Interphalangeal Joint In Horses Research Articles

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.

Evaluation of four techniques for injection of the proximal interphalangeal joint in horses.

To describe a dorsoproximal midline (DPM) standing technique for proximal interphalangeal joint (PIPJ) injection and to compare it to established dorsolateral flexed (DLF), palmaroproximal (PP), and dorsolateral standing (DLS) techniques. Ex vivo study. Sixty cadaver equine thoracic limbs. Limbs were divided into four groups (n = 15 each group), DLF, DPM, PP, and DLS. For each technique, three operators injected radiopaque contrast and methylene blue into the PIPJ in five limbs. The number of attempts required was recorded. Successful injection was confirmed by radiographic presence of contrast media within the PIPJ. Iatrogenic cartilage damage was assessed by gross examination. Statistical analysis was performed by Wilcoxon signed-rank test (P < .05). The overall success rates were 86.6% to 93.3%. Although there was no difference in success rate, the frequency of needle repositioning was influenced by injection technique (P = .009). Dorsolateral standing had the highest mean ± SD value of attempts required to insert the needle in the joint space (2.62 ± 1.94). Injection technique influenced cartilage damage (P = .025), with the highest frequency recorded for DLS. All four techniques for injecting the PIPJ were highly successful; DLS was associated with the highest number of needle repositionings and the highest incidence of iatrogenic injury to cartilage. Dorsolateral flexed should be considered as an alternative to the DLS technique to reduce iatrogenic cartilage injury when injecting the PIPJ. Dorsoproximal midline and DLF techniques have success rates comparable to traditional techniques, with lower incidence of iatrogenic cartilage damage in cadaver limbs.

A Standing Percutaneous Technique for Proximal Interphalangeal Joint Arthrodesis in Twelve Horses (2014–2017)

This report describes the use of a minimally invasive standing pastern arthrodesis technique for the treatment of osteoarthritis in horses and documents its clinical outcome in 12 horses. Medical records and radiographs of horses diagnosed with proximal interphalangeal joint osteoarthritis that underwent standing pastern arthrodesis using transarticular screws were reviewed. Follow-up information for determination of outcome was obtained via phone interview with the owners. Twelve horses (15 limbs) were included in the study. Radiographical findings revealed severe osteoarthritis in 12/15 limbs and moderate osteoarthritis in 3/15 limbs. Follow-up information was available for 11/12 cases (13/15 limbs). Phone surveys with the owners revealed that 8/11 horses were performing at their previous activity level or higher. Two horses remained lame. One horse developed a surgical site infection and was euthanatized. The average time for horses to return to their previous level of activity was 6.5 months (range: 1-18 months). Stabilization of the proximal interphalangeal joint in horses with moderate-to-severe osteoarthritis can be performed using this minimally invasive standing technique. This procedure can be performed safely and provides a similar outcome when compared with other described techniques.

Transthecal Arthroscopy of the Palmar Distal Interphalangeal Joint in the Horse: A Cadaver Study.

To describe a transthecal approach to the palmar pouch of the distal interphalangeal joint (DIPJ) in horses and compare it with the conventional blind arthroscopic technique. Ex vivo study. Cadaver forelimbs (n = 26 pairs) from mature horses. One limb from each pair was randomly assigned to each arthroscopic approach (conventional or transthecal). The conventional arthroscopic approach was performed as previously described and the transthecal approach was performed through sharp dissection of the distal reflection of the digital flexor tendon sheath (DFTS). The proportion (0-100%) of the navicular bone, palmar aspect of the condyles of the 2nd phalanx, collateral sesamoidean ligaments, and palmar synovial pouches of the DIPJ visualized by each approach was estimated. Limbs were dissected and iatrogenic damage of relevant structures was assessed. Nondirectional Mann-Whitney U-test was used to compare groups. Significance was set at P < .05. The transthecal approach provided greater visualization of the navicular bone (P < .001), palmar aspect of the 2nd phalanx (P < .001), and palmar synovial pouches of the DIPJ (P < .001) than the conventional approach. There were no significant differences in iatrogenic damage between approaches. The transthecal approach provides improved visualization of the palmar aspect of the DIPJ compared to the conventional blind approach and may be useful in nonseptic conditions of the DIPJ. However, because of the creation of communication with the DFTS, use of the transthecal approach for suspected synovial sepsis of the DIPJ may be contraindicated.

