i.v. as a bolus or as a constant-rate infusion. Treatment resulted in a successful outcome in 16 of 20 crias. Weight loss and refractory azotemia were common in nonsurvivors but not in surviving crias. CLINICAL RELEVANCE: Findings suggested that Cryptosporidium spp may be a diarrheal pathogen of unweaned alpaca crias that may be more widespread than has been recognized and can become endemic on some farms. Metabolic derangements were unpredictable and should be determined by biochemical analysis before fluid and electrolyte replacement is initiated. Cryptosporidiosis has zoonotic potential, and the infection can be self-limiting in alpacas receiving supportive treatment.     

Surgical correction of metacarpophalangeal valgus deformity in an alpaca

A 1-month-old alpaca cria presented with a 13 degree valgus deformity of the left metacarpophalangeal joint. The angular limb deformity was centered on the distal metacarpal physes. Transphyseal bridging of the physes was recommended. Two 2.7 mm cortical bone screws were placed either side of the distal metacarpal physes and a figure of eight wire was placed medially around the screw heads. The screws extended through the medial metacarpus into the axial cortex of the lateral metacarpus. Seven weeks after surgery the limb was straight and the screws and wire were removed. Transphyseal bridging of the distal metacarpal physes can be effectively used for the treatment of metacarpophalangeal valgus in crias with open physes.     

Flexural deformities of the distal interphalangeal joint (clubfeet)

A true clubfoot results from a flexural deformity of the distal interphalangeal joint that is characterised by a shortening of the deep digital flexor tendon musculotendinous unit. Flexural deformities are a problem not only in foals but are also responsible for the clubfoot conformation seen in mature horses. Treatment is most successful when the cause is investigated and therapy initiated as early as possible, and when the biomechanical properties of the foot are thoroughly understood. Flexural deformities in foals and mature horses are addressed through appropriate farriery, often combined with surgery.     

Acquired flexural deformity of the distalinterphalangeal joint in horses: Treatment by desmotomy of the accessory ligament of the deep digital flexor tendon: A retrospective study

Hospital records of 29 horses treated by desmotomy ofthe accessory ligament of the deep digital flexor tendon for correction of acquired flexural deformity of the distal interphalangeal joint in one or both forelimbs were reviewed and evaluated retrospectively. Information on correction of the deformity, cosmetic appearance of the surgery site, and current use of the horses was obtained by interviews with the owners.At the time of surgery, 27 horses were less than one year old and two horses were more than one year old. Eleven months to five years after surgery, 26 horses had normal appearance of the hoof and limb, and 26 horses had acceptable cosmetic appearance of the surgery site due to no or minimal scarring. At the time of interview, all but two of the 11 horses more than three years old were in full training.It is concluded that desmotomy of the accessory ligament of the deep digital flexor tendon is an effective and cosmetically acceptable treatment for acquired flexural deformity of the distal interphalangeal joint in the horse.     

Unusual Polydactylism in a Foal: A Case Report

A 2 month old quarter horse colt had multiple skeletal abnormalities of the left fore limb, including two supernumerary metacarpal bones, two supernumerary carpal bones, abnormal carpal bone development, and a valgus deformity originating at the carpal joint. The largest supernumerary metacarpal bone was removed completely, a portion of the smaller supernumerary metacarpal bone was removed, and the leg was placed in a tube cast. Surgical treatment improved the clinical appearance and prevented further injury to the limb. The carpal joint width remained increased but the carpal valgus deformity partially responded to hemicircumferential periosteal transection. The foal was sound 2 1/2 years after surgery.     

Retrospective study of outcome following desmotomy of the accessory ligament of the deep digital flexor tendon for type 1 flexural deformity in Thoroughbreds

Objective Determine the long‐term outcome for Thoroughbreds undergoing desmotomy of the accessory ligament of the deep digital flexor tendon (DAL‐DDFT) for type 1 flexural deformity of the distal interphalangeal joint (DIPJ). Design Retrospective matched cohort study Procedure Medical records were retrieved over a 17‐year period for Thoroughbreds that underwent DAL‐DDFT for type 1 flexural deformity. Long‐term outcome was determined by analysis of race records and comparison with maternal siblings. Comparisons between cases and controls included 2‐year‐old, 3‐year‐old and total career performance data. Results There were 46 cases of DAL‐DDFT. The mean age at surgery was 151 days (median 118, range 2–562); 48% of case horses and 77% of 90 controls started in a race. For case horses that did race, the time to first race, total number of starts and prize money per race were not significantly different to maternal siblings. Age at the time of surgery did not alter the likelihood of starting a race. Conclusion Thoroughbreds undergoing DAL‐DDFT for type 1 flexural deformity of the DIPJ are less likely to race when compared with their maternal siblings. For those that do race, the time to first race, total races and earnings per race are not different from controls. There is no evidence to suggest that age at the time of surgery influences the likelihood of racing.     

