Radiographic anatomy of the nasal conchal bullae and conchal sinuses in mature horses.

The dorsal and ventral nasal conchal bullae and conchal sinuses are part of the complex equine paranasal sinus system and are commonly affected by secondary sinusitis. However, the radiographic anatomy of the conchal sinuses is poorly reported in the literature. The present study aimed to describe the radiographic anatomical characteristics of the nasal conchal bullae and conchal sinuses in mature horses. Six equine cadaveric heads without sinus or dental disorders were studied. A maxillary sinusotomy was performed to identify the dorsal and ventral nasal conchal bullae and conchal sinuses, allowing the application of radiopaque contrast medium in these structures. Afterward, the same projections were repeated. Laterolateral views allowed an adequate visualization of nasal conchal bullae and conchal sinuses; however, they overlapped the same contralateral structure. In the latero30°dorsal- lateroventral oblique view, the same structures were easily recognizable, but in an oblique view, the structures were projected dorsally in relation to the contralateral one. The dorsoventral view allowed partial visualization of the dorsal conchal bullae and dorsal sinuses, but it was not possible to identify the ventral conchal sinus and ventral conchal bullae. The offset dorsoventral view helped in the identification of the dorsal conchal bullae and dorsal conchal sinus, also achieving visualization of the medial region of the ventral conchal sinus and ventral conchal bullae. The use of contrast medium, added to the anatomical dissection, allowed a better radiographic identification of the sinuses and conchal bullae. The combination of different radiographic views is recommended for the evaluation of these structures.

Does the proximal screw type affect stress and strain in pastern arthrodesis with locking plate in horses?

The implantation of unicortical cortex screws in the proximal hole of locking compression plates (LCP) has been recommended for proximal interphalangeal (PIP) arthrodesis in horses to prevent fractures resulting from stress risers in the proximal phalanx (P1). However, this cortex screw fixation technique may limit efficient dorsal compression of the PIP joint by the plate, potentially affecting the stability of the construct. In this study, we aimed to measure stress and strain in P1 and the plate using an ex vivo model of PIP arthrodesis in horses. We employed various implantation methods and proximal screw types in conjunction with two 5.5 mm transarticular cortex screws. Ten pairs of equine forelimbs were divided into four groups based on proximal screw placement: GUC (unicortically placed cortex screw), GBC (bicortically placed cortex screw), GUL (unicortically placed locking screw), and GBL (bicortically placed locking screw). We calculated the magnitude and direction of strain, strain ratio, and stress using strain gauges during an axial compression mechanical testing. The palmar surface of P1 exhibited higher stress and strains than the dorsal surface, with the plate part located at the articular level suffered more stress than the proximal part. Both the implantation method and proximal screw type significantly influenced the analyzed parameters. The GUC promoted greater changes in strain direction in the proximal portion of the P1. Bicortical placement of a cortex screw appears to be the most suitable option for filling the proximal hole of the LCP, because it allows effective dynamic compression via the plate and prevents abrupt shifts in the direction of the forces acting on the proximal part of P1 during loading.

Radiographic texture of the trabecular bone of the proximal phalanx in horses with metacarpophalangeal osteoarthritis.

Osteoarthritis (OA) is a prevalent condition in horses, leading to changes in trabecular bone structure and radiographic texture. Although fractal dimension (FD) and lacunarity have been applied to quantify these changes in humans, their application in horses remains nascent. This study evaluated the use of FD, bone area fraction (BA/TA), and lacunarity in quantifying trabecular bone differences in the proximal phalanx (P1) in 50 radiographic examinations of equine metacarpophalangeal joints with varying OA degrees. In the dorsopalmar view, regions of interest were defined in the trabecular bone of the proximal epiphysis, medial and lateral to the sagittal groove of P1. Lower BA/TA values were observed medially in horses with severe OA (P=0.003). No significant differences in FD and lacunarity were found across OA degrees (P>0.1). FD, BA/TA, and lacunarity were not effective in identifying radiographic texture changes in the P1 trabecular bone in horses with different metacarpophalangeal OA degrees.

Radiographic characterization of the maxillary septum and septal bullae in horses: An ex vivo study.

The anatomical variations of the maxillary septum and the septal bullae can generate challenges during the interpretation of radiographs of the horses' heads and make it difficult to accurately identify the sites affected in sinus disorders. The description of the radiographic appearance of these structures is currently scarce in the scientific literature. This work aims to describe the anatomical and radiographic characteristics of the maxillary septum and maxillary septal bullae in horses. Six chemically preserved equine cadaver heads were used which, after being submitted to the maxillary osseous flap, the maxillary septum and its respective bullae were identified. Radiographic examinations before and after contrast impregnation on these structures were performed. The positioning of the maxillary septum varied between the anatomical specimens and between the sides of the same specimen. The 30° oblique dorsoventral lateral and lateral projections allowed the identification of the maxillary septum and septal bullae. However, the bullae remained superimposed on the dental arches in the dorsoventral projections with the mandible in a neutral position or with the mandible displaced. The oblique offset radiographic positioning was suggested and proved effective for the examination of the maxillary septal bullae, where the mandible was displaced to the side of the bullae to be examined, and the radiographic beam inclined in the same direction. The maxillary septum and its bullae could be properly identified in a macroscopic way after the osseous flap and the contrasted radiographic examination allowed its adequate interpretation. Variations in size and position are considered normal for the equine species.

