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Objective To report on technical aspects and outcomes after scapulohumeral arthrodesis (SHA) with a locking compression plate (LCP) in small equids. Study design Retrospective multicenter case series. Animals Client-owned Shetland Ponies, Miniature Shetlands, and American Miniature Horses (n = 15). Methods Inclusion criteria were completed SHA with an LCP to treat scapulohumeral osteoarthritis/subluxation and availability of postoperative radiographs. Contributing surgeons completed a questionnaire to collect data. All radiographs were reviewed for this study. Follow-up information was obtained via re-admission to the hospital or telephone interview of the referring veterinarian or owner. Outcome was subjectively scored as excellent, good, moderate, or poor based on lameness and function. Results Sixteen SHAs were performed in 15 equids (body weight 65-145 kg) by nine different surgeons. A narrow 4.5/5.0 mm LCP (7-16 holes) was used in 14 of the 16 SHAs. Follow-up was collected 2.5 years after surgery (median; range: 9 weeks to 10 years). Major complications related to the SHAs were noted in 4 of the 13 horses alive long term, consisting of implant failure (n = 1), surgical site infection (n = 2), and scapular fracture (n = 1). The outcome was graded as excellent in 4, good in 5, and moderate in 4 horses. Two ponies were euthanized because scapulohumeral osteoarthritis and subluxation developed in the contralateral limb. Conclusion Although major complications occurred in about one-third of ponies, SHA with LCP led to long-term survival with good function in most ponies. Clinical significance SHA with an LCP offers a high chance for good long-term outcome in small equids although contralateral disease may affect outcome.

BACKGROUND: Pathology of the digital flexor tendon sheath is a significant cause of lameness in the horse. Imaging is important to identify lesions and inform on prognosis prior to tenoscopic surgery. OBJECTIVES: To use a large population to evaluate 1) the sensitivity and specificity of digital flexor tendon sheath (DFTS) contrast radiographs in diagnosing manica flexoria (MF) tears, deep digital flexor tendon (DDFT) tears and constriction of the palmar/plantar annular ligament (PAL) using novel criteria; 2) predisposition to pathology in signalment and limb affected. STUDY DESIGN: Multicentre retrospective cohort study. METHODS: The medical records of 206 horses with lameness localised to the DFTS, contrast radiographs and subsequent tenoscopic surgery were reviewed. Breed and limb predispositions were evaluated for pathology of the DDFT, MF and PAL constriction. Contrast radiographs of the DFTS were reviewed by four masked operators and for each pathology the sensitivity, specificity and interobserver variability were calculated. RESULTS: Contrast tenography was a sensitive test for MF tears (92% confidence interval [CI] 88.4–94.4%; specificity 56%, CI 51.1–61.1%) and specific for diagnosing DDFT tears (73%, CI 68.6–76.8%; sensitivity 54%, CI 47.8–60.2%) but had a lower sensitivity (71%, CI 65.1–75.9%) and specificity (45%, CI 39.1–52.0%) for PAL constriction. It had good to substantial interobserver agreement for MF and DDFT tears (Krippendorff's alpha 0.68 and 0.46 respectively). Ponies (57%) and cobs (58%) were significantly more likely to be affected with MF tears (other breeds 20–39%, P = 0.003) and Thoroughbreds (50%), warmbloods (45%) and draught breeds (48%) were more likely to have DDFT tears (other breeds 22–34%, P = 0.01). MF tears and PAL constriction were overrepresented in the hindlimbs compared to DDFT tears in forelimbs. MAIN LIMITATIONS: No standardisation of contrast radiographs was possible. The subjectivity of diagnosis of PAL constriction may also have led to bias. Radiographs were read as JPEGS reducing ability to manipulate images. CONCLUSIONS: Contrast radiography of the DFTS is accurate in the pre‐operative diagnosis of DFTS pathologies. Different pathologies are overrepresented in certain breeds and limbs.

