Treatment of Degenerative Joint Disease of the Horse: A Review and Commentary

Some of the predisposing factors for the development of degenerative joint disease, such as fatigue, early training, conformation defects, and others, are outlined. Swimming, a controlled weight-bearing exercise, is discussed and strongly recommended for treatment of degenerative joint disease in the horse. A brief review of counterirritants and vesicants, as well as current therapeutic suggestions, are presented. Cryotherapy, which is a relatively new form of counterirritation, is discussed. The benefits and limitations of radiation therapy are briefly discussed, and gamma rays are felt to be superior to x-rays. The most frequently used antiinflammatory drugs are discussed, and the two main categories, corticosteroids and nonsteroidal antiinflammatory drugs, are presented in detail. Among the nonsteroidal antiinflammatory drugs, hyaluronic acid, DMSO, and superoxide dismutase are presented and their mode of action, as well as benefits and disadvantages, are evaluated. Joint lavage is an effective tool in the management of joint disease, because it removes degenerative debris and inflammatory cells from the joint. The management of degenerative joint disease generally involves more than one of the therapeutic regimens mentioned. On the other hand, there is not a single treatment combination that is superior in all situations. The clinician treating degenerative joint disease must select the treatment regimen that works best for him and for the case to be treated. Such a choice must be based on a thorough understanding of applicable therapeutic agents and modes of physical therapy.     

CONTRAST‐ENHANCED MAGNETIC RESONANCE ANGIOGRAPHY FOR DIAGNOSIS OF PORTOSYSTEMIC SHUNTS IN 10 DOGS

Computed tomography angiography, sonography, scintigraphy, and portography can be used to evaluate the portal vasculature to evaluate for a portosystemic shunt (PSS). Time‐of‐flight magnetic resonance angiography (TOF‐MRA) and contrast‐enhanced MRA (CE‐MRA) are other potentially useful techniques. The aim of this study was to evaluate CE‐MRA in 10 dogs suspected of having a PSS. Noncontrast MR images of the abdomen were obtained using a Siemens Symphony MR‐scanner (1.5 T) and a T1‐weighted FLASH‐3D sequence with a very short scan time (about 20 s). After injection of contrast medium, the initial sequence was repeated five times. The sequence with the best contrast medium filling of the portal vasculature was selected subjectively, subtracted from the initial survey image series, and a maximum intensity projection (MIP) of the subtraction data, in multiple views, was created. The cross‐sectional and MIP images were evaluated for abnormal portosystemic vasculature. A single PSS was identified and confirmed at surgery in all dogs. A portocaval shunt was found in five dogs, a portophrenic shunt in three dogs, a portoazygos shunt in one, and a central divisional intrahepatic shunt in one other dog. Based on our results, CE‐MRA is a useful tool for imaging abdominal and portal vasculature and for the diagnosis of a PSS.     

Surgical Repair of Tibial Tuberosity Avulsion Fractures in Four Horses

Four horses, 2 to 17 years old, were treated for unilateral avulsion fractures of the tibial tuberosity. Two horses were treated successfully with tension band wiring or plating in combination with lag screw fixation. One horse was euthanatized because of implant failure during recovery and one was euthanatized on day 11 because a longitudinal fracture of the tibial tuberosity occurred through the plane of the screws used for stabilization.     

Pharyngeal lymphoid hyperplasia in Thoroughbred racehorses in training

The prevalence of pharyngeal lymphoid hyperplasia in Thoroughbred racehorses in training was investigated using a fibre optic endoscope. Of the 70 horses examined, all but 8 showed evidence of pharyngeal lymphoid hyperplasia and the severity of the pharyngeal changes decreased with age. Two-year old horses had greater pharyngeal lymphoid hyperplasia (p less than 0.05) when compared to all other age groups. More horses (p less than 0.05) with Grade 3 or Grade 4 pharyngeal lymphoid hyperplasia experienced recent mild respiratory disease than did horses with Grade 2 or less pharyngeal lymphoid hyperplasia. None of the horses examined had a history of diminished racing performance although 30% had either Grade 3 or Grade 4 pharyngeal lymphoid hyperplasia.     

Changes in Cardiopulmonary Variables and Platelet Count During Anesthesia for Total Hip Replacement in Dogs

Changes in cardiopulmonary function and platelet count were determined in 22 dogs of various breeds that underwent total hip replacement with cemented femoral prostheses. In 11 dogs (group I) polymethylmethacrylate (PMMA) was inserted without venting the reamed and lavaged femoral canal. In a second group of 11 dogs (group II) a urethral catheter (ID: approximately 2.7 mm) was placed into the medullary cavity before the insertion of PMMA. The application of PMMA resulted in a decrease in end-tidal carbon dioxide tension (PETco₂) until 5 minutes after insertion of bone cement. Increases in arterial to end-tidal pCO₂ gradient [P(a-ET)co₂] and physiological dead space (V_D/V_T) were recorded between 2 minutes before and 5 minutes after insertion of PMMA in 12 dogs. A significant decrease in platelet count occurred in both groups of dogs. Decreases in arterial pO₂ (Pao₂), arterial/alveolar oxygen tension ratio (Pao₂/PAo₂), and percent O₂ saturation of hemoglobin in arterial blood (Sao₂) were not statistically significant. No significant differences could be detected between data obtained from both groups of dogs. An increase in femoral intramedullary pressure caused by the insertion of PMMA and subsequent pulmonary microembolism by medullary contents has been considered the most likely cause for changes in pulmonary function. The lack of statistically significant differences in cardiopulmonary variables and platelet count between the two groups of dogs could have been related to inefficient pressure reduction by the method used.     

