Clinical and imaging findings, treatment details and outcomes in foals with extensor tendon rupture-A multicentre retrospective study.

BACKGROUND: Forelimb extensor tendon rupture (ETR) in foals is sparsely documented. OBJECTIVES: To describe clinical and imaging findings, treatment details, and long-term outcome in foals with ETR. STUDY DESIGN: Multicentre retrospective case-series. METHODS: Clinical record review of foals with ETR, presented to Faculty of Veterinary Medicine at Ghent University (Belgium), the Clinic for Horses at the University of Veterinary Medicine Hannover (Germany), and Rossdales Equine Hospital (UK) between 2009-2021. Long-term outcome based on structured telephone interview with the owner at the university hospitals and on future ratings from a public racing results archive at Rossdales Equine Hospital. RESULTS: Eight foals (28%; 95%CI: 11.7%-44.3%) presented with ETR only, whereas 21 foals (72%; 95%CI: 55.7%-88.3%) presented with ETR and concurrent flexural limb deformity foals with ETR only were older (median 20 days; Interquartile range [IQR] 13-22) than foals with ETR and flexural limb deformity (median five days; IQR 3-11; p = 0.001). Treatment included medical support, immobilization, and box rest. Hospitalisation time was longer for foals with ETR and flexural limb deformity (median 26 days; IQR 16-44) than for ETR-only foals (median 11 days; IQR 6-16; p = 0.03). Total rehabilitation time was longer for foals with ETR and flexural limb deformity (median 58 days; IQR 42-91) than for foals without flexural limb deformity (median 32 days; IQR 12-39; p = 0.03). Six foals (21%; 95%CI: 6.3%-35.7%) were euthanased within seven months: three because of problems with limb protraction and progressive flexural limb deformity. Long-term follow-up (>18 months) was available for two cases with ETR only, and seven cases with ETR and flexural limb deformity. Both ETR-only foals had a positive cosmetic outcome but only one a positive functional outcome. Foals with ETR and concurrent flexural limb deformity suffered limitations regarding cosmetic appearance (5/7 negative) and limb function (7/7 negative). MAIN LIMITATIONS: Small sample size, retrospective study, and no clinical follow-up. CONCLUSIONS: ETR is a rare condition in this sample of foals treated under hospital conditions often requiring prolonged care, especially with concurrent flexural limb deformity. Further research should investigate potential associations with future athletic performance.

Accuracy of transcranial magnetic stimulation and a Bayesian latent class model for diagnosis of spinal cord dysfunction in horses.

BACKGROUND: Spinal cord dysfunction/compression and ataxia are common in horses. Presumptive diagnosis is most commonly based on neurological examination and cervical radiography, but the interest into the diagnostic value of transcranial magnetic stimulation (TMS) with recording of magnetic motor evoked potentials has increased. The problem for the evaluation of diagnostic tests for spinal cord dysfunction is the absence of a gold standard in the living animal. OBJECTIVES: To compare diagnostic accuracy of TMS, cervical radiography, and neurological examination. ANIMALS: One hundred seventy-four horses admitted at the clinic for neurological examination. METHODS: Retrospective comparison of neurological examination, cervical radiography, and different TMS criteria, using Bayesian latent class modeling to account for the absence of a gold standard. RESULTS: The Bayesian estimate of the prevalence (95% CI) of spinal cord dysfunction was 58.1 (48.3%-68.3%). Sensitivity and specificity of neurological examination were 97.6 (91.4%-99.9%) and 74.7 (61.0%-96.3%), for radiography they were 43.0 (32.3%-54.6%) and 77.3 (67.1%-86.1%), respectively. Transcranial magnetic stimulation reached a sensitivity and specificity of 87.5 (68.2%-99.2%) and 97.4 (90.4%-99.9%). For TMS, the highest accuracy was obtained using the minimum latency time for the pelvic limbs (Youden's index = 0.85). In all evaluated models, cervical radiography performed poorest. CLINICAL RELEVANCE: Transcranial magnetic stimulation-magnetic motor evoked potential (TMS-MMEP) was the best test to diagnose spinal cord disease, the neurological examination was the second best, but the accuracy of cervical radiography was low. Selecting animals based on neurological examination (highest sensitivity) and confirming disease by TMS-MMEP (highest specificity) would currently be the optimal diagnostic strategy.

Viability and cell death of synovial fluid neutrophils as diagnostic biomarkers in equine infectious joint disease: a pilot study.

Synovial fluid samples from culture-confirmed infected joints (n=13), joints with pronounced non-infectious synovitis (n=11) and healthy joints (n=14) were collected from 24 equine patients and seven slaughterhouse horses. The samples from the joints with non-infectious synovitis and healthy joints served as negative controls. After isolation, counting and identification of neutrophils, the percentage viability, and the proportion apoptotic and necrotic neutrophils were determined by flow cytometry. Viability was significantly higher in infected samples compared to the controls. A significant difference in cell death type was observed, with apoptosis predominating in infected joints, and necrosis being more present in joints with pronounced non-infectious synovitis and healthy joints. The results of this pilot study suggest that flow cytometric analysis of neutrophil viability and cell death dynamics may assist the discrimination between infected and non-infected joints.

Evaluation of an automated blood culture system for the isolation of bacteria from equine synovial fluid.

The objective of this study was to evaluate an automated blood culture system for the isolation of microorganisms from infected equine synovial fluid (SF). Samples were collected from 220 severely inflamed synovial joints and classified as either presumably infected (group A: n=149) or not infected (group B: n=71), based on a combination of clinical history, clinical signs and cytological analysis of the SF. Samples were inoculated into blood culture bottles and after incubation were subcultured onto agar media to confirm the results and to facilitate full bacterial identification. Microorganisms were isolated from 107 group A samples (71.8%) and from three group B samples (4.2%). Overall, the detection system identified 117 bottles as positive and 103 as negative, including nine instrument-false-positives and two instrument-false-negatives. The median time-to-detection for Gram-positive bacteria, Gram-negative bacteria, and for fungi was 14.3 (interquartile range [I.R.] 10.0) h, 8.8 (I.R. 12.8) h, and 72.0 (range 60.8-74.8) h, respectively. It was concluded that culture of infected SF using the automated system combines the advantages of enrichment in specialised medium with the rapid detection of bacterial growth.