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1.
Reasons for performing the study: The conventional arthroscopic approach to the palmar/plantar aspect of the distal interphalangeal joint (DIPJ) may result in the inadvertent penetration of the digital flexor tendon sheath (DFTS) and the navicular bursa (NB). This iatrogenic communication would be undesirable subsequent to arthroscopic lavage of a septic DIPJ. Hypothesis: A lateral/medial approach to the palmar/plantar aspect of the DIPJ will result in a significantly lower rate of inadvertent penetration of the DFTS and NB, whilst still providing adequate intra‐articular evaluation. Methods: The conventional palmar/plantar approach or a novel lateral/medial approach to the DIPJ was performed on cadaver fore‐ and hindlimbs (30 limbs/approach). Subsequently, India ink was injected into the dorsal pouch of the DIPJ, and the DFTS (n = 60) and NB (n = 20) were examined for the presence/absence of ink. In addition, observations of the number of attempts made to access the joint, evidence of iatrogenic intra‐articular trauma and occurrence of incomplete visualisation of the palmar/plantar pouch were recorded. Results: With the conventional approach, DFTS penetration was noted in 18/30 (60%) of the limbs, compared to 1/30 (3.3%) with the lateral/medial approach (P≤0.001). NB penetration was seen in 5/10 limbs with the palmar/plantar approach compared to 0/10 with the lateral/medial approach (P = 0.01). No significant differences were found between the approaches in the number of attempts made to access the joint, the incidence of iatrogenic intra‐articular trauma, or the occurrence of incomplete visibility of the palmar/plantar pouch. Conclusions: The novel lateral/medial approach to the DIPJ significantly decreases the risk of inadvertent penetration of the DFTS and NB. Potential relevance: The novel lateral/medial approach to the DIPJ is an effective technique to gain access to the palmar/plantar pouches, and is particularly advantageous for arthroscopic lavage of a septic DIPJ.  相似文献   

2.
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3.
Equine carpal and fetlock joints have been the most frequent sites for arthroscopic surgical procedures and were the initial locations where techniques were developed. The primary indication for surgical treatment of chip fragments in the equine athlete is normalization of the interior of the joint and prevention of osteoarthritis. Osteochondral chip fragments in the equine carpus are common in racehorses. The overall success rate with arthroscopic removal is 68.1% racing at a level equal to or better to preinjury in 88.6% starting at least one race. Depending on the degree of articular cartilage and bone damage, the prognosis for return to racing at a level equal to or better than preinjury ranges from 71% to 54%. Success rate with proximodorsal first phalanx chip fragments is 83.5% return to their previous use; 73.6% return to racing at the same level of performance. Other fracture fragments operated in the fetlock joint include, plantar or palmar first phalanx fragments, osteochondritis dissecans fragments from the sagittal ridge and distal dorsal metacarpus as well as apical, abaxial and basal sesamoid fragments. The success rates with these various arthroscopic surgeries are also presented.  相似文献   

4.
Reasons for performing study: Thoroughbred racehorses are commonly affected by subchondral bone injury, but the exact prevalence and the distribution of palmar/plantar osteochondral disease (POD) lesions are unknown. The relationship between pathologies has not been elucidated, although it is widely accepted that POD is a manifestation of traumatic overload arthrosis. Hypothesis: There is an association between grade of POD and other pathologies affecting the third metacarpal and metatarsal (MC/MTIII) condyles (wear lines, cartilage loss, marginal remodelling, dorsal impact injuries and linear fissures). Objectives: To evaluate the pathology found affecting the distal MC/MTIII condyles of Thoroughbred racehorses at post mortem examination, to describe the prevalence and distribution of POD lesions within a population of racing Thoroughbreds and to determine relationships between pathologies of the distal condyles of the third metacarpal and metatarsal bones. Methods: The metacarpo/metatarsophalangeal joints of 64 Thoroughbred racehorses were examined at routine post mortem examination and graded for third metacarpal and metatarsal condylar pathology. Associations between pathologies were determined. Results: POD had a within horse prevalence of 67%. There was a significant linear relationship between grade of POD and grades of wear lines, cartilage ulceration and dorsal impact injuries. There was a significant relationship, but this was not linear, between grade of POD and grade of linear fissures. Using ordinal logistic regression, compared to condyles with grade 0 or grade 2 linear fissures, condyles with grade 1 linear fissures were found to be more likely to have a lower POD grade. Potential relevance: POD can be considered to be a manifestation of traumatic overload arthrosis, but the role of subchondral bone adaptation is complex and warrants further investigation.  相似文献   