BACKGROUND A triangular screw configuration has been suggested as preferable for repair of sagittal fractures of the proximal phalanx. OBJECTIVE To assess the outcome of a triangular screw construct for repair of incomplete and complete minimally displaced proximal phalanx fractures under standing sedation in a population of Thoroughbred racehorses, compared with a cohort repaired using a linear screw configuration. STUDY DESIGN Retrospective cohort study. METHODS Medical records and radiographs were accessed to garner clinical data. Date of return to racing was determined from www.racingpost.com. Survival data were compared using log-rank test. RESULTS Sixty-two horses with one horse having two separate fractures. Fifty-four fractures were repaired using triangular screw configuration, 10 with a linear screw configuration. 81% (43/53) of horses with triangular repair returned to racing at a median of 289 days (161-482 days), 70% (7/10) horses with linear screws returned to racing at a median of 351 days (230-815 days). MAIN LIMITATIONS A limited number of horses underwent conventional (linear) screw placement. CONCLUSION A triangular screw configuration placed in the standing sedated horse is an effective way to repair incomplete and complete minimally displaced proximal phalanx fractures. The rate of return to racing was excellent with a low rate of complications.

BACKGROUND: Current arthroscopic approaches to the caudal pouches of the lateral femorotibial joint are challenging and risk iatrogenic nerve and cartilage injury. OBJECTIVE: Describe an alternative arthroscopic approach to the caudal pouches of the lateral femorotibial joint in the horse and report intra‐articular abnormalities observed during diagnostic stifle arthroscopy of these pouches. STUDY DESIGN: Descriptive cadaver anatomical and clinical study. METHODS: An approach to the caudal pouches of the lateral femorotibial joint was developed during clinical surgery using an arthroscopic portal in the popliteal tunnel of the femorotibial joint. Relevant anatomy of the lateral femorotibial joint was reviewed and the arthroscopic landmarks validated on 19 cadaver limbs. The procedure was then incorporated as part of routine inspection of 38 joints in 33 horses. RESULTS: Entry and examination of both pouches of the caudal lateral femorotibial joint was consistently achieved using an arthroscopic portal immediately cranial to the lateral collateral ligament in both cadaver and clinical limbs, with no adverse effects noted in the latter. Contrary to published descriptions, the division of the pouches was principally formed by a meniscopopliteal septum derived from the joint capsule in all cases, rather than the popliteus muscle and tendon as previously described. Abnormalities were detected in five cases. The finding of bilateral tearing within the popliteus muscle may represent a previously unrecognised arthroscopic condition. MAIN LIMITATION: Limited case numbers. CONCLUSION: An arthroscopic portal immediately cranial to the lateral collateral ligament permitted consistent entry into the popliteal tunnel and both pouches of the caudal lateral femorotibial joint.

BACKGROUND: Previous studies investigating factors associated with survival following endoscopic treatment of contamination/sepsis of the calcaneal bursa are limited.OBJECTIVES: To investigate the factors associated with survival in horses with contamination/sepsis of the calcaneal bursae treated endoscopically and to describe the bacterial isolates involved in the synovial infections.STUDY DESIGN: Retrospective analysis of clinical records.METHODS: Medical records from 128 horses with contamination/sepsis of the calcaneal bursae treated by endoscopic lavage at seven equine hospitals were reviewed. A follow-up questionnaire was used to determine survival and return to athletic performance. Descriptive statistics and Cox proportional hazards survival models were used to determine factors associated with survival.RESULTS: Horses underwent one (n = 107), two (n = 19), or three (n = 2) surgeries. Survival to hospital discharge was 84.4%. Univariable survival analysis revealed that administration of systemic antimicrobials prior to referral was associated with reduced mortality (Hazard Ratio, (HR) 0.41, 95% CI 0.18-0.91, P = 0.03). Increased mortality was associated with bone fracture/osteomyelitis (HR 2.43, 95% CI 1.12-5.26, P = 0.03), tendon involvement (≥30% cross sectional area) (HR 3.78 95%CI 1.78-8.04, P = 0.001), duration of general anaesthesia (HR 1.01, 95%CI 1.00-1.02, P = 0.04), post-operative synoviocentesis (HR 3.18, 95%CI 1.36-7.43, P = 0.006) and post-operative wound dehiscence (HR 2.5, 95%CI 1.08-5.65, P = 0.04). Multivariable Cox proportional hazards model revealed reduced mortality after systemic antimicrobial administration prior to referral (HR 0.25, 95%CI 0.11-0.60, P = 0.002) and increased mortality with tendinous involvement (≥30% cross sectional area) (HR 7.92, 95%CI 3.31-19.92, PMAIN LIMITATIONS: Retrospective study and incomplete follow-up.CONCLUSION: Endoscopic treatment of contamination/sepsis of the calcaneal bursae has an 84% survival rate to hospital discharge. Tendinous involvement reduced survival whilst systemic antimicrobials administration prior to referral improved survival.