Surgical management of complete diaphyseal third metacarpal and metatarsal bone fractures: Clinical outcome in 10 mature horses and 11 foals

Reasons for performing study: Osteosynthesis of third metacarpal (McIII) and third metatarsal (MtIII) bone fractures in horses is a surgical challenge and complications surrounding the repair are common. Retrospective studies evaluating surgical repair, complications and outcome are necessary to increase knowledge and improve success of long bone fracture repair in the horse. Objectives: To evaluate clinical findings, surgical repair, post operative complications and outcome of 10 mature horses and 11 foals with McIII or MtIII fractures that were treated with open reduction and internal fixation (ORIF). Methods: Medical records were reviewed and follow‐up information obtained by means of radiographs and/or telephone questionnaire. Results: Survival was achieved in 62% of the horses (3 mature/10 foals). On long‐term evaluation (>6 months) 11 horses (2 mature/9 foals) were fit for their intended activity, one mature horse had a chronic low grade lameness, and one foal was lost to follow‐up because it was sold. The main fracture types were simple transverse (33.3%) or simple oblique (28.6%) and 71.4% of the fractures were open, 3 Type I (one mature/2 foals) and 12 type II (7 mature/5 foals). The preoperative assessment revealed inadequate emergency treatment in 10 horses (5 mature/5 foals; 47.6%). Survival rate of horses with open fractures was 12.5% (1/8) in mature and 85.7% (6/7) in foals. Post operative incisional infection (4 mature, 3 foals) was only managed successfully in 2 foals. Fracture instability related to inadequate fracture fixation technique occurred in 4 horses (all mature) and was always associated with unsuccessful outcome. Conclusions: Age, bodyweight and infection are strongly associated with outcome in treatment of complete McIII/MtIII fractures. Clinical relevance: Rigid fixation using plates and screws can be successful in treatment of closed or open, complete diaphyseal McIII/MtIII fractures in mature horses and foals. Instable fixation, infection and a bodyweight >320 kg are major risk factors for unsuccessful outcome.     

RADIATION THERAPY COMMUNICATION: EQUINE HEMANGIOMA

A 13-month-old Standardbred Colt had a recurrent hemangioma at the level of the coronary band. Multiple excisions had led to a nonhealing skin and hoof defect. Using 14 MV electrons, a total dose of 36 Gy was administered, given as six fractions of 6 Gy twice a week. Wound healing by second intention was achieved over the next 4 months and the colt began race training 6 months after the end of therapy. Twenty months later the colt is sound and there is no evidence of tumor recurrence.     

Copper salicylate and copper phenylbutazone as topically applied anti-inflammatory agents in the rat and horse

Topically applied copper phenylbutazone, phenylbutazone, copper salicylate, salicylate and dimethylsulfoxide glycerol (80:20) were investigated as anti-inflammatory agents in rats and horses. Dimethylsulfoxide and glycerol (80:20) or dimethylsulfoxide, ethanol and glycerol (60:20:20) were used as the drug solvents. Subcutaneously administered carrageenin was used to induce inflammatory oedema, either in the paws of rats or the alar fold of the horse. The severity of the oedema and the anti-inflammatory effect of the drugs were assessed by measuring changes in the paw or alar-fold diameters. Copper salicylate and copper phenylbutazone were effective inhibitors of the inflammatory oedema in both species, but dimethylsulfoxide:glycerol (80:20) was not. In the rat, copper salicylate and copper phenylbutazone were superior anti-inflammatory agents compared to either salicylate or phenylbutazone, respectively. Following the topical application of four times the recommended daily dose of copper phenylbutazone to the horse for 5 days, minor skin irritation occurred and trace concentrations of phenylbutazone (maximum 0.6 microgram/ml) and negligible concentrations of oxyphenbutazone and gamma-hydroxyphenylbutazone were detected in the plasma.     

Crosspin Fixation of Fractures of the Proximal Tibia in Three Foals

Three foals, each less than 1 month of age, were presented with Salter Type II fractures of the proximal tibial physis. Reduction of the fractures was accomplished manually and maintained by crosspin fixation. Fracture healing in two of the foals was uncomplicated. The third foal developed an infection around the implants, which responded to periodic local antiseptic flushing and administration of penicillin and gentamicin. Follow-up information ranging from 11 to 22 months after surgery revealed satisfactory results in two of three foals; premature closure of the proximal tibial physis was found in the other foal, resulting in the development of an angular limb deformity.