5.
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6.
A synovial plica is present at the dorsoproximal aspect of the fetlock joint. The objective of this study was to describe the location of the synovial plica during induced hyperextension using Magnetic Resonance Imaging. For this study 20 cadaver limbs from five Warmblood horses were used. Measurements were made of the dorsal; palmar/plantar length and the thickness of the plica with the joint in a normal position. During induced hyperextension of the joint, the position of the plica was described; the dorsal angle of extension and angle of contact between the proximal phalanx (P1) and the condyle were measured. The dorsal length differed between front/hind limbs and between the medial/lateral aspect of the joint. The angle of contact between P1 and condyle differed between front/hind limbs; between the lateral and medial aspect of the joint and between different positions of the plica. Four different positions of the plica were observed: shortened with the tip curved towards palmar/plantar; projecting distally; projecting towards dorsal and projecting distally with the tip interposed between P1 and the condyle. During induced hyperextension, a close relation is present between the synovial plica, P1 and the condyle with a variable position of the plica; which is suggestive for a contact interface between P1 and the metacarpal/metatarsal bone. However the plica does not seem to act consistently as a cushioning surface.  相似文献   

7.
Objective— To describe anatomic considerations and arthroscopic technique in horses for arthroscopic removal of palmar/plantar osteochondral fragments from the proximal interphalangeal (PIP) joint. Study Design— Retrospective study. Animals— Adult horses (n=4) with osteochondral fragments of the palmar/plantar PIP joint. Methods— Arthroscopic removal of palmar/plantar osteochondral fragments within the PIP joint was performed with horses in dorsal recumbency under general anesthesia. Medical records of affected horses were reviewed to determine history; physical, lameness, and radiological findings; surgical technique; complications and outcome. Results— Two horses had lameness localized to the PIP joint. Two other horses had lameness suspected, but not confirmed to the pastern region. One of these horses had a history of intermittent lameness, but was not lame on admission. All horses had radiographic evidence of palmar/plantar osteochondral fragmentation within the PIP joint. Fragmentation was located abaxially in 2 horses in the hind limb and axially in 2 horses in the left forelimb. Osteochondral fragments were successfully removed via a palmar/plantar arthroscopic approach in all horses. Three horses returned to previous levels of athletic performance; 1 horse was used for trail riding instead of reining. Conclusions— Arthroscopy of the palmar/plantar pouch of the PIP joint allowed limited assessment of the joint and removal of osteochondral fragments. Clinical Relevance— Arthroscopy of the palmar/plantar PIP joint pouch for assessment and removal of osteochondral fragments is possible and should be considered when lameness is localized to this joint.  相似文献   

8.
OBJECTIVE: To determine changes in the distal ends of the third metacarpal and metatarsal bones (MCIII and MTIII) of Thoroughbred racehorses that had sustained a catastrophic condylar fracture during high-speed exercise. SAMPLE POPULATION: Fractured and contralateral MCIIIs and MTIIIs from 11 Thoroughbred racehorses that sustained a displaced condylar fracture during racing, both MCIIIs from 5 Thoroughbred racehorses euthanatized because of a catastrophic injury other than a condylar fracture, and both MCIIIs from 5 horses of other breeds that had not been professionally trained or raced. PROCEDURE: Macroscopic observations were made of the distal ends of the bones before and after digestion of the articular cartilage with NaOH. RESULTS: In all 11 racehorses with a displaced condylar fracture, the fracture was associated with a branching array of cracks in the condylar groove. In this region, fracture margins were smooth, and there was loss of subchondral bone. Comminution of the dorsal cortex was also seen. Parasagittal linear wear lines in the articular cartilage, erosions in the articular cartilage of the condyles, loss of the underlying subchondral bone, and cracking of condylar grooves were all more severe in the Thoroughbred racehorses than in the horses that had not been professionally trained or raced. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that condylar fractures in horses are pathologic fatigue or stress fractures that arise from a preexisting, branching array of cracks in the condylar groove of the distal end of MCIII or MTIII.  相似文献   

