Palmar/plantar oblique projections improve radiographic detection of fractures of the palmar/plantar processes of the equine distal phalanx.

Radiography is a standard diagnostic test for horses with suspected fractures of the palmar/plantar processes (PP) of the distal phalanx, however published studies evaluating the diagnostic utility for radiography are currently lacking. The objectives of this retrospective, diagnostic case-control study were to determine the sensitivity of radiographs for the detection of PP fractures, and determine the diagnostic utility of the palmar/plantar oblique projections of the PP for the identification of PP fractures compared to standard radiographic series. The medical records of horses undergoing MRI examination were reviewed and 23 horses diagnosed with a PP fracture were included as cases for analysis. Forty-six control horses were selected. Radiographs, including palmar/plantar oblique (palmaro/plantaro50o -proximal 45o -medial(lateral)-dorsodistolateral (medial) oblique (PPrM(L)-DDiL(M)O) projections, and MRI images were assessed independently for the presence or absence of PP fractures and the sensitivity and specificity of radiographs for their detection were calculated, using MRI as the gold-standard. A second, blinded, radiographic evaluation excluding the palmar/plantar oblique views was performed. Twenty-seven PP fractures were identified in the 23 case horses on MRI examination. Twenty-two fractures were identified in 20/23 horses on examination of the full radiographic series (sensitivity and specificity of 81.5% and 100% respectively). Fractures were most frequently identified on the palmar/plantar oblique projections (19/22 fractures), followed by the lateromedial projection. Radiographic assessment excluding the palmar/plantar oblique projections identified 18 PP fractures in 16/23 horses. Careful assessment of a standard radiographic series of the foot will allow identification of PP fractures but palmar/plantar oblique projections will improve the detection of these fractures.

Equine nutrition in the post-operative colic: Survey of Diplomates of the American Colleges of Veterinary Internal Medicine and Veterinary Surgeons, and European Colleges of Equine Internal Medicine and Veterinary Surgeons.

BACKGROUND: Evidence is lacking concerning re-introduction of feed and water following colic surgery. OBJECTIVES: To describe current approaches of European and American specialists to re-introduction of feed and water in adult horses following surgical treatment of common intestinal lesions, assuming an uncomplicated recovery. STUDY DESIGN: Cross-sectional survey. METHODS: Electronic invitations, with a link to the online survey, were sent to 1,430 large animal specialists, including Diplomates of the ECVS, ACVS, ECEIM and ACVIM colleges. RESULTS: The response rate was 12.6% including partial respondent data. Responses for each multiple-choice question were between 123 and 178. Results are expressed as the percentage of the total number of responses and as a range where specific lesions are grouped together. Respondents reported that horses with large intestinal displacements were offered free choice water (63%-65%) within 3 hours (55%-63%), whereas horses with a small intestinal strangulating lesion were offered < 2 L water (64%-74%) 12-24 hours (28%-34%) post-operatively. Horses with a large colon displacement were offered feed within 3 hours of surgery (16%) with the majority offered feed 6-12 hours (35%-36%) post-operatively. Horses with small intestinal strangulating lesions and small colon lesions were offered feed 24-48 hours (34%-42%) after surgery. Following small intestinal, small colon or caecal lesions, horses were re-introduced feed in handfuls (79%-93%) and initially with grass (41%-54%). Horses with large colon displacements were mostly fed handfuls (49%-50%) of forage initially, but a number of respondents would offer larger quantities such as a small bucket (35%-37%) and predominantly of hay (50%-51%). MAIN LIMITATIONS: Low response rate. This study did not take into account common post-operative complications that may alter the clinical approach. CONCLUSIONS: This post-operative colic nutrition survey is the first to describe current clinical practice. Further research is required to investigate nutritional strategies in post-operative colic cases.

A retrospective study comparing the outcome of horses undergoing small intestinal resection and anastomosis with a single layer (Lembert) or double layer (simple continuous and Cushing) technique.

OBJECTIVES: To (1) compare postoperative complications and survival in horses after small intestinal resection and anastomosis using 2 anastomosis techniques (single layer Lembert; double layer simple continuous oversewn with Cushing), and (2) to compare outcome by anastomosis type (jejunoileostomy; jejunojejunostomy). STUDY DESIGN: Retrospective case series. ANIMALS: Horses (n = 53). METHODS: Medical records (July 2006-July 2010) of all horses that had small intestinal resection and anastomosis. Horses were divided into groups based on technique and type of anastomosis. Comparisons of pre- and intraoperative findings (disease severity), postoperative complications, and survival rates were made between groups. RESULTS: There were no differences in disease severity, postoperative complications, or survival between single layer (n = 23) or double layer (n = 31) anastomoses. There were no differences in disease severity or survival between jejunoileostomy (n = 16) or jejunojejunostomy (n = 38). There was a higher incidence of postoperative colic in hospital after jejunoileostomy (13/16) compared with jejunojejunostomy (18/38) (P = .0127). CONCLUSIONS: Postoperative complications and survival are comparable between horses undergoing single layer and double layer small intestinal end-to-end anastomoses. With the exception of increased postoperative colic in the hospital, postoperative complications and survival after jejunoileostomy and jejunojejunostomy are also comparable.

