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Autologous osteochondral grafting (mosaic arthroplasty) for treatment of subchondral cystic lesions in the equine stifle and fetlock joints.

OBJECTIVE: To describe treatment of equine subchondral bone cysts (SBCs) by reconstruction of the articular surface with osteochondral grafts. STUDY DESIGN: Case series of horses with SBCs unresponsive to conservative therapy. ANIMALS: Eleven horses (1-12 years). METHODS: SBCs were identified in 4 locations: medial femoral condyle (5 horses), lateral femoral condyle (1), distal epiphysis of the metacarpus (4), or metatarsus (1). Osteochondral autograft transplantation (mosaic arthroplasty) was performed, taking grafts from the abaxial border of the medial femoral trochlea of the unaffected limb. Graft implantation was achieved through a small arthrotomy or by arthroscopy depending on SBC location. RESULTS: All horses improved postoperatively; 10 horses had successful outcomes with radiographic evidence of successful graft incorporation and 7 returned to a previous or higher activity level. On follow-up arthroscopy (5 horses) there was successful reconstitution of a functional gliding surface. One horse had delayed incorporation of a graft because of a technical error but became sound. One horse had recurrence after 4 years of work and soundness. One stallion was used for breeding and light riding because of medial meniscal injuries on the same limb. CONCLUSIONS: Implantation of osteochondral grafts should be considered for SBC when conservative management has not improved lameness and there is a risk of further joint injury and degeneration. CLINICAL RELEVANCE: Mosaic arthroplasty should be considered for treatment of subchondral bone cysts of the femoral condyle and distal articular surface of the metacarpus/tarsus in horses that are refractory to non-surgical management.

Animals↗

Quantitative methods for indirect CT lymphography.

In this investigation, we applied quantitative CT methods to characterize contrast enhanced lymph nodes opacified using iodinated contrast media for indirect CT lymphography. Iodinated nanoparticles were injected into the buccal submucosa and SQ into the metatarsus and metacarpus of four normal swine (1.0-4.0 ml/site, 76 mg I/ml). Attenuation (HU), volume (cm3), iodine concentration (mg I/cm3), total iodine uptake (mg I), contrast-to-noise ratio (CNR), and percent injected dose (%ID) were estimated in opacified inguinal, cervical and parotid/mandibular lymph nodes using manual image segmentation techniques on 24 hour post-contrast CT images. Lymph node volumes estimated by multiple slice ROI analysis were compared with estimates obtained by post-excisional weight measurements. HU and iodine concentration increased 5-20 fold in opacified nodes (p < 0.01) and CNR increased more than four-fold (p < 0.001). %ID ranged between 3.5 and 11.9% and did not appear dose related. ROI estimated lymph node volumes approximated volumes calculated from weight measurements. (R2 = 0.94, p < 0.0001). We conclude that interstitially injected iodinated nanoparticles increase attenuation and conspicuity of targeted nodes on CT images. Quantitative methods could play an important clinical role in more accurate metastasis detection.

Animals↗

Third metacarpal bone laterality asymmetry and midshaft dimensions in Thoroughbred racehorses.

OBJECTIVE: The aims of this study were to test whether longer third metacarpal (MC3) bones had thicker dorsal cortices in a group of racehorses that were exercising at similar maximum speeds, and to establish if horses with larger differences in length between their right and left MC3 bones showed larger differences in the dorsal cortical thickness between the two limbs. DESIGN: An observational study. PROCEDURE: Forty Thoroughbred racehorses aged between 2 and 6 years and in training at racing speed at two racing stables were used. Two sets of radiographs of each left and right metacarpus of each horse were measured for bone length and dorsal cortical width according to standardised methods. RESULTS: The dorsal cortex thickness showed a linear relationship with bone length for the range of lengths between 25 and 30 cm for both the right MC3 (R2 = 0.30, P = 0.0003) and the left (R2 = 0.23, P = 0.002). The longer bones had thicker dorsal cortices. When results from the two limbs were combined to test if the difference in length between the right and left MC3 in an individual horse was associated with a thicker dorsal cortex in the longer MC3 there was no consistent relationship (R2 = 0.008, P = 0.58). CONCLUSION: In this sample of racehorses longer MC3 bones were likely to have been exposed to a greater dorsopalmar bending moment at the mid shaft that was reflected in a thicker dorsal cortex. The lack of a relationship between midshaft thickness and bone length within individual horses suggests that direct mechanical effects of conformation and environment were less important than the individual's level of skill (or the degree of laterality in their movements) developed before their exposure to fast exercise. It is likely that racehorses with longer right MC3 bones were more able to control the loading of the right MC3 than the left during fast exercise.