Background Sagittal plane slab fractures of the third carpal bone are a recognised injury in the racehorse. Currently no published data exist for the UK Thoroughbred racehorse population. Objectives To document return to racing following sagittal slab fracture of the third carpal bone in a UK-based racehorse population, and to compare conservative and surgical management. Study design Single centre retrospective study. Methods Computerised medical and racing records were searched over a 15-year period for Thoroughbred racehorses with a simple sagittal slab fracture of the third carpal bone. Horses with comminuted fractures and short incomplete linear lucencies were excluded. Time from intervention to next race was recorded. Success rates were compared by Fisher's Exact Test and Mann-Whitney U Test. Results Forty-seven horses, with 49 fractures met the inclusion criteria. Overall, 27 horses raced following injury (60%). Median time to first start was 251 days (115-600, IQR 109). Fifteen horses with 16 fractures were managed conservatively. Seven horses (47%) raced, 115-508 days following injury (median 240 days, IQR 306). Thirty horses underwent surgery; this involved placement of a single 3.5-mm lag screw under arthroscopic guidance. Twenty horses (67%) raced again 145-600 days following surgery (median 264 days, IQR 102). A higher proportion of horses managed surgically improved their Racing Post Rating (RPR) following injury (14/20), compared with those managed conservatively (1/7, P = .02). Main limitations The numbers of horses are small, particularly for those managed conservatively. Treatment was not randomly allocated, and as such several horses which underwent conservative management were subsequently retired for breeding. Conclusions This case series indicates that both arthroscopic repair and conservative management of sagittal slab fractures of the third carpal bone allows horses to successfully return to training and racing.

Objective To investigate the feasibility and complications associated with ceratohyoidectomy (CHE) in standing sedated horses unaffected (experimental horses) and standing sedated horses affected (clinical cases) with temporohyoid osteoarthropathy (THO). Study design Case series. Animals Six experimental horses and four clinical cases. Methods Standing CHE was performed in six experimental horses euthanized 30 minutes (n = 3) and 7 days (n = 3) postoperatively. The four clinical cases were presented because of central facial nerve paralysis (n = 3), vestibular ataxia (n = 3), auricular hemorrhage (n = 2), quidding (n = 1), and oesophageal impaction (n = 1). Evolution was assessed by clinical examination during hospitalization and later by telephone interviews for the clinical cases. Results The procedure was successfully performed in all horses. Experimental horses did not show any short-term postoperative complications. Hemorrhage was experienced intraoperatively in one of the clinical cases and was successfully managed with placement of hemostatic forceps. Vestibular ataxia and other symptoms of THO improved within days, but facial nerve paralysis did not improve until 9 days to 6 months after surgery. Follow-up ranged from 9 to 24 months. All clinical cases returned to performance, and client satisfaction was excellent. Conclusion Ceratohyoidectomy was consistently feasible in standing sedated horses. The method did not result in postoperative complications and led to resolution of clinical signs associated with THO. Clinical significance Standing CHE should be considered in horses affected with THO, especially when horses present with marked vestibular deficits and ataxia, to reduce risks associated with recovery from general anesthesia.

Background Palmar osteochondral disease (POD) is a common cause of lameness in competition horses. Magnetic resonance imaging (MRI) is the most sensitive diagnostic modality currently available, however it may not be financially or logistically practical for routine screening of POD. There is increasing interest in the use of metabolomics for diagnosis prior to progression to irreversible damage. Objectives To determine metabolite levels in synovial fluid (SF) of horses with a clinical diagnosis of POD based on diagnostic analgesia and MRI, with the hypothesis that metabolomic profiles differ between diseased and healthy joints. Study design Prospective clinical study. Methods Synovial fluid was collected from metacarpo/tarsophalangeal joints (MC/TPJ) of 29 horses (n = 51 joints), including 14 controls (n = 26) and 15 cases (n = 25), the latter with lameness localised to the MC/TPJ and MR changes consistent with POD (n = 23). Spectra were produced using 1 H-nuclear magnetic resonance (NMR) spectroscopy and analysed. Results Twenty-five metabolites were recognised associated with various biosynthetic and degradation pathways. The metabolite abundances within the controls demonstrated increased variability compared with the clinical group. The low level of variance between the spectra of the two groups was explained by five principal components. Cross-validation of the cohort demonstrated modest separation of predictive power (R2 = 0.67; Q2 = 0.34). Although statistical significance was not achieved, the most influential metabolites were glucose and lactate. Main limitations The modest sample size and variation in signalment, background and presenting condition of the controls may have impacted the discriminative power of the constructed models. The lack of matched controls, differences in time of fluid collection and freezing times may have also reduced accuracy when representing metabolite profiles. Conclusions This study identified and quantified metabolites present in MC/TPJ SF of clinical cases with POD.