9.
The objective of the present study was to describe the arthroscopic anatomy of the bovine fetlock joint using one palmar/plantar and three dorsal joint approaches. A comparative anatomic, ultrasonographic and arthroscopic study using 20 cadaveric feet from 13 non-lame adult dairy cows was performed. Arthroscopy was accomplished using a rigid arthroscope to view the synovial cavities with their synovial villi and parts of the following structures: the distal ends of the metacarpal/metatarsal III/IV bones with their trochleae and sagittal ridges, synovial grooves, the articular surfaces of the proximal sesamoid bones, the proximal aspects of the first phalanges, the lateral and medial collateral ligaments, the suspensory ligament and the interdigital ligaments as parts of the interosseus muscle, the cruciate sesamoidean ligaments, the communication site between the lateral and medial pouch in the palmar/plantar area, and dorsally the septum between the lateral and the medial pouch. The technique allowed a good overall view of most relevant structures in the sound cadaver joint. Further investigations are warranted to evaluate the diagnostic, therapeutic and prognostic applications of these techniques in the treatment of septic arthritis.  相似文献   

10.
An arthroscopic approach to the palmaroproximal or plantaroproximal pouch of the distal interphalangeal joint was developed in six cadaver limbs and seven limbs of three clinically normal horses. The dorsal aspect of the proximal border and the proximal articular margin of the distal sesamoid (navicular) bone, the palmar aspect of the distal articular margin of the middle phalanx, the collateral sesamoidean ligaments of the distal sesamoid bone, and the joint capsule attachments were readily accessible. Distending the joints with fluid gave access to portions of the articular surface between the distal sesamoid bone and the middle phalanx in all joints, and to a small portion of the distal phalanx in two hind distal interphalangeal joints. Two horses allowed to recover from anesthesia were not lame on days 30 and 37, respectively. Problems encountered initially were difficulty entering the joint, hemarthrosis, and minimal iatrogenic cartilage damage.  相似文献   

11.
REASONS FOR PERFORMING STUDY: Radiography in presale examinations of TB yearlings has become standard practice in recent years. OBJECTIVES: To describe the prevalence and distribution of radiographic changes in the fetlocks, carpi, tarsi, stifles and fore feet of Thoroughbred yearlings in central Kentucky when these joints were examined as part of routine pre- and post sale evaluations. METHODS: Horses subjected to radiographs included the fore (n = 1127) and hind (n = 1102) fetlocks, carpi (n = 1130), tarsi (n = 1101), stifles (n = 660) and fore feet (n = 300). Radiographic changes were categorised by location and type of change present (e.g. lucency, fragment) for each series. RESULTS: In the fore fetlocks 1.6% had fragmentation of the proximal dorsal first phalanx and 0.5% fragmentation of the proximal palmar aspect. In the hind fetlocks 5.9% had fragmentation at the plantar aspect and 3.3% fragmentation dorsally. Lucencies, fragments or loose bodies were detected at the dorsal aspect of the distal third metacarpus in 2.8% and, at the same location on the third metatarsus, 3.2%. Most yearlings (98%) had vascular channels in the proximal sesamoid bones and irregular vascular channels (> 2 mm wide or with nonparallel sides) were more common (79%) than regular vascular channels (56%). The intermediate ridge of the distal tibia was the most common location for fragmentation in the tarsus (4.4%). CONCLUSIONS: While some radiographic changes, e.g. vascular channels in proximal sesamoid bones, are very common in Thoroughbred yearlings, others, e.g. fragmentation or subchondral lucency within joints are quite rare usually affecting less than 5% of the population. POTENTIAL RELEVANCE: Veterinarians should expect to find radiographic changes in Thoroughbreds presented for examination prior to the yearling sales. The rarity of some changes thought to affect soundness or racing performance will make further invesigation of these conditions in horses without clinical signs more difficult.  相似文献   