Locking conical coupling plates in small animal orthopedics: A review.

Conical coupling locking plates (CCP) have become an interesting alternative in veterinary orthopedics and traumatology. Available data in this regard, however, must be interpreted with caution, and several studies are still required to reach definitive conclusions on the clinical use of these implants. In this context, this review aims to discuss CCP applications and mechanical aspects in small animals and summarize in vivo, in vitro and ex vivo study results.

Comparison of Hemodynamic Effects of Dobutamine and Ephedrine Infusions in Isoflurane-Anesthetized Horses.

The objective of this study was to compare the hemodynamic effects of dobutamine and ephedrine during the management of anesthesia-related hypotension in healthy horses. Thirteen horses underwent general anesthesia with isoflurane and were randomly divided into two different groups, one of which received a dobutamine constant rate infusion (CRI) (1 µg/kg bwt/min) and the other received an ephedrine CRI (20 µg/kg bwt/min) when hypotension (<60 mmHg) was identified, following up to 15 min after the blood pressure reached 70 mmHg. All horses were equipped with a pulmonary artery catheter and a peripheral artery catheter, and multiparameter monitoring commenced as soon as they were under mechanical ventilation. Hemodynamic parameters were recorded, while tissue perfusion markers (peripheral oxygen saturation, arterial oxygen partial pressure, arterial carbon dioxide partial pressure, arterial pH, arterial plasma bicarbonate concentration, arterial oxygen saturation, mixed venous oxygen saturation, mixed venous oxygen content, arterial oxygen content, arteriovenous oxygen difference, oxygen delivery index, oxygen consumption index, and oxygen extraction ratio), serum lactate concentration, and troponin I concentrations were analyzed before the start of infusions (T0), when the blood pressure reached 70 mmHg (T1), and 15 min after T1 (T2). The time to restore the arterial pressure was similar in both groups (p > 0.05); however, the heart rate was higher in the ephedrine group (p = 0.0098), and sinus bradyarrhythmia occurred in the dobutamine group. Furthermore, both experimental protocols increased cardiac output (p = 0.0012), cardiac index (p = 0.0013), systemic vascular resistance (p = 0.008), systemic vascular resistance index (p < 0.001), and ameliorated perfusion markers. In the dobutamine group, the pulmonary artery wedge pressure (p < 0.001) and systolic index (p = 0.003) were elevated, while the arteriovenous oxygen difference was reduced in the ephedrine group (p = 0.02). Troponin I was used as a myocardial injury indicator, and did not differ between moments or between groups (p > 0.05). We concluded that both drugs were effective and safe to treat anesthetic hypotension under the conditions of this study.

Ultrasound Morphometry and Mean Echogenicity of Digital Flexor Tendons, Suspensory Ligament, and Accessory Ligament of Digital Deep Flexor Tendon in Gaited Horses.

The objective of this study was to evaluate and compare the sonographic characteristics of the digital flexor tendons and ligaments of the palmar/plantar of the metacarpal and metatarsal regions in gaited horses, as well as to establish normal reference ultrasound values for Mangalarga Marchador (MM) and Campeiro breeds. Transverse sonographic images were obtained of 50 adult and healthy horses from the MM (n = 25) and Campeiro (n = 25) breeds. The images were taken in six metacarpal/metatarsal zones, and the following measurements were taken: transverse area, circumference, dorsopalmar/plantar length, lateromedial length, and mean echogenicity. Differences were observed between breeds in the fore- and hindlimbs, and, even when not significant, the Campeiro breed tended to have higher values for most variables and structures. Variations between zones and between structures in the same zone followed a similar trend in both breeds for all variables. In addition, the dimensions and variations between zones and structures were different between the fore- and hindlimbs, highlighting the need for specific values for the digital flexor tendons and ligaments of the metatarsal plantar region. In conclusion, the digital flexor tendons, suspensory ligaments, and accessory ligaments of the digital deep flexor tendon are influenced by the breed factor in gaited horses, and they are different between the fore- and hindlimbs.

Proximal Interphalangeal Arthrodesis in Horses: A Meta-Analysis of Retrospective Studies.