Use of Body-Mounted Inertial Sensors to Objectively Evaluate the Response to Perineural Analgesia of the Distal Limb and Intra-articular Analgesia of the Distal Interphalangeal Joint in Horses With Forelimb Lameness

Diagnostic analgesia of the distal interphalangeal (DIP) joint is theoretically helpful to localize the source of pain in the foot to the joint and/or navicular bursa. However, it has been suggested that potential diffusion of local anesthetic agent to nearby distal limb nerves may anesthetize other areas of the foot. The objective of this study was to compare the results of palmar digital (PD) and abaxial sesamoid (AS) nerve blocks to intra-articular anesthesia of the DIP joint in horses with distal forelimb lameness. Palmar digital nerve block (group 1) or PD and AS nerve blocks (group 2) were used to abolish digital pain in 22 horses. The following day lameness was again evaluated in all horses before and 2, 5, and 10 minutes after DIP joint anesthesia. All lameness evaluations were performed objectively with a body-mounted inertial sensor system (Lameness locator; Equinosis LLC, Columbia, MO). In group 1 horses, overall improvement in group lameness was the same after DIP joint block, but only six showed positive response after DIP joint analgesia, five after 2 minutes, and one after 5 minutes. In group 2 horses, overall improvement in lameness was less after DIP joint block, with seven showing a positive response after DIP joint analgesia, one after 2 minutes, four after 5 minutes, and two after 10 minutes. Intra-articular analgesia of the DIP joint and perineural analgesia of the digit result in overlapping but unequal areas of analgesia. In addition, a time-dependent response was observed after DIP joint block with full effect requiring 5–10 minutes.

Retrospective evaluation of facilitated pastern ankylosis using intra‐articular ethanol injections: 34 cases (2006–2012)

While surgical arthrodesis is the treatment of choice for osteoarthritis of the proximal interphalangeal joint, some clients are unable to pursue surgery due to costs. A more economical technique was sought using intra-articular ethyl alcohol injections to facilitate ankylosis. To describe the technique and outcome of intra-articular ethyl alcohol injections for facilitated ankylosis of proximal interphalangeal joints with osteoarthritis. As a retrospective case series, the medical records (2006-2012) of clinical cases diagnosed with proximal interphalangeal joint osteoarthritis treated with intra-articular ethyl alcohol injections were reviewed. Cases with follow-up of at least 6 months were included. Technique and outcome were determined. Evaluation of outcome was assessed using return to previous performance or intended use and owner satisfaction as the indicators of success. Soundness and level of work are also reported. Thirty-four horses were included in the study. At the time of follow-up, 17 horses (50%) were sound, while 13 horses (38%) were improved but not sound. One horse's lameness was unchanged, and 3 horses were lost to follow-up. The median time until horses became sound or returned to work was 8 months. Six horses had complications, 4 of which were mild and transient. The use of intra-articular ethyl alcohol in the proximal interphalangeal joint in horses affected by osteoarthritis appears to be a viable method for facilitated ankylosis if surgical management is not an option.

Ultrasonography of the Collateral Ligaments of the Distal Interphalangeal Joint in Horses: Technique and Reference Images

This study describes ultrasound (US) technique and reference images of the equine distal interphalangeal joint collateral ligaments (CLs), and evaluates the portion of the CLs assessable by US in a series of normal forelimbs. Transverse and longitudinal US images were obtained on five healthy horses and on 25 equine cadaver forelimbs. On six limbs, a needle was placed under US-guidance at the distal limit of visualization of each CL, and the portion of CL visible at US was evaluated on computed tomographic (CT) images. The normal CLs appear as oval structures located abaxial to the fossae of the middle phalanx in the transverse sections, obtained at the level of the coronary band. A centrodorsal hypoechoic image appears with increasing proximodistal probe inclination, demonstrating different fiber orientations within the ligament. Two main fascicles, a deep and a superficial, distally divergent, are visible on longitudinal images obtained in the central part of the ligament. The proportion of CL visible at US examination was more than 50% of the total ligament length in nine of the 12 CLs assessed by CT. Awareness of the estimated portion of distal interphalangeal joint CLs visible at US and detailed knowledge of the US technique and CLs morphology are essential to efficiently use US examination on clinical cases.