12.
SUMMARY The clinical presentation and outcome of treatment is presented for 26 cases of osteochondral fragmentation of the plantar/palmar proximal aspect of the proximal phalanx. Twenty-three were racing Standardbreds and three were racing Thoroughbreds. The most common reason for presentation was an inability to run straight at high speed. Only eight horses presented for lameness, although on examination 19 were lame. A positive flexion test was recorded in 90% of affected fetlock joints and effusion in 48%. Arthroscopic fragment removal was performed on 23 occasions in 21 horses and arthrotomy in one horse. Of the 16 horses that had returned to racing, 12 had improved their performance, while three showed no improvement, and one was retired for other reasons. In three horses refragmentation occurred after surgery, two of which had improved after initial arthroscopic removal. Degenerative changes within the fetlock joint were detected at surgery in eight horses. Of the four horses treated conservatively, one returned to its previous level of performance temporarily after intra-articular medication, one showed no improvement and two were still resting. Plantar/palmar osteochondral fragmentation of the proximal aspect of the first phalanx is a common cause of low-grade lameness in racing horses, and arthroscopic removal results in improvement in race performance in a high percentage of cases.  相似文献   

13.
This study concerns the vestigial metacarpal and metatarsal bones, so called splint bones. The soft tissues, which stabilize the splint bones were carefully examined. The palmar metacarpal/plantar metatarsal fascia, the metacarpal/metatarsal interosseous ligaments and the fibres, which exit distally from the splint bone, were examined in depth. Cadaveric distal limbs were collected from 5 slaughtered or euthanized horses. The legs were examined both, microscopically and macroscopically. The palmar metacarpal/plantar metatarsal fascia is a very stable structure, which connects the splint bone with its environment. The connection between splint and McIII/MtIII, established through the metacarpal/ metatarsal interosseous ligaments, showed impressive differences between specimens examined. Macroscopic examination of the soft tissue in the distal region showed a band structure, which originates from the distal end of the splint bone and extends in dorsal and distal direction towards the proximal sesamoid bone.  相似文献   

14.
This study aimed to quantify the factors associated with the prevalence of the radiological signs of osteochondrosis (OC) and osteochondrosis dissecans (OCD) in South German Coldblood (SGC) horses. The prevalence of OC and OCD in fetlock and hock joints was analysed in 167 young coldblood horses with a mean age of 14 months. The presence of at least one osteochondrotic lesion (OC) in fetlock or hock joints was documented for 61.7% of the horses and 26.9% of the horses had osseus fragments. Osteochondrotic findings at the dorsal aspect of the sagittal ridge of the third metacarpal/metatarsal bone were seen in 53.9% of the horses and palmar/plantar osseous fragments in fetlock joints in 16.2% of the horses. Hock joint OC was found in 40.1% of the horses and hock OCD in 0.6%. Osteochondrotic findings in the distal part of the tibia were prevalent in 28.1% and in the lateral trochlea tali in 17.4% of the horses. The sex of the investigated horses significantly influenced the prevalence of OC in fetlock and hock joints, as well as the findings in the distal part of the tibia and lateral trochlea tali. Age at radiological examination was significant for the prevalence of OC in hock joints, palmar/plantar osseous fragments in fetlock joints and osteochondrotic findings in the distal part of the tibia. Female horses showed a 2-fold higher risk for OC in fetlock and hock joints than male horses. The distribution of the affected horses by age classes showed that radiographic signs of OC in fetlock and hock joints significantly increased at an age of about 1 year. We can conclude from our study that fetlock and hock OC is a prevalent radiographic finding in more than 1-year-old female and male SGC horses.  相似文献   