Congenital elbow dislocations

Three categories of congenital elbow dislocations are described in the literature: humeroulnar, humeroradial, and dislocation or joint laxity with other congenital anomalies. Congenital humeroulnar dislocation is a well-defined problem that occurs predominantly in small breeds of dogs and causes severe limb deformity and dysfunction. Early reduction and stabilization are simple to achieve and have provided good results. Radial head dislocations occur most often as a result of growth disturbance of the radius and ulna. There is a lack of conclusive information on congenital radial head dislocations. Regardless of the etiology, radial head dislocation causes rather mild deformity and lameness and can be treated by conservative management, surgical correction, or radial head ostectomy. Dislocation of the elbow may occur concurrently with other rare congenital anomalies and has been described with ectrodactyly and polyarthrodysplasia.     

Electrosurgical tenoscopic desmotomy of the accessory ligament of the superficial digital flexor muscle (proximal check ligament) in horses

Objective: To report a tenoscopic technique using monopolar electrosurgery to transect the accessory ligament of superficial digital flexor muscle (AL‐SDFM) and outcome in 33 horses. Study Design: Case series. Animals: Horses (n=33). Methods: Medical files and surgery video recordings of horses that had AL‐SDFM desmotomy performed by tenoscopy with monopolar electrosurgical electrodes were reviewed. Results: Of 33 horses, 24 were Standardbred racehorses with surgery performed bilaterally for superficial digital flexor tendonitis and 9 horses had flexural deformity. Severe (n=6) and mild (6) intrathecal hemorrhage was the most common intraoperative complication. Large intrathecal vessels including the nutrient artery were successfully electrocoagulated and AL‐SDFM transection was completed. Clear/serosanguinous drainage from skin incisions was observed for 4.3±3.3 days (mean, SD). Protracted wound drainage for >4 days occurred in 10 horses, principally in the group treated for flexural deformities (P=.01). Conclusions: Sixty‐four AL‐SDFM were transected under tenoscopic observation using monopolar electrodes. Electrocoagulation of large intrathecal vessels, including the nutrient artery, was possible in all cases and allowed completion of desmotomy. Postoperative wound care was similar to routine tenoscopy in most (70%) horses. Aseptic protracted wound drainage was observed in 30% of horses (principally those with flexural deformity), and led to a prolonged hospitalization.     

Desmotomy of the accessory ligament of the deep digital flexor tendon for treatment of chronic deep digital flexor tendinopathy in three Quarter Horses

Effective treatments for horses diagnosed with severe deep digital flexor (DDF) tendinopathy are limited. In this study, three Quarter Horses diagnosed with severe bilateral DDF tendinopathy underwent bilateral desmotomy of the accessory ligament of the DDF tendon after failing to respond to conservative therapy. Lameness markedly improved in all three horses. Given that severe DDF tendinopathy is typically associated with persistent or recurrent lameness, desmotomy of the accessory ligament of the DDF tendon might be a treatment option to alleviate lameness in horses with DDF tendinopathy. This treatment option appears promising; however, a larger number of cases is necessary to support the results in these three horses.     

Potential pathogens in feces from unweaned llamas and alpacas with diarrhea

OBJECTIVE: To identify potential pathogens in feces from llama and alpaca crias with diarrhea. DESIGN: Prospective observational study. ANIMALS: 45 unweaned crias with diarrhea. PROCEDURE: Fecal samples were evaluated for Eimeria spp, Giardia spp, Cryptosporidium spp, enteric viruses, and Salmonella spp. A questionnaire yielded information concerning herd management and presence of other affected camelids. RESULTS: 28 crias were < or = 31 days old, 11 were 32 to 62 days old, and 6 were 63 to 210 days old. Potential pathogens were isolated from feces from 32 of the 45 crias. A total of 39 potential pathogens were obtained, including coronavirus (n = 19 crias; 42%), Giardia spp (8; 18%), Eimeria spp (6; 13%), Cryptosporidium spp (4; 9%), rotavirus (1; 2%), and nematode ova (1; 2%). Salmonella spp were not isolated. Most crias from which potential pathogens were isolated were identified during outbreaks of diarrhea involving other camelids, although only coronavirus was isolated from crias identified during outbreaks involving adult camelids. Coronavirus was detected throughout the year, whereas protozoa were most commonly isolated during the fall and winter. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that a variety of potential pathogens may be isolated from young crias with diarrhea. Many crias shed coronavirus, which may also have been affecting older camelids. Protozoa were isolated most often during wetter months, suggesting that crias born during these months may have greater exposure to protozoal pathogens.     

Surgical treatment of lameness.

Digital diseases are commonly seen in cattle. Cattle affected by digital disorders do not always respond to conservative therapy and require surgery. Surgical procedures for the common digital disorders are described, with emphasis on the different approaches to the distal interphalangeal joint.     

Arthrodesis for Congenital Flexural Deformity of the Metacarpophalangeal and Metatarsophalangeal Joints

A llama, a miniature horse, and a miniature donkey with severe bilateral congenital flexural deformities of the metacarpophalangeal and metatarsophalangeal joints were treated successfully by arthrodesis with dynamic compression plating or external skeletal fixation. The flexor tendons were more taut than the suspensory ligaments and were transected. In the llama, the suspensory ligament was transected, and overcorrection caused ischemic necrosis of one distal limb and subluxation of the other fetlock joint. In the horse and donkey, the suspensory ligament was preserved and wedge osteotomy was performed to correct the deformity.