Ultrasonographic examination of the collateral ligaments of the distal interphalangeal joint in horses: Part A: Technique and normal images

SummaryThe collateral ligaments (CL) of the distal interphalangeal joint (DIPJ) are important structures for DIPJ stability. Collateral ligament injuries must be considered in the differential diagnosis of foot pain. An accurate examination of the CL‐DIPJ can be performed with an adequate ultrasonographic technique and equipment. This paper describes the technique and normal ultrasonographic images as reference data for the diagnosis and documentation of CL‐DIPJ desmopathies and enthesopathies.

Ultrasonographic examination of the collateral ligaments of the distal interphalangeal joint in horses. Part B: Abnormal findings and lesions

Summary Ultrasonography is an easy and rewarding technique for the assessment of collateral ligaments of the distal interphalangeal joint (CL-DIPJ) desmopathies and enthesopathies. Comparison between ligaments of both feet and oblique incidence improve sensitivity and specificity of the ultrasonographic diagnosis. The main limitation of the procedure is imaging the distal part of the CL-DIPJ and corresponding fossa of the distal phalanx. Alone, or in combination with other imaging procedures, ultrasonography is valuable in the diagnosis of the injured structures, which may help to determine the corrective shoeing and the rehabilitation programme of the horse.

Comparison of three methods of injecting the proximal interphalangeal joint in horses

The efficacy of three methods of injecting the equine proximal interphalangeal (pastern) joint was compared using cadaver limbs. Five veterinary students without prior experience attempted to inject an aqueous radiographic...

Transfixation cast technique for arthrodesis of the distal interphalangeal joint of horses

Surgical arthrodesis of the distal interphalangeal (DIP) joint by transfixation casting was used to salvage a three-year-old filly and a yearling filly that were chronically lame because of infection of the DIP joint for breeding. Unlike previously described techniques for arthrodesis of the DIP joint, the technique used did not require insertion of implants across the joint, which may have contributed to the successful outcome.

Comparison of three dorsal techniques for arthrocentesis of the distal interphalangeal joint in horses

To compare 3 dorsal techniques for arthrocentesis of the distal interphalangeal joint in horses with regard to ease of performing the technique and to determine the role of operator experience in ease of performing these techniques. Observational study. Sample Population-Forelimbs from 17 equine cadavers and 12 horses (16 joints) undergoing arthrocentesis for therapeutic or diagnostic purposes. In both forelimbs from 7 of the equine cadavers, 3 arthrocentesis techniques (dorsal perpendicular, dorsolateral, and dorsal inclined) were performed in random order by a single experienced individual, and number of attempts needed to successfully insert the needle into the joint was recorded. For the forelimbs from the remaining 10 cadavers, veterinary students without experience in arthrocentesis performed each of the 3 arthrocentesis techniques (2 limbs/student) in random order, and number of attempts was recorded. In the clinical patients, arthrocentesis was performed by means of the dorsal inclined technique. For both the experienced individual and the veterinary students, number of attempts needed was significantly lower with the dorsal inclined technique than with the dorsal perpendicular or dorsolateral technique. Arthrocentesis was successful with the dorsal inclined technique in all 16 joints in the clinical patients; synovial fluid was recovered from 14 of the 16 joints. The procedure was well tolerated in all horses, except one that reacted to needle insertion. Results suggested that the dorsal inclined technique for arthrocentesis of the distal interphalangeal joint was easier to perform than was the dorsal perpendicular or dorsolateral technique, regardless of experience level of the operator.

Diagnostic Value of MMP-2 and MMP-9 in Synovial Fluid for Identifying Osteoarthritis in the Distal Interphalangeal Joint in Horses

Our aim was to examine the diagnostic potential of matrix metalloproteinases MMP-2 and MMP-9 for identifying osteoarthritis in the horse. Horses were divided into two groups - a positive group consisting of 28 horses with cartilage damage in the distal interphalangeal joint and a negative group of 17 control horses. Clinical examination of the horses included evaluation of lameness, flexion test, diagnostic nerve blocks, X-ray and arthroscopy. MMP-2 and MMP-9 were detected in synovial fluid using gelatin zymography. Monomers of MMP-2 and MMP-9 appeared not to be specific for osteoarthritis since they also occurred in control samples. In contrast, detection of active forms of MMPs was found to be more effective than radiological examination in identifying horses with osteoarthritis, on the grounds of higher sensitivity. Active forms of MMP-2 and MMP-9 were observed with 88.24% and 82.35% specificity respectively, indicating the high accuracy in correctly identifying horses without osteoarthritis. Thus, as an addition to clinical examination, detection of MMPs could improve the diagnosis of osteoarthritis. Detection of active forms of MMP-2 and MMP-9 was evaluated as an additional diagnostic tool in diagnosing osteoarthritis, especially in the case of a negative X-ray result. The proportions of animals with confirmed osteoarthritis, which tested positive, were found to be 81.82% and 76.92%, respectively. The results of this study confirm that active forms of MMP occur in synovial fluid of osteoarthritic joints more frequently than in synovial fluid from normal joints of the horse. Detection of active forms of MMP-2 and MMP-9 is shown to have an important diagnostic potential.