Animals↗

Some observations on lameness associated with pain in the proximal metacarpal region.

The carpus and metacarpus of 40 horses which were free from lameness and 40 horses with lameness associated with the metacarpophalangeal joint or more distal limb were examined radiographically (Group A). The opacity of the proximal third of the third metacarpal bone was regular, with a uniform trabecular pattern. Osseous cyst-like lesions (OCLLs) were identified in the radial carpal bone (1), the ulnar carpal bone (2), the second carpal bone (15) and the fourth carpal bone (1). Thirty-one of 638 horses (4.8 percent) with forelimb lameness had pain localised to the proximal metacarpal region using local anaesthesia (Group B). All these horses were examined radiographically and an ultrasonographic examination was performed in seven. No definitive diagnosis was reached in 16 horses, seven of which had an OCLL in one of the carpal bones or the second metacarpal bone. One horse had, in addition to a poorly defined lucent area in the second carpal bone, radiographic evidence of degenerative joint disease of the carpometacarpal joint and an hypoechoic lesion in the accessory ligament of the deep digital flexor tendon. One horse had an hypoechoic lesion in the proximal part of the suspensory ligament. Abnormalities of the trabecular structure of the third metacarpal bone were identified in 13 horses. In 11 of these there was a vertically orientated lucent line, usually surrounded by sclerotic bone. These lucent lines may represent fatigue fractures seen end on. In one horse an horizontal lucent line was seen. One of these 13 horses also had a lesion in the proximal part of the suspensory ligament. Ten of the 13 (77 per cent) horses with presumed fractures of the third metacarpal bone recovered completely, whereas only eight of the 16 (50 per cent) horses in which no definitive diagnosis was reached returned to their former function.

Anesthesia, Local↗

Monitoring the effects of treadmill exercise on bone by non-invasive means during a progressive fitness programme.

Six Standardbred horses underwent a 14-week training programme on a treadmill. The training schedule consisted of five weeks of slow work of six to 12 km/day at 5 m/sec. This was followed by a nine week interval programme increasing in its intensity so that for the last three weeks the horses did three to four intervals/day from 600 to 1000 m at or above maximum heart rate. Ultrasound velocity through the third metacarpus showed a significant increase as a result of training. There was also a significant increase in modulus of elasticity, but no change in bone mineral content, bone mineral density or compact bone density. A decrease in ultrasound velocity was noted immediately after a session of trotting on the treadmill for 6 km. These changes reflected the potential to alter the viscoelastic properties of cortical bone through treadmill exercise, but did not explain the mechanism involved.

Absorptiometry, Photon↗

The use of the walking cast to repair fractures in horses and ponies.

The walking cast was used to repair 46 fractures of long bones (distal radius and tibia, metacarpus and metatarsus) and 10 fractures of first phalanx of 35 horses and 21 ponies. The walking cast proved to be highly effective. Even heavily comminuted and 'hopeless' fractures, which could not be treated with osteosynthesis, were treated successfully, because the weight of the animal, a common failure factor in large animal orthopaedics, was relieved from the injured leg. Immediate full weight bearing was possible post operatively. In five cases the walking cast was used in combination with osteosynthesis. Infection was the main complication that caused the walking cast to fail. Osteomyelitis may also be treated with a walking cast. Because of its success rate of 57 per cent, which is impressive, considering the type of fractures treated, we recommend the walking cast for international accreditation.