The aim of this study was to determine the clinical outcomes reported in retrospective studies of proximal interphalangeal arthrodesis (PIA) in horses through a meta-analysis of retrospective studies. CAB Abstracts, PubMed, ScienceDirect, Web of Science, and Scopus were searched. The primary outcomes included survival and surgical site infection (SSI) rates, return to activities, and time of hospital stay and casting. Subgroups were formed for fractures and other conditions. Meta-analyses were performed with fixed and random effects models to estimate proportions, mean values, and effect size by odds ratio (OR) with 95% confidence intervals (CI). Twenty-one full articles were included, totaling 458 horses. The survival rate was 90% (95% CI [86%-93%]), return to activities was 65% (95% CI [61%-70%]), and SSI was 12% (95% CI [8%-16%]). The mean hospitalization was 25 days (95% CI [18-35 days]) and time of casting was 29 days (95% CI [21-42 days]). The OR of survival (P = .769), return to activities (P = .576), and SSI (P = .467) were similar between cases of fractures and other conditions. PIA is an efficient and safe method to treat injuries in the pastern region, with a high survival rate and low SSI. However, the rate of return to soundness for intended use was modest, being potentially lower for fracture cases. Thus, investigations of more efficient interventions are needed to improve this outcome.

Anatomical position of the palmar/plantar nerves at the metacarpal/metatarsal distal level in horses: An in vivo study by means of ultrasonography.

The neurovascular bundle of the equine distal cannon can dynamically vary with limb position, and this can affect the performance of low 4- or 6-point block. This study aims to identify and describe the anatomical position and variations of the lateral and medial palmar/plantar nerve at the metacarpal/metatarsal distal level in horses by ultrasonography. Eight mares underwent ultrasound examination on the lateral and medial palmar/plantar sides of the metacarpus/metatarsus. Images were obtained for measurements of the cross-sectional area of the nerve, distances between the nerve and the skin surface, branch of the suspensory ligament (SL), deep digital flexor tendon (DDFT) and superficial digital flexor tendon (SDFT) with limbs supported and elevated. The distance to the skin for forelimbs was higher on the lateral side when the limb was elevated (p < 0.001). The comparisons between supported and elevated limbs on the same side showed longer distances to the skin with the limb supported on the medial side (p < 0.001). Hindlimbs showed longer distances to the skin with the limb supported on the medial face (p = 0.027). The anatomical position of palmar/plantar nerves was similar between the lateral and medial sides of the limb, generally being in contact with the dorsal edge of DDFT. The strategy of elevating the limb during the injection of the low 4- or 6-point block can lead to a higher risk of puncture of the digital sheath.

Diffusion of dye after perineural injection of the palmar/plantar nerves in two different sites in horses: an ex-vivo study.

This study aimed to evaluate the distribution of dye at two perineural injection sites of the palmar/plantar nerves and describe their anatomical variations of positioning at the level of the distal metacarpus/metatarsus in horses. Two ml of 1% methylene blue solution was injected in 24 limbs (12 forelimbs and 12 hindlimbs) of horse cadavers at two different points: Group 1: between the branch of the suspensory ligament and deep digital flexor tendon, and Group 2: between the deep and superficial digital flexor tendons. This was followed by dissection and evaluation of the solution diffusion. A photographic record and description of the anatomical position of the palmar/plantar nerve were performed. A comparison of diffusion directions in each portion (medial or lateral) between groups showed no statistical difference (P > 0.05), except in the dorsal direction on the medial portion of hindlimbs, which was higher in Group 2 (P = 0.025). The digital flexor tendon sheath was inadvertently injected four times into the forelimbs of Group 2. Both injection sites offered good dye contact with the palmar/plantar nerves, with the position between the deep digital flexor tendon and suspensory ligament branch having a higher contact area, regardless of the limb portion. The anatomical position of the palmar/plantar nerve in the cadaver specimens was similar between the same limb portions.

Evaluation of platelet-rich plasma applied in the coronary band of healthy equine hooves.

Platelet-rich plasma (PRP) is a widely used hemocomponent that holds great promise in equine medicine due to its feasible production and regenerative therapy potential. Its use has been considered as a treatment for chronic laminitis, mainly in terms of its analgesic properties and because it can induce growth in affected hooves. The aim of this study was to evaluate the effect on hoof growth attributable to PRP applied in the coronary band of clinically healthy horses by comparing the responses to PRP, saline, and trimming alone. After randomization, the forelimbs of 9 horses received specific treatment at intervals of 33 days and were trimmed, measured, and radiographed at the same time. Neither hoof growth nor hoof angles were different between the treatment groups at any time point. The application of PRP in the coronary band of horses may be a safe procedure; however, it had no effect on the growth or conformation of hooves in clinically healthy horses.