Summary Gastric impaction associated with large colon volvulus (LCV) was identified in seven horses. Right dorsal displacement of the large colon and suspected nephrosplenic entrapment was identified in 2 of the 7 horses as well as LCV with concurrent gastric impaction. All horses underwent surgery for LCV and none survived. Five horses died or were subjected to euthanasia intraoperatively or in recovery. One horse was subjected to euthanasia post operatively due to persistent gastric reflux, following resolution of the gastric impaction. One horse was subjected to euthanasia post operatively due to a suspected gastric rupture, which was confirmed on post mortem examination. It is hypothesised that a large mass in the cranial abdomen, such as a gastric impaction may disrupt the normal anatomical large colon alignment or may cause colonic motility or microbiota alterations, and thus increase the risk of large colon displacement and volvulus.

Summary This case report outlines the successful management of a case of chronic grass sickness in a donkey and highlights that the occurrence of grass sickness may be underestimated in this species. Furthermore, grass sickness should be considered in the differential diagnosis in cases of inappetance and ill thrift in donkeys.

†‡ § # Summary Reasons for performing study: The factors associated with outcome following solar foot penetration involving synovial structures treated using endoscopic lavage have not been described in the UK population. Objectives: To provide descriptive data on horses with synovial contamination or sepsis following solar penetration in 4 UK equine referral hospitals and to identify specific factors associated with the outcome. Study design: Retrospective case series. Methods: Data were collected from 4 veterinary hospitals. Follow-up data were obtained via a telephone questionnaire. Two multivariable logistic regression models were generated. Model 1 included all horses with synovial contamination following foot penetration undergoing surgical treatment, with the outcome variable being euthanasia during hospitalisation. Model 2 included all horses surviving anaesthesia, with the outcome variable being failure to return to pre-injury athletic function. Results: Ninety-five horses were included. Overall, 56% of horses survived to discharge and 36% of horses returned to pre-injury athletic function. Model 1 included penetration of the central frog sulcus (odds ratio [OR] 10, 95% confidence interval [CI] 1.9–51.8), concurrent distal phalanx involvement (OR 32, 95% CI 2.6–101.9), increasing days to presentation (OR 1.2, 95% CI 1.0–1.3) and hospital. Model 2 included increasing days to presentation (OR 1.1, 95% CI 1.1–1.6), breed (OR 32, 95% CI 2.2–135.4), more than one surgery (OR 5.6, 95% CI 1.0–32.7) and hospital. Conclusions and potential relevance: Synovial involvement following solar foot penetration has a guarded prognosis for survival to discharge and a poor prognosis for return to pre-injury athletic function. Penetration of the central sulcus of the frog and distal phalanx involvement are associated with euthanasia during hospitalisation. Delayed referral and hospitalisation are associated with both euthanasia and failure to return to pre-injury athletic function. Breed and more than one surgery are associated with failure to return to pre-injury athletic function. These data may assist veterinary surgeons and owners to make evidence-based decisions when managing cases with synovial involvement following solar foot penetration.

Objective To determine typical clinical features associated with tears of the manica flexoria (MF) and prognosis for return to athletic function after surgical resection. Study design Case series. Methods Medical records (January 2001–December 2011) of horses that underwent tenoscopic surgical treatment of MF tears were reviewed and outcome obtained by telephone questionnaire of owners. Results Fifty three horses (65 MF tears) were treated; 83% were cobs or ponies. Injuries occurred more frequently in hindlimbs (85%) and effusion of the digital flexor tendon sheath was associated with all MF tears. Follow-up (>3 months after surgery) revealed that 42 horses (79%) returned to pre-injury level of ridden exercise, 7 horses returned to a lower level of exercise, 3 remained lame, and 1 was euthanatized. Conclusions Injury to the MF is most likely to occur in hindlimbs with cobs and ponies overrepresented.