Animals↗

Ultrasound speed in the metacarpal cortex--a survey of 347 thoroughbreds in training.

Transmission ultrasound speed was determined in the third metacarpal bone of 347 Thoroughbred racehorses in training. In addition to direct measurement of apparent ultrasound speed and lateral bone diameter, several derived parameters were estimated (cortical ultrasound speed, corticomedullary ratio and cortical cross-sectional area). Multiple regression equations were developed for each ultrasound measurement using the explanatory variables: sex, age, duration and intensity of training, preparation number and previous shin soreness. The horses (114 females, 82 entire males and 151 geldings ranging in age from 20 to 116 months) had been in continuous training for an average of 10.0 weeks when measurements were made. All measurements except corticomedullary ratio were influenced by the sex of the horse. Geldings had significantly lower ultrasound transmission speed than entire males and females, reflecting a lower bone density. However, the geldings had larger cross-sectional areas (ie bone size). We suggest that the relationship between low ultrasound speed (ie low bone density) and large cross-sectional area maintains the overall mechanical integrity of the metacarpus. This relationship (high ultrasound speed and low cross-sectional area) was also found in each sex group. Ultrasound speed and corticomedullary ratio, but not cross-sectional area, were affected by age. Both duration and intensity of training influenced the ultrasound speed measurements. This study indicated that sex, age and state of training affect ultrasound results, but this explained only about 30% of the variance in the data. Other factors, ie genetic variation in bone density and size, differences in soft tissue thickness and distal limb temperature, presumably account for most of the variance.

Age Factors↗

Follow-up of 28 horses with third metacarpal unicortical stress fractures following treatment with osteostixis.

The results of 31 intracortical dorsal metacarpal stress fractures in 28 horses following unicortical osteostixis were reviewed. The incidence was predominately in the middle third of the lateral aspect of the left metacarpus, and males were affected more commonly. Approximately half of the surgical procedures were performed with the horse in the standing position. The mean times to return to training and racing were 4.25 and 6.9 months respectively. There was no correlation between time taken to return to racing and position of surgery. Complications experienced included lack of suture removal and one case with a seroma.

Animals↗

Surgical treatment of subchondral cystic lesions of the third metacarpal bone: results in 15 horses (1986-1994).

Subchondral cystic lesions (SCLs) in the condyle of the third metacarpal bone (MCIII) were surgically treated in 15 horses. The median age at presentation was 18 months (range 10 months-12 years) with 10 of 15 horses less than age 2 years. The SCLs were confined to the front limbs in all cases with 2 horses having bilateral lesions. Lesions were isolated to the medial condyle(s) of MCIII in 13 of 15 horses; a cystic lesion occurred in the lateral condyle in one horse and in the sagittal ridge in one horse. One horse with bilateral lesions had an additional cystic lesion located in the right medial femoral condyle. Fourteen of 15 horses had a history of moderate lameness attributable to the metacarpophalangeal joint; the lesion was an incidental finding in one horse. Duration of lameness ranged from 4 weeks to 8 months and was either acute in onset, or occurred intermittently and was associated with exercise. Fetlock flexion significantly exacerbated the lameness in all cases. Synovial effusion was absent in 8 (53%) cases. Cystic lesions were curetted arthroscopically in 12 horses, and through a dorsal pouch arthrotomy in 3 horses. Concurrent osteostixis of the cystic cavity was performed in 7 horses. Two horses were treated arthroscopically for osteochondral fragmentation of the proximodorsal aspect of the proximal phalanx one year following surgical curettage of the SCL. Twelve of 15 horses (80%) were sound for intended use following surgical treatment. Two horses did not regain soundness and follow-up information was unavailable for one horse. Total period of follow-up was 1-6 years. Follow-up radiographic examinations were available for 9 horses. Mild periarticular osteophyte formation and enthesiophyte formation at the dorsal joint capsular attachments was present in 5 of the 9 horses. Bony ingrowth of the cystic lesion was detectable in 8 horses and enlargement of the cystic cavity was observed in one horse. Based on the information gained from this study, it would appear that surgical treatment of SCLs in the distal metacarpus can result in a favourable outcome for athletic use.

