Medial malleolus fragmentation following talocalcaneal arthrodesis by a dorsomedial approach in a horse.

A 16-year-old, Quarter Horse mare was presented for a 3/5 right hind lameness associated with osteoarthritis of the talocalcaneal joint (TCLJ). Positron emission tomography (PET) and computed tomography (CT) demonstrated marked increased uptake of 18F-sodium fluoride and bone remodeling at the medial facet of the TCLJ, respectively. Under general anesthesia 2 cortical screws (4.5 and 5.5 mm) were placed in neutral fashion via an arthrotomy from dorsomedial to plantaromedial through the medial facet of the TCLJ followed by copious lavage of the tarsocrural joint. Eight weeks after surgery, observable effusion of the tarsocrural joint was present and lameness had worsened. Radiographic examination revealed a fragmented medial malleolus of the tibia, likely secondary to repetitive trauma of the screw heads during tarsal flexion. Repeated CT showed partial fusion of the TCLJ. Both screws were removed and the tarsocrural joint was thoroughly lavaged arthroscopically. At a 20-month recheck the lameness had not improved, and ultrasound examination revealed severe thickening of the TCLJ capsule. Recheck examination 48 mo after surgery showed complete fusion of the TCLJ and resolution of the lameness. Key clinical message: Diagnosis of osteoarthritis of the TCLJ is challenging. Management by arthrodesis using a dorsomedial approach can result in fragmentation of the medial malleolus, with secondary synovitis and capsulitis of the tarsocrural joint.

Fragmentation de la malléole médiale suite à une arthrodèse talo-calcanéenne par voie dorsomédiale chez un cheval. Une jument Quarter Horse âgée de 16 ans a été présentée pour une boiterie postérieure droite de 3/5 associée à une arthrose de l'articulation talo-calcanéenne (TCLJ). La tomographie par émission de positrons (TEP) et la tomodensitométrie (CT) ont démontré une augmentation marquée de l'absorption du fluorure de sodium-18F et un remodelage osseux significatif au niveau de la facette médiale du TCLJ, respectivement. Sous anesthésie générale, deux vis corticales (4,5 et 5,5 mm) ont été placées de façon neutre via une arthrotomie dorsomédiale à plantaro-médiale à travers la face médiale du TCLJ suivie d'un lavage abondant de l'articulation tarsocrurale. Huit semaines après la chirurgie, un épanchement significatif de l'articulation tarso-crurale était présent et la boiterie s'était aggravée. L'examen radiographique a révélé une malléole médiale du tibia fragmentée, probablement secondaire à un traumatisme répétitif des têtes de vis lors de la flexion du tarse. La tomodensitométrie répétée a montré une fusion partielle du TCLJ. Les deux vis ont été retirées et l'articulation tarso-crurale a été soigneusement lavée par arthroscopie. Lors d'un nouveau contrôle après 20 mois, la boiterie ne s'était pas améliorée, et l'échographie a révélé un épaississement sévère de la capsule TCLJ. Un nouvel examen 48 mois après la chirurgie a montré une fusion complète du TCLJ et une résolution de la boiterie.Message clinique clé :Le diagnostic de l'arthrose du TCLJ est difficile. La prise en charge par arthrodèse par voie dorso-médiale peut entraîner une fragmentation de la malléole médiale, avec synovite secondaire et capsulite de l'articulation tarso-crurale.(Traduit par Dr Serge Messier).

Factors affecting successful ultrasound-guided injection into the podotrochlear bursa using a palmarolateral approach.