Évaluation du plasma riche en plaquettes appliqué dans la bande coronaire de sabots équins sains. Le plasma riche en plaquettes (PRP) est un hémo-composant largement utilisé qui est très prometteur en médecine équine en raison de sa production réalisable et de son potentiel de thérapie régénérative. Son utilisation a été considérée comme un traitement de la fourbure chronique, principalement en termes de ses propriétés analgésiques et parce qu'elle peut induire la croissance des sabots atteints. Le but de cette étude était d'évaluer l'effet sur la croissance des sabots attribuable au PRP appliqué dans la bande coronaire de chevaux cliniquement sains en comparant les réponses au PRP, à la solution saline et à la taille seule. Après randomisation, les membres antérieurs de neuf chevaux ont reçu un traitement spécifique à des intervalles de 33 jours et ont été taillés, mesurés et radiographiés au même moment. Ni la croissance ni les angles des sabots n'étaient différents entre les groupes de traitement à aucun moment. L'application de PRP dans la bande coronaire des chevaux peut être une procédure sûre; cependant, il n'a eu aucun effet sur la croissance ou la conformation des sabots chez les chevaux cliniquement sains.(Traduit par Dr Serge Messier).

The influence of the metacarpophalangeal joint angle on the transversal area and mean echogenicity of the superficial digital flexor tendon and suspensory ligament in gaited horses.

The objective of this study was to assess the influence of the metacarpophalangeal (MCP) joint angle on the transversal area (TA) and mean echogenicity (ME) of the superficial digital flexor tendon (SDFT) and suspensory ligament (SL) in gaited horses. Ultrasound images were obtained from 50 healthy adult horses of the Mangalarga Marchador (MM; n=25) and Campeiro (n=25) breeds. Static and dynamic angles of the MCP joint were measured from photographs and video recordings. Higher ME values were evinced for the SL only in the group with the smaller dynamic angles of the MCP joint in the MM horses, in addition to weak negative correlation between the dynamic angle and ME. Moreover, weak negative correlation was also observed between the static angle and TA of the lateral branch of the SL and between the static angle and the ME of the SDFT. However, the difference observed in the group of MM horses, as well as the weak correlation, was not considered sufficient to support the hypothesis that a smaller angle of the MCP joint (greater extension) is associated with larger TA and ME values for the structures. The results also suggest that the static and dynamic angles of the MCP joint do not influence the TA and ME values of the SDFT and SL in gaited horses.

Comparison of a 3-hole 4.5-mm Dynamic Compression Plate and a 7-hole 5.5-mm Y Locking Compression Plate for Arthrodesis of the Proximal Interphalangeal Joint in Horses-an Ex Vivo Biomechanical Study.

The objective of this study was to compare the biomechanical properties in a single cycle axial loading test and the types of failures in two constructs (a 3-hole 4.5-mm dynamic compression plate (DCP) and 7-hole 5.5-mm Y locking compression plate (Y-LCP)) in equine proximal interphalangeal joint (PIJ) arthrodesis. One limb in each pair was randomly assigned to PIJ arthrodesis using a 3-hole 4.5-mm DCP combined with two transarticular 5.5-mm cortical screws, whereas the contralateral limb was submitted to PIJ arthrodesis using a 7-hole Y-shaped 5.0-mm LCP in conjunction with one transarticular 4.5-mm cortical screw inserted through the central plate hole. Cortical screws were inserted in lag fashion. Constructs were submitted to a single axial load cycle to failure. Construct stiffness, load, and deformation were analyzed. Dynamic compression plate and Y-LCP arthrodesis constructs did not differ significantly and were equally resistant to axial loading under the conditions studied (DCP and Y-LCP group stiffness, 5685.22 N/mm and 6591.10 N/mm, respectively). Arthrodesis of the PIJ using a DCP and two transarticular 5.5-mm cortical screws or a Y-LCP yielded biomechanically equivalent outcomes under the test conditions considered. However, Y-LCP provides less impact in the palmar/plantar bone. Application of Y-LCP with unicortical screws has equivalent biomechanical characteristics of DCP and may be a safe option for PIJ arthrodesis, where potential trauma secondary to applying bicortical screws in the palmar/plantar aspect of the pastern can be avoided.

What is the Evidence of Hyaluronic Acid and Polyacrylamide Hydrogel in Intra-articular Therapy in Equines? Systematic Literature Review.

A systematic review was conducted to investigate evidence to support or refute the use of hyaluronic acid and polyacrylamide hydrogel as intra-articular therapy in equines, which are frequent treatment options in the routine of veterinarians of equines in cases of osteoarthritis. In total, 19 studies were included, among clinical and in vitro studies, as well as a retrospective series of cases. The outcomes of the included studies provided fragile evidence supporting the recommendation for intra-articular use of hyaluronic acid. No study was included showing any clinical outcome in diseased synovial tissues of the polyacrylamide hydrogel. There is no concrete evidence of benefits, treatment protocols, and mechanisms of action of hyaluronic acid in the joint therapy in equines.