Clinical signs, treatment, and prognosis for horses with impaction of the cranial aspect of the base of the cecum: 7 cases (2000-2010).

OBJECTIVE: To determine the clinical signs, treatment, and prognosis for horses with impaction of the cranial aspect of the base of the cecum (cecal cupula). DESIGN: Retrospective observational case series. ANIMALS: 7 horses with colic attributed to cecal cupula impaction. PROCEDURES: Medical records were reviewed and horses that underwent exploratory celiotomy from 2000 through 2010 were identified. Horses with cecal cupula impaction and without other abdominal problems to which colic could be attributed were selected for inclusion in the study. Information regarding history, clinical findings, diagnostic testing, surgical findings and treatments, and treatments and complications after surgery was recorded. Rate of survival of horses to discharge from the hospital was determined. Long-term follow-up information was obtained with telephone questionnaires. RESULTS: Cecal cupula impaction without other cecal abnormalities was identified in 7 horses during exploratory celiotomy. Although clinical signs varied, horses typically had mild signs of colic and nondiagnostic rectal examination findings but were in systemically stable conditions at the time of the initial evaluation. Typhlotomies were performed and impactions were resolved by means of lavage and evacuation. All horses survived to discharge from the hospital and lived ≥ 2 years after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this study suggested cecal cupula impaction was a novel type of cecal impaction that was uncommon. Impactions did not involve the cecal body or apex and hypertrophy of the cecal wall was not grossly detected. Impactions were successfully treated with typhlotomy, lavage, and evacuation. Horses had a good prognosis after surgical treatment.

Risk factors for colic in equids hospitalized for ocular disease.

OBJECTIVE: To evaluate the incidence of colic and risk factors for colic in equids hospitalized for ocular disease. DESIGN: Retrospective observational study. Animals-337 equids (317 horses, 19 ponies, and 1 donkey) hospitalized for ocular disease. PROCEDURES: Medical records of equids hospitalized for > 24 hours for treatment of ocular disease between January 1997 and December 2008 were reviewed. Information from only the first hospitalization was used for equids that were hospitalized for ocular disease on more than 1 occasion. Information gathered included the signalment, the type of ocular lesion and the treatment administered, and any colic signs recorded during hospitalization as well as the severity, presumptive diagnosis, and treatment of the colic. Statistical analysis was used to identify any risk factors for colic in equids hospitalized for ocular disease. RESULTS: 72 of 337 (21.4%) equids hospitalized for ocular disease had signs of colic during hospitalization. Most equids (59.7% [43/72]) had mild signs of colic, and most (87.5% [63/72]) were treated medically. Ten of 72 (13.9%) equids with colic had a cecal impaction. Risk factors for colic in equids hospitalized for ocular disease were age (0 to 1 year and ≥ 21 years) and an increased duration of hospitalization (≥ 8 days). CONCLUSIONS AND CLINICAL RELEVANCE: There was a high incidence of colic in equids hospitalized with ocular disease in this study. Findings from this study may help identify equids at risk for development of colic and thereby help direct implementation of prophylactic measures.

In vitro comparison of a single-layer (continuous Lembert) versus two-layer (simple continuous/Cushing) hand-sewn end-to-end jejunoileal anastomosis in normal equine small intestine.

OBJECTIVES: To compare in vitro physical and mechanical characteristics of 1-layer and 2-layer end-to-end jejunoileostomy. STUDY DESIGN: In vitro experimental study. ANIMALS: Adult horses (n = 6). METHODS: Harvested equine jejunum and ileum was used to create 1- and 2-layer end-to-end jejunoileostomy specimens. Construction time, bursting pressure, and relative lumen diameter (anastomosis diameter expressed as a percentage of the lumen diameter of adjacent jejunum and ileum) were compared. Construction time and relative lumen diameters were compared using a paired t-test. Bursting pressure for anastomoses and control jejunal segments were compared using a repeated-measure ANOVA. Statistical significance was set at P < .05. RESULTS: Mean (± SEM) construct completion times were shorter for 1 layer (21 ± 0.91 minutes) than 2 layers (26.71 ± 1.16 minutes; P = .005). Relative lumen diameters (percentage of jejunal diameter) were larger for 1 layer (77.67 ± 4.46%) than for 2 layers (69.37 ± 2.8%; P = .035). There were no significant differences in bursting pressures between the 2 groups and the control jejunum (P =.155) or relative lumen diameters (percentage of ileal diameter; P =.118). CONCLUSIONS: One-layer jejunoileostomy can be created in a shorter time and maintain a larger anastomosis luminal diameter without compromising maximum bursting pressure when compared to 2-layer jejunoileostomy.