Analgesia effects of detomidine HCl when administered into the distal interphalangeal joint in horses with experimental solar pain

Stimulation of the sympathetic nervous system, acting through the release of noradrenaline, influences the nociceptor activity that develops after tissue surgery. The alpha-2 adrenergic agonist detomidine produces analgesia through a central mechanism but also inhibits noradrenaline release at terminal nerve fiber endings. Detomidine may induce analgesia when administered at peripheral sites (eg, at the joint cavity or around the nerves). An experimental lameness was induced in the toe region of the left forelimb in 6 adult horses to test the analgesic effects of detomidine at a peripheral site. Lameness was induced by creating pressure on the dorsal margin of the sole with the help of set-screws that were screwed into a nut, then welded to the inside of each branch of the shoe. Gaits were recorded on videotape before and after application of the screws and after application of either detomidine HCl or saline into the distal interphalangeal (DIP) joint. The gaits were evaluated independently by 2 blinded clinicians and scored. Lameness scores were high after application of the screws and remained high after the administration of saline but decreased significantly ( P

Proximal interphalangeal joint arthrodesis in 34 horses using two parallel 5.5-mm cortical bone screws.

To report clinical experience with arthrodesis of the proximal interphalangeal joint in horses using two parallel 5.5-mm cortical bone screws placed in lag fashion. Retrospective, clinical study. Thirty-four horses, aged 1 to 19 years. Medical records for all horses admitted (1991-1997) for pastern arthrodesis using two 5.5-mm ASIF cortical bone screws, in parallel orientation, and placed in lag fashion by use of a combined aiming device to facilitate accuracy were reviewed. Signalment, lameness diagnosis, duration of lameness, limb(s) involved, and outcome were recorded. Criteria for successful outcome were determined as return to previous level of function or future intended athletic use. Thirty-nine proximal interphalangeal joint arthrodeses were performed on 34 horses. One horse was euthanatized in the recovery room and was excluded from data analysis. Successful outcome occurred in 85% of frontlimbs and 89% of hindlimbs. Failure occurred in 5 joints; 1 horse had lameness directly associated with surgery, whereas 4 horses had unrelated lameness. Age, breed, and initial disease did not affect outcome. Arthrodesis of the proximal interphalangeal joint by use of two 5.5-mm ASIF cortical bone screws, in parallel orientation, placed in lag fashion by use of a combined aiming device, resulted in sound use of the limb in >85% of the joints with shortened postoperative coaptation.

Lateral approach for arthrocentesis of the distal interphalangeal joint in horses

Objective To determine anatomic landmarks for a lateral approach for arthrocentesis of the proximopalmarolateral aspect of the distal interphalangeal (DIP) joint in horses and the likelihood of entering synovial structures other than the DIP joint through this approach. Design Prospective study. Sample Population Paired forelimbs of 8 cadavers and 12 horses. Procedure Anatomic preparations were used to determine anatomic landmarks. Positive-contrast arthrography was used to determine which structures were entered. Results Landmarks for the lateral approach included a depression in the proximal border of the lateral ungular cartilage and the palmar border of the middle phalanx. Use of the lateral approach for arthrography resulted in deposition of contrast material exclusively in the DIP joint in only 13 of 20 limbs, whereas use of the dorsal approach resulted in deposition of contrast material exclusively in the DIP joint in 20 of 20 limbs. Clinical Implications The lateral approach is an alternative to the conventional dorsal approach to the DIP joint in horses; however, inadvertent entry into adjacent synovial structures is a possible complication. The lateral approach provides an additional portal for through-and-through lavage and arthroscopic access to the palmar aspect of the DIP joint. (J Am Vet Med Assoc 1998;212:1413–1418)