15.
Heritabilities were estimated for osteochondrosis (OC) in fetlock and hock joints and palmar/plantar osseous fragments in fetlock joints of South German Coldblood (SGC) horses using Residual Maximum Likelihood (REML) under a linear animal model. The analyses were based on the results of a standardized radiographic examination of 167 SGC horses with a mean age of 14 months. The heritabilities linearly estimated and transformed onto the liability scale were for OC in fetlock joints 0.16 and for OC in hock joints 0.04. Considering fetlock and hock OC together, results in a heritability of 0.17. Palmar/plantar osseus fragments of the fetlock joints showed a heritability of 0.48. We concluded that there is most likely a genetic component in the variation of the development of osteochondrosis in fetlock and hock joints as well as for palmar/plantar osseus fragments of fetlock joints of the investigated population of SGC horses.  相似文献   

16.
The fore and hind feet of 50 unselected Rottweilers were examined clinically and radiographically for abnormalities of their volar and plantar sesamoid bones. Lesions were found in 22 (44 per cent), invariably affecting the No. 2 and/or No. 7 sesamoids. The majority occurred in the forelimb. Clinical signs were detected in only five dogs and local analgesia in these cases indicated that the sesamoid changes were not the cause of the presenting lameness. Radiographically the defect varied from small radiodense foci separated from an otherwise normal sesamoid, to gross distortion of the bone into a number of calcified bodies. In none of these dogs was the sesamoid abnormality demonstrated to cause lameness and it was not necessary, therefore, to treat the condition surgically. It is postulated that these lesions result from disordered ossification with subsequent degenerative changes.  相似文献   

17.
OBJECTIVE: To identify sites for arthroscopic access to the palmar aspects of the antebrachiocarpal (AC) and middle carpal (MC) joints, and describe visible carpal bone surfaces for each approach. STUDY DESIGN: Prospective experimental study. ANIMALS: Equine carpi: 16 cadavers, 8 live horses. METHODS: A latex model was used to identify possible sites for arthroscopic access to the palmar aspects of the AC and MC joints. Carpi (n = 24) were examined arthroscopically and arthroscopic access sites and visible carpal bone surfaces were described. RESULTS: Arthroscopic approaches and instrument portals were developed for the medial and lateral aspects of the palmar pouches of the AC and MC joints. The palmar surface of the radial carpal bone and radius, and the dorsal articular surfaces of the accessory carpal bone, could be viewed using palmar approaches to the AC joint. The palmar aspect of the radial, third and second carpal bones (medially) and ulnar and fourth carpal bones (laterally) could be observed using a palmar approach to the MC joint. CONCLUSIONS: Arthroscopic access, using separate medial and lateral portals to the AC and MC joints, allowed assessment of portions of the caudodistal radius, the palmar surfaces of the radial, ulnar, second, third and fourth carpal bones, and the dorsal aspect of the accessory carpal bone. CLINICAL RELEVANCE: Arthroscopic approaches to the palmar aspect of the carpus could be used to remove fracture fragments, and to assess the medial palmar intercarpal ligaments.  相似文献   

18.
A new surgical approach to the infected fetlock joint is described in two cattle suffering from septic tenosynovitis of the lateral digital flexor tendon sheaths of the right lateral hind-digits with concurrent septic serofibrinous arthritis of the adjoining fetlock joints, caused by penetrating wounds. In both patients, the infected sheaths were opened and the superficial and deep digital flexor tendons were removed. Intraoperatively, a small entry through the fetlock joint capsule was detected, directly distal to the lateral proximal sesamoid bone. The tract was surgically enlarged and a second approach into the plantar fetlock joint pouch was created proximally by making a 3 cm long and 0.5 cm wide incision between the two lateral suspensory ligament branches. This allowed easy access to the plantar joint pouch, removal of fibrin clots and an effective joint lavage using 5L of sterile saline solution. The incisions of the fetlock joint capsules remained unsutured and were drained using soft polyurethane foam to preclude premature closure. The tendon sheath wounds remained unsutured. In both patients, the digital flexor tendon sheath and the fetlock joint were lavaged daily for the following three days. The infection was eliminated in both cattle and both fully recovered without residual lameness.  相似文献   