Animals↗

Analysis of a radiographic technique for measurement of equine metacarpal bone shape.

Accuracy and limitations of a radiographic technique were established for measurement of metacarpal bone shape in horses. A radiographic index (RI) has been used to measure changes in third metacarpal (Mc3) bone shape in response to training in young racehorses. The aim of these experiments was to determine the effects of positioning of the radiographic equipment on RI measurements from lateromedial radiographs of a left ex vivo metacarpus. Repeatability of the RI measurement in left lateromedial and right mediolateral view Mc3s were evaluated. The width of the dorsal cortex (DC), palmar cortex (PC) and medulla (M) were measured at a position 25 mm distal to the nutrient foramen and the RI calculated where RI = [(DC + PC)/M] x [DC/PC]. The reference RI values were obtained from 12 standard lateromedial radiographs. Factors analysed included the optimum focus-object distance, the angle at which the x-ray machine was positioned, the distance of the cassette from the limb, and the horizontal angle and vertical tilt of the cassette. The RI values included within the confidence interval (mean +/- 1.96 x s.d.) were considered sufficiently accurate. The optimum focus-object distance was 1 m. Accurate measurements were obtained when the cassette was held as close to the limb as possible with the horizontal angle not exceeding 5 degrees. The x-ray machine needed to be orientated within 6 degrees of the lateromedial plane. These findings suggest that the radiographic index can be used to measure Mc3 bone shape, providing there is accurate alignment of the x-ray machine, cassette, and limb, with respect to one another.

Animals↗

The navicular fat stripe: a useful roentgen feature for evaluating wrist trauma.

The navicular fat stripe (NFS) is a useful roentgenographic feature for evaluating traumatic wrist injury. A radiolucent stripe, cast by a thin collection of fat paralleling the lateral surface of the navicular bone, was seen in 96 percent of 400 normal wrists examined because of trauma. Obliteration or displacement of this line (positive NFS sign) is commonly present in acute fractures of the naviculum, radial styloid process, and proximal first metacarpus. A ositive NFS sign serves to alert the radiologist that an underlying fracture is likely. In particular, the NFS sign generally accompanies a navicular fracture.

Adipose Tissue↗

Use of magnetic resonance imaging identify suspensory desmitis and adhesions between exostoses of the second metacarpal bone and the suspensory ligament in four horses.

Four horses were examined because of chronic forelimb lameness. In all horses, the cause of the lameness was localized to the metacarpus by means of physical examination and diagnostic anesthesia, and radiography of the affected limb revealed a small exostosis of the second metacarpal bone. Magnetic resonance imaging revealed suspensory desmitis in the region of this exostosis in all 4 horses. In addition, an abnormal area of low signal intensity, suggestive of an adhesion, was seen between the exostosis and the suspensory ligament. In all horses, an adhesion between the suspensory ligament and the exostosis on the second metacarpal bone was identified and transected at surgery, and the exostosis and distal portion of the second metacarpal bone were removed. All horses were able to return to their previous athletic use following a 6-month rest and rehabilitation program for treatment of the suspensory desmitis. Findings in these horses suggest that adhesions between the suspensory ligament and an exostosis of the second metacarpal bone may be a cause of chronic or recurrent forelimb lameness in horses.

Animals↗

Liposarcoma of bone marrow origin in a kudu (Tragelaphus strepsiceros).

A primary intraosseous liposarcoma in a kudu (Tragelaphus strepsiceros), is reported. The lesion had a multilocular radiographic appearance and caused fracture of a metacarpus of the right front leg. Microscopically the lesion consisted of a lobular proliferation of lipoblasts of varying maturity. This is the first description of an intraosseous liposarcoma in a nondomesticated animal.