Summary This retrospective study summarises the case details, presenting signs, management and outcome in cases of temporohyoid osteoarthropathy (THO) and describes the findings of diagnostic imaging modalities. The condition appears to be relatively rare in Europe and the objective of this study is to make clinicians aware that THO can have a range of various neurological and clinical presentations. The records of 2 referral equine practices in England were reviewed and 7 horses with THO diagnosed on guttural pouch endoscopy indentified. The clinical and neurological signs, diagnostic procedures, treatment and outcomes were reviewed. Although small, this group is the largest case series of THO from Europe. One horse was a yearling, whereas THO is generally considered usually to affect middle aged and older horses. Computed tomography was used to confirm the diagnosis and demonstrated stylohyoid bone fractures in 2 cases while there was mild increased radionuclide uptake in one of 2 cases undergoing nuclear scintigraphy. Treatment is still controversial, although ceratohyoidectomy led to complete resolution of signs in 2 of 5 cases thus treated and improvement in the other 3. One horse with mild signs treated with antimicrobials and nonsteroidal anti-inflammatory drugs made a full recovery while another, presented with head shaking and managed with a phased exercise programme, improved but did not resolve completely.

Obstructions of the large colon are relatively common causes of colic in the horse. Diagnosis involves establishing what type of obstruction is present in order to decide whether medical therapy is appropriate or if exploratory laparotomy is indicated. Strangulating obstructions cannot be managed medically and require surgical intervention. This article discusses the medical management of non-strangulating obstructions in horses, and highlights situations where surgery might need to be considered.

Summary 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.

Summary Reason for performing the study: There are few published data regarding the success rates of cheek tooth (CT) removal by lateral buccotomy in the horse. Objectives: A retrospective study of 114 horses admitted to 2 private equine referral hospitals over a 10 year period (1999–2009), which underwent CT removal via a lateral buccotomy. Methods: Hospital records were analysed and details including case details, presenting complaint and results of all diagnostic tests and surgical reports were documented. Information obtained during post operative reassessment was also available for analysis. Long-term follow-up information (>2 months) was obtained for 112 horses. Results: Short-term complications ( 2 months with no complications. Conclusion: Horses with CT removal by a lateral buccotomy have a reasonable prognosis for long-term outcome. Potential relevance: Performing a lateral buccotomy is a justified treatment alternative for the surgical removal of equine CT following unsuccessful attempts by standing oral extraction, offering advantages over alternatives such as retropulsion, endodontic therapy and periapical curettage.

Summary There is limited information on the treatment of lateral malleolus (LM) fractures in the horse, with no previously published case series for the outcome following arthroscopic removal of such fractures. This report reviews and evaluates findings of a retrospective study of 13 horses admitted to a private equine referral hospital over a 10 year period (1999–2009) that underwent arthroscopic removal of fractures of the LM. Hospital records were reviewed and details including patient history, aetiology of the fracture and limb affected, results of all diagnostic tests and surgical reports were documented. Performance information concerning Thoroughbred horses that went onto race post operatively was collected using an online database. Owners and trainers were contacted regarding the return to performance for non-Thoroughbred cases or those that did not go onto race post operatively. Of the 13 horses presented, 12 were Thoroughbreds, 9 of which were National Hunt racehorses and 3 were Flat racehorses. The other horse in the study was used for general purpose riding. All cases presented with an acute unilateral fracture. Eleven of the 13 had >6 months post operative follow-up and all were nonlame. Of the 12 Thoroughbreds, 10 have raced again, a total of 104 times (median 5 times). The median time from surgery to return to racing was 241 days (180–366 days). It is concluded that horses with fractures of the LM have an excellent prognosis for return to full athletic performance following arthroscopic debridement; and that arthroscopic fragment removal is an appropriate treatment method for fractures of the LM.

Summary Reasons for performing study: Increased radio-isotope uptake (IRU) in the subchondral bone of the plantaro-lateral condyle of the third metatarsus (MTIII) is a commonly reported scintigraphic finding and potential cause of lameness in UK Thoroughbred racehorses in training and has not been fully documented. Objectives: To characterise lameness attributable to IRU of the subchondral bone of MTIII, compare the scintigraphic findings of these horses with a normal population and evaluate the use of scintigraphy as an indicator of prognosis. Hypothesis: IRU will be in significantly higher in horses with subchondral bone injury and will be related to prognosis and future racing performance. Methods: Data were analysed from 48 horses in which subchondral bone injury of the plantaro-lateral condyle of MTIII had been diagnosed using nuclear scintigraphy and that met the inclusion criteria. Data recorded included age, sex, trainer, racing discipline, lameness assessment, treatment regimes, radiographic and scintigraphic findings, response to diagnostic analgesia where performed and racing performance pre- and post diagnosis. Region of interest (ROI) counts were obtained for the plantar condyle and the mid diaphysis from the latero-medial view, the ratio calculated and then compared with a control group of clinically unaffected horses. Results: The mean condyle mid-diaphysis ROI ratio was significantly (P