OBJECTIVE: To evaluate potential factors affecting ultrasonographic visibility of the suprasesamoidean region and the success rate of ultrasound-guided injection (USGI) into the podotrochlear bursa (PB). STUDY DESIGN: Ex vivo, experimental study. ANIMALS: 24 cadaveric forelimbs. METHODS: The PB was distended with 0, 1, or 2 ml of iodinated contrast material and saline under radiographic guidance. Ultrasonographic visibility of the suprasesamoidean region and PB was graded before and after distention with the limb loaded in three positions (vertical, cranial and caudal). Two operators with different experience levels performed an USGI into the PB with methylene blue (12 limbs each [four limbs with each of three volumes of PB distension]) using a palmarolateral approach and caudal foot placement. Limbs were frozen and sectioned to assess accuracy. RESULTS: Ultrasonographic visibility scores of the suprasesamoidean region (p = .0081) and PB (p < .0001) were improved using a caudal foot placement. Higher visibility grades of the suprasesamoidean region were associated with higher injection success rate (p = .047). The injection success was 75% (9/12) for the experienced versus 41.6% (5/12) for the less experienced operator (p = .14). PB distension improved visibility during caudal foot placement (p = .013) but not injection success rates (p = .78). CONCLUSION: Caudal foot placement enhances visibility of the PB and suprasesamoidean region. Limbs with poor visibility of the suprasesamoidean region are more likely to undergo a failed USGI. CLINICAL SIGNIFICANCE: The lateral USGI approach should be performed only in cases of optimal visibility. The reported success rates support the technical challenge of PB injections.

Preoperative factors associated with resection and anastomosis in horses presenting with strangulating lesions of the small intestine.

OBJECTIVE: To determine if preoperative and intraoperative clinical variables correlate with resection and anastomosis (RA) in horses presenting with strangulating small intestinal (SI) lesions. STUDY DESIGN: Retrospective case series. ANIMALS: Horses undergoing exploratory celiotomy for a strangulating SI lesion (n = 243). METHODS: The records of horses undergoing surgical correction for strangulating SI lesions from January 1, 2000 to December 31, 2017 were reviewed. Horses were categorized as treated with RA or not treated with RA. Obtained information included history, signalment, clinical findings, diagnostic test results, intraoperative findings, and survival to discharge. Univariable and multivariable analyses were used to compare data between horses treated with RA vs those not treated with RA (P = .05). RESULTS: In total, 172 SI lesions were resected, and 71 were not resected. Horses that had gastric reflux at admission to the hospital (odds ratio [OR] 5.56; 95% CI 1.76, 17.59) and horses with amotile SI according to abdominal ultrasonography (OR 9.69; 95% CI 3.09, 30.37) were more likely to undergo RA. Increased difference between peritoneal fluid and blood lactate was higher in horses that underwent RA (OR 1.55; 95% CI 1.12, 2.13). Survival to hospital discharge was lower in the group of horses that underwent RA compared with horses that did not undergo RA. CONCLUSION: Resection and anastomosis of strangulating SI lesions was associated with several preoperative variables. CLINICAL SIGNIFICANCE: This study highlights the value of preoperative diagnostic procedures in aiding intraoperative decision making and prognostication in horses presenting with strangulating SI lesions.

Arthroscopic removal of osteochondral fragments in the dorsal pouch of the proximal intertarsal joint in 29 horses.

OBJECTIVE: To describe the radiographic and surgical findings of horses with osteochondral fragments (OCF) in the proximal intertarsal joint (PIJ) and to detail the technique for arthroscopic fragment retrieval and report outcomes. STUDY DESIGN: Retrospective case series. ANIMALS: Twenty-nine horses (32 tarsi) with OCF in the PIJ. METHODS: Medical records of horses with radiographic evidence of OCF in the PIJ were reviewed. Clinical features, number of fragments, location, arthroscopic appearance, and outcome were recorded. Technical modifications with visual aids specific to this arthroscopic technique are described. RESULTS: Twenty-seven horses (93%) had radiographic evidence of osteochondritis dissecans lesions in the tarsocrural joint (TCJ). OCF were most commonly located distal to the medial trochlear ridge of the talus. In all cases, fragments were successfully retrieved with a technique based on exposing the fragments after resection of the proximal intertarsal joint capsule (PIJC). Fragments were visible from the TCJ prior resection of the PIJC in 4 of 32 tarsi. A third portal was created to access fragments located distal to the lateral trochlear ridge in 3 of 32 tarsi. Moderate intra-articular bleeding occurred when the PIJC was resected in 3 of 32 tarsi. One horse had postoperative swelling that resolved with conservative medical management. All horses with long-term follow-up available (16/29) started training or returned to their athletic career. CONCLUSION AND CLINICAL SIGNIFICANCE: The arthroscopic technique based on resection of PIJC was effective in retrieving OCF in the PIJ and was associated with minor complications. The clinical relevance of these fragments in the PIJ remains unknown.