Animals↗

[Brachymetacarpia in disorders of the rate of physical growth].

On the basis of studying roentgenograms of 1007 wrists in 769 persons the author presents the incidence of the metacarpal syndrome in the population and in some disturbances of the rate of physical development. A metacarpal index determined by roentgenogram as the ratio of the IV and the II metacarpal bones multiplied by 100 is suggested. The value ocal and is often encountered in gonad dysgenesia. Estrogen therapy failed to eliminate this ratio disturbance in the metacarpus. Girls with an accelerated physical development had a tendency to increase of the metacarpal index. As a rule this index was within the normal limits in Klinefelter's syndrome.

Adolescent↗

Abnormal bone development and lameness associated with secondary copper deficiency in young cattle.

Lameness in a group of 5- to 12-month-old calves was found to be clinically, radiographically, and pathologically associated with abnormal bone development of the distal growth plates of the metacarpus and metatarsus. Copper concentrations in serum and liver were low. Serum calcium, phosphorus, and alkaline phosphatase values were normal. In pasture forage samples, sulfate, zinc, and molybdenum concentrations were high, whereas copper, calcium, and phosphorus concentrations were normal. Red blood cell (RBC) counts and hemoglobin values were within normal limits. Radiographic findings included a widened zone of cartilage and lipping of the medial and lateral areas of the physeal plate. Histologic findings included focal widenings of the growth plate consisting of tongues of uncalcified cartilage.

Animal Feed↗

[Osteoid-osteoma of the hand skeleton].

According to the literature it seems that osteoid-osteoma is quite often seen in the skeleton of the hand. Three cases (os scaphoideum, os hamatum, metacarpus III) are described. The clinical diagnosis may be difficult. Priority is given to the symptomatology which may lead to the diagnosis in spite of difficulty in radiological evaluation.

Adult↗

Surgical approaches to certain long bones of the horse for application of tension band plates.

In the horse, surgical approaches for plating fractures of the ulna, radius, metacarpus, tibia, and metatarsus involved a single curvilinear skin incision and incision of the superficial fascia in a manner to prevent postoperative dehiscence. The tension side of the bones, as well as location of nerves, arteries, veins, and muscles, were the major determinants in developing these approaches for atraumatic surgery and short operative time.

Animals↗

Effects of 3 biologic dressings on healing of cutaneous wounds on the limbs of horses.

Three biologic dressings [split-thickness allogeneic skin (STS)], allogeneic peritoneum (P), and xenogenic porcine small intestinal submucosa (PSIS)] were studied to determine their effects on bacterial proliferation, inflammatory reaction, vascularization, and overall healing and to compare the effects of these dressings with the effects of a nonbiologic dressing, a nonadherent synthetic pad (NASP). A medial wound (3 cm in diameter) and 2 lateral wounds (2 cm in diameter) were created at the junction of the proximal and middle thirds of each metacarpus and metatarsus in 5 horses. Each medial wound and the proximolateral wound received an STS, P, PSIS, or NASP dressing on day 8 after wounding. The other lateral wound received an NASP dressing. Bacterial proliferation, inflammatory reaction (histologic changes), and drhessing vascularization were evaluated 6 d after application of the dressing. Percentages of contraction and epithelialization, as well as healing time, were determined when the wounds had completely epithelialized. The practical applicability of the different dressings to equine wound management was also assessed. No significant difference was detected in the parameters evaluated among the treated wounds or between the treated and control wounds. The biologic dressings had no effect on infection, inflammatory response, or healing time. Vascularization was not identified in any of the biologic dressings. The PSIS and P dressings required numerous applications over the study period. The STS dressings are more practical than PSIS and P dressings owing to ease of application and stability. Thus, these biologic dressings offer no apparent advantage over a nonbiologic dressing for treatment of small granulating wounds.

Animals↗