Summary Reasons for performing study: There is limited information regarding the number of races and the period for evaluation of outcome which is critical for assessment of SDF tendonitis treatments. Objective: To evaluate the re-injury rate and racing performance of Thoroughbred racehorses that sustain SDF tendonitis in relation to matched controls in terms of number of races post treatment and maximum racing performance ratings before and after injury. Study design: Clinical records and racing histories of 401 racehorses with a first occurrence of SDF tendonitis diagnosed by ultrasonography. Controls were of the same age, sex and were horses training in the same establishment at the time of injury as the case horses and where the trainer reported that the horse had not had a previous SDF tendon injury or treatment. Results: Eighty percent of both case and control horses returned to racing after the date of injury, and the re-injury proportion within 3 years of treatment was 53%. The difference in Racing Post Rating(max) (RPR(max)) and the Racing Post Rating in the race immediately before the treatment date was significantly smaller in case horses (mean = 9.6 lbs; range = 0–75) compared to control horses (mean = 17.0 lbs; range = 0–79). No significant decrease in RPR(max) was noted post injury. No difference between case and control horses was found for return to racing and racing 3 times, but control horses were significantly more likely to compete 5 races post treatment date than case horses. Conclusion and clinical relevance: Injury was associated with an individual's pre-injury maximum performance level and return to racing and completion of 3 races are not useful indicator of the outcome of horses with SDF tendonitis. The assessment of the outcome of horses with an SDF injury in a population of racehorses using the number of races post injury requires a minimum of 5 races post injury to be a useful indicator. Further, a re-injury proportion in a population of horses in training for 3 years post treatment.

Summary Reasons for performing study: Lacerations to the digital flexor tendon sheath (DFTS) are a common injury in the horse, but little information is available in the literature regarding prognostic indicators. Objective: To ascertain whether laceration of the DFTS carried a better prognosis if treated by tenoscopic lavage, debridement and repair within 36 h of the original injury. Methods: A retrospective analysis of 39 horses treated surgically for lacerations to the DFTS was performed over a 3 year period. The injury-to-surgery interval was recorded as 36 h. The structures damaged by the injury were also recorded, as well as age, sex, use and outcome. Results: Sixteen horses had laceration and contamination of the DFTS alone, of which 15 (94%) returned to their original or intended use. Sixteen horses had lacerations involving the superficial digital flexor tendon, of which 12 (75%) made a full recovery. Six horses had lacerations to both superficial and deep digital flexor tendons, 5 were subjected to euthanasia intraoperatively and one is paddock sound. Treatment within 36 h of initial laceration carried a significantly better prognosis for return to intended athletic use (25 of 28 horses allowed to recover from anaesthesia) than treatment after 36 h (2 of 5 P = 0.03; Fisher's Exact Test). Conclusions: If sepsis is treated early using tenoscopic visualisation, lavage and repositol antibiotics, the limiting factor in return to athletic function is tendon damage. Potential relevance: This study supports anecdotal evidence that early treatment of synovial sepsis improves the prognosis for return to intended use. It also provides information on prognostic indicators including extent of damage to collateral structures.

The objective of this study was to assess the reliability of lameness scoring in horses. One veterinary surgeon examined nineteen lame horses on four occasions. Gait was recorded by camcorder, and scored from 0 to 10 ranging from sound to non-weight bearing lameness. A global score of overall change in lameness during the study was also determined for each horse. To measure intra-assessor reliability of the scoring systems, one veterinary surgeon scored videotapes of the horses' gaits on two occasions. To measure inter-assessor reliability, three veterinary surgeons viewed the videotapes, assigning individual lameness scores plus global scores to each horse. Reliability of individual lameness scoring was good intra-assessor, but only just within our acceptable limit inter-assessor. However, global scoring of change in lameness throughout the study was found to be reliable overall. Since clinician scoring is commonly used to assess lameness in horses, this is an important finding, fundamental to future clinical studies.