Conservative management of a transverse fracture of the distal phalanx in a Quarter Horse.

CASE DESCRIPTION: A 7-year-old Quarter Horse gelding was evaluated because of sudden onset of severe left forelimb lameness of 4 days' duration. CLINICAL FINDINGS: Clinical evaluation and diagnostic perineural analgesia localized the lameness to the distal portion of the left forelimb. Radiography revealed a transverse fracture of the distal phalanx of the left forelimb. TREATMENT AND OUTCOME: The horse was treated conservatively with stall rest and stabilization of the hoof with fiberglass cast material and an elevated heel support. These treatments improved the lameness considerably. Over the following 4 months, the horse was exercised at an increasing level; external coaptation of the hoof was removed, and the horse was gradually shod in a flat shoe. At 6 months after injury, the horse had no signs of lameness when working at its previous performance level, but it was euthanized for reasons unrelated to orthopedic disease. Radiographically, the fracture was unapparent; however, results of magnetic resonance imaging and histologic examination of the cadaveric limb confirmed the presence of tissue changes consistent with a healing fracture. CLINICAL RELEVANCE: Conservative management of transverse fractures of the distal phalanx of a forelimb may be effective and enable affected horses to be returned to their intended use.

Magnetic resonance imaging features of serous atrophy of bone marrow fat in the distal limb of three horses.

Emaciated human patients have changes in the fat content in medullary bone that are consistent with serous atrophy of the bone marrow histologically. Serous atrophy has been identified at postmortem examination in horses; however, the magnetic resonance (MR) characteristics have not been documented. Herein we describe the abnormalities of the bone marrow and medullary bone detected by low-field and high-field MR imaging of the distal limbs of three emaciated horses. These low- and high-field MR imaging abnormalities are characterized by a decrease in signal intensity on T1-weighted images in combination with an increase in signal intensity on short tau inversion recovery images in all areas of trabecular bone in the distal limbs, in the absence of lameness. Serous atrophy was confirmed microscopically in two horses. Appreciating the sensitivity of MR imaging for detection of bone marrow changes may assist in assessment of fat atrophy in welfare cases where starvation is suspected.

Osseous lesions in the metacarpo(tarso)phalangeal joint diagnosed using low-field magnetic resonance imaging in standing horses.

We report the use of low-field standing magnetic resonance imaging in the standing horse for the diagnosis of osseous lesions in the metacarpophalangeal (MCP) or metatarsophalangeal (MTP) joint that were not apparent using standard radiography. Thirteen horses were studied and all had thickening of the subchondral bone plate and abnormal signal intensity in the adjacent spongiosa in either the condyles of metacarpal/metatarsal III or the proximal phalanx or both. Abnormalities were characterized by diffuse decreased signal intensity on T1-weighting adjacent to the subchondral bone and within the spongiosa in at least two imaging planes; in the absence of increases in signal intensity in fat-suppressed images, this change was interpreted as bone sclerosis. Nine horses also had a diffuse decreased signal intensity on T2*-weighting in the same areas and five had a diffuse increase in signal intensity in fat-suppressed images in conjunction with a decrease in signal intensity on T1- and T2*-weighted images; the increase in signal intensity in fat-suppressed images was interpreted as fluid accumulation. Five horses had a focal area of change in signal intensity within the subchondral bone with apparent loss of definition between the subchondral bone and the articular cartilage. Eleven horses were available for follow up, of which eight were sound and three remained lame. We conclude that lameness originating from the MCP or MTP joint may be associated with osseous damage in horses of any signalment in the absence of radiographic changes.

Evidence-based gastrointestinal surgery in horses.

Colic surgery is now performed at many equine hospitals around the world. Despite the tremendous improvements in survival rates over the past 30 years, the morbidity and mortality rates remain relatively high. This fact, coupled with the high cost of treatment, makes it important to apply evidence-based medicine principles to establish the best possible treatment plans and surgical techniques whereby the outcomes can be optimized. Factors affecting survival rates and rates of major complications (incisional complications and postoperative ileus) are discussed. Preoperative assessment and postoperative care are not considered in this review.