19.
OBJECTIVE: To develop a technique for arthroscopic excision of apical sesamoid fracture fragments using electrocautery probes. ANIMALS OR SAMPLE POPULATION: A total of 18 Standardbred horses. METHODS: Arthroscopic removal of apical sesamoid fracture fragments using both hook and loop electrocautery probes was performed on 18 Standardbred horses. The fracture fragments were approached using either an ipsilateral (3) or contralateral (15) arthroscopic triangulation technique. Distension of the metacarpo- (metatarso)-phalangeal joints was achieved using a 1.5% glycine solution. Under arthroscopic guidance, both the suspensory and intersesamoidean ligament attachments to the abaxial and the axial margins of the apical fragment were transected using a hook electrocautery probe. Subsequently, the palmar (plantar) soft tissue attachments to the apical fragment were transected with a loop electrocautery probe. Once freed of soft tissue attachments, the apical fragment was removed with Ferris-Smith intervertebral disc rongeur. The arthroscopic portals were closed in a routine manner. RESULTS: Horse ages ranged from 2 to 8 years (median, 2.5 years). Eighteen apical sesamoid fracture fragments were removed from the left (8) and right (8) hind limbs and the left (1) and right (1) forelimbs. Apical fragments occured in 15 lateral and 3 medial proximal sesamoid bones. No major complications occurred during or after surgery. The electrocautery probes permitted an easy and precise dissection of all soft tissue attachments to the apical sesamoid fracture fragments in all horses. Follow-up time was 7 to 44 months (median, 26 months); 10 of 14 horses returned to racing. Seven of nine horses that raced before surgery raced again and three of five that had not raced before surgery, raced afterwards. CONCLUSION: Arthroscopic excision of apical sesamoid fracture fragments can be accomplished arthroscopically using electrocautery probes. CLINICAL RELEVANCE: Arthroscopic electrosurgery is an efficient and safe alternative for intra-articular dissection in horses.  相似文献   

20.
REASONS FOR PERFORMING STUDY: Although the radiographic examination of yearlings has become commonplace at some large Thoroughbred sales, there are few data to support the decisions facing veterinarians who are asked to evaluate future racing potential. OBJECTIVES: To identify radiographic changes in the fetlocks, proximal sesamoid bones, carpi, tarsi, stifles and fore feet of Thoroughbred yearlings associated with future racing performance during ages 2 and 3 years. METHODS: Radiographs from routine pre- and post sale examinations of 1162 yearlings were used to identify individual radiographic changes in sale yearlings. Starting a race, the percent of starts placed, money earned and earnings per start were used to assess racing performanceand examined for associations with the radiographic changes observed. RESULTS: Overall 946 (81%) yearlings started at least one race during ages 2 or 3 years. Fourteen of 24 (58%) yearlings with moderate or extreme palmar supracondylar lysis of the third metacarpus, 8 of 14 (57%) of those with enthesophyte formation on the proximal sesamoid bones and 19 of 30 (63%) of those with dorsal medial intercarpal joint disease started a race. The odds of starting a race when age 2 or 3 years were 3 times lower for yearlings with these changes (P < 0.01) compared with yearlings that did not have these changes. Twenty-five of 36 (69%) yearlings with proximal dorsal fragmentation of the first phalanx in the hind fetlock started a race and these yearlings were also less likely (OR = 0.51, P = 0.07) to start a race. Yearlings with enthesophyte formation on hind proximal sesamoid bones placed in a smaller percentage of starts (16%, P = 0.01) earned less money (987 US dollars, P = 0.02) and had lower earnings per start (252 US dollars, P = 0.03) compared to starters without this change. CONCLUSIONS: Although many of the changes observed on radiographs of sale yearlings do not appear to influence future racing performance, some are associated with reduced performance. POTENTIAL RELEVANCE: The results of this study are best applied in parallel with the clinical impressions of veterinarians experienced in examining radiographs of sale yearlings. Some findings support those established in the literature as incidental findings and others suggest new areas for concern not previously reported as a problem in Thoroughbred sale yearlings.  相似文献   

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