SummaryReasons for performing study The overall rate of sepsis following endoscopic surgery of synovial structures has not previously been documented. Clinical observation has led to the conjecture that tendon sheaths, in particular the carpal flexor tendon sheath, are more prone to post operative synovial sepsis than other synovial structures. Objectives To document and investigate the rate of post operative synovial sepsis following elective endoscopic surgery. Study design Retrospective case series. Methods The medical records of horses that underwent arthroscopy, tenoscopy or bursoscopy at Donnington Grove Veterinary Surgery between January 1999 and July 2012 were reviewed. The signalment, anatomical structure involved, use of electrosurgery, tourniquet or motorised resector, presence of a fracture, whether surgery was performed with the horse standing or under general anaesthesia and the number of structures examined were recorded. Multivariable logistic regression was used to test the association between the selected variables and synovial sepsis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Level of significance was P

Reasons for performing study Sagittal plane slab fractures of the third carpal bone are a recognised injury in the racehorse. One study [1] reported 32 horses with sagittal fractures, 69% raced again. Surgical management appeared beneficial, with all horses that underwent inter-fragmentary compression racing again. Objectives To document the success rate following sagittal slab fracture of the third carpal bone in UK-based racehorses, and to compare conservative and surgical management. Study design Retrospective study. Methods Inclusion criteria were Thoroughbred racehorses with a simple sagittal slab fracture of the third carpal bone. Exclusion criteria were comminuted fractures, radial carpal bone fractures and short incomplete linear lucencies. Fractures were classified as complete, incomplete or uncertain. Time from injury to next race was recorded. Success rates were compared by Fisher's exact test. Results Forty horses were identified. Two were subjected to euthanasia and 3 have

The factors associated with outcome following solar foot penetration involving synovial structures treated using endoscopic lavage have not been described in the UK population.To provide descriptive data on horses with synovial contamination or sepsis following solar penetration in 4 UK equine referral hospitals and to identify specific factors associated with the outcome.Retrospective case series.Data were collected from 4 veterinary hospitals. Follow-up data were obtained via a telephone questionnaire. Two multivariable logistic regression models were generated. Model 1 included all horses with synovial contamination following foot penetration undergoing surgical treatment, with the outcome variable being euthanasia during hospitalisation. Model 2 included all horses surviving anaesthesia, with the outcome variable being failure to return to pre-injury athletic function.Ninety-five horses were included. Overall, 56% of horses survived to discharge and 36% of horses returned to pre-injury athletic function. Model 1 included penetration of the central frog sulcus (odds ratio [OR] 10, 95% confidence interval [CI] 1.9-51.8), concurrent distal phalanx involvement (OR 32, 95% CI 2.6-101.9), increasing days to presentation (OR 1.2, 95% CI 1.0-1.3) and hospital. Model 2 included increasing days to presentation (OR 1.1, 95% CI 1.1-1.6), breed (OR 32, 95% CI 2.2-135.4), more than one surgery (OR 5.6, 95% CI 1.0-32.7) and hospital.Synovial involvement following solar foot penetration has a guarded prognosis for survival to discharge and a poor prognosis for return to pre-injury athletic function. Penetration of the central sulcus of the frog and distal phalanx involvement are associated with euthanasia during hospitalisation. Delayed referral and hospitalisation are associated with both euthanasia and failure to return to pre-injury athletic function. Breed and more than one surgery are associated with failure to return to pre-injury athletic function. These data may assist veterinary surgeons and owners to make evidence-based decisions when managing cases with synovial involvement following solar foot penetration.

SummaryReasons for performing study An in-depth review of dynamic compression plate (DCP) fixation of propagating medial condyle fractures of the third metacarpus or metatarsus has not been previously reported. Objectives To describe the technique, evaluate short-term outcome and long-term race performance of racehorses that underwent DCP fixation for repair of propagating or spiralling medial condylar fractures of the third metacarpal (McIII) or metatarsal (MtIII) bone. Study design Retrospective case series. Methods The surgical case records of 30 horses with propagating fractures of the medial condyle of McIII or MtIII were reviewed. Medical information included: age, breed, sex, presentation, how injury occurred (racing or training), surgical treatment and post operative complications. Racing information included: starts, top 3 placing and career earnings. Results Long propagating fractures of the medial condyle of Mc/tIII were identified in 23 Thoroughbred (TB) and 7 Standardbred (STB) racehorses. The fracture spiralled proximally in 22 of 30 cases (73%). Standardbreds had a higher propensity for hindlimb involvement (71%), whereas TBs tended to have more front limb involvement (61%). Twelve of 30 (40%) horses raced post surgery. Career earnings were significantly lower for TB horses with medial condylar fractures; $34,916 when compared with the national average of $60,841 (P≤0.03). Overall, horses having DCP fixation for medial condylar fractures had less starts post surgery (3.1 TBs and 5.8 STBs) compared with the national average (7 TBs and 17.3 STBs) and decreased lifetime starts 13.4 (TBs) compared with 17.3 nationally. Conclusions Propagating medial condyle fractures can be repaired with plate fixation to potentially lessen the risk of catastrophic fracture destabilisation and return to racing can be expected in 40% of horses. Further prospective studies are warranted comparing lag screw fixation with DCP fixation for repair of severe medial condylar fractures of the metacarpus/metatarsus.

Objective To determine the success of medical management of suspected displacement of the ascending (large) colon in horses. Study Design Retrospective case series. Animals Horses (n = 127) with suspected large colon displacement. Methods Medical records (January 1998–September 2008) of horses admitted for colic were reviewed. Suspected large colon displacement was diagnosed from clinical examination and in some cases, subsequent surgical examination. Medically managed horses were exercised and administered intravenous fluids and analgesia. Horses with suspected left dorsal displacement (LDD) of the large colon were also administered phenylephrine. Results Medical management had a high success rate for treatment of suspected right dorsal displacement (RDD) (64%) and LDD (76%) of the large colon; 4 horses died (1) or were euthanatized (3) and 36 horses had surgery. Of 127 horses treated medically or surgically for a colon displacement, 94% survived to hospital discharge. Conclusions Horses with suspected RDD or LDD of the large colon may respond to medical management including exercise.

Records of horses admitted to a veterinary surgery in the UK for lameness investigation during 2000 to 2008 were reviewed. Twenty-one horses were identified with both scintigraphic and radiological evidence of enostosis-like lesions (ELLs), in which 68 individual foci of increased radiopharmaceutical uptake were confirmed in 57 long bones. The presenting lameness was attributed to ELLs in 15 of 21 (71 per cent) horses; the remainder were thought to be incidental findings. Five horses were subjected to a repeat examination, four of which showed the occurrence of new lesions in the same or different limbs. Hindlimbs had significantly more lesions than forelimbs, but there was no difference between the right and left limbs. All 18 horses for which follow-up information was available were treated conservatively and returned to soundness after a variable period of time. Following ELL resolution, thoroughbred horses performed at a similar level to that before investigation and diagnosis.

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.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.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.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.The novel lateral/medial approach to the DIPJ significantly decreases the risk of inadvertent penetration of the DFTS and NB.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.

There are few published data regarding the success rates of cheek tooth (CT) removal by lateral buccotomy in the horse.A retrospective study of 114 horses admitted to 2 private equine referral hospitals over a 10 year period (1999-2009), which underwent CT removal via a lateral buccotomy.Hospital records were analysed and details including case details, presenting complaint and results of all diagnostic tests and surgical reports were documented. Information obtained during post operative reassessment was also available for analysis. Long-term follow-up information (2 months) was obtained for 112 horses.Short-term complications (2 months) occurred in 24/77 horses (31%) undergoing exodontia of the maxillary CT and 10/37 horses (27%) involving mandibular CT, with the majority arising from partial wound dehiscence and infection following 16 extractions (47%). All healed well by second intention. Other complications included both temporary (n = 6) and permanent (n = 3) facial nerve paralysis, myositis (n = 4) and the inadvertent establishment of an oroantral fistula (n = 4). One myositis case was subjected to euthanasia 24 h post operatively. Five horses had persistent sinusitis following surgery due to dental remnants (n = 2) and excessive packing material (n = 1) found in the sinuses. No inciting cause could be found in the remaining 2 horses. One further horse suffered a fatal cardiac arrest at induction of anaesthesia. Of all horses, 92% operated on had returned to their previous level of work after2 months with no complications.Horses with CT removal by a lateral buccotomy have a reasonable prognosis for long-term outcome.Performing a lateral buccotomy is a justified treatment alternative for the surgical removal of equine CT following unsuccessful attempts by standing oral extraction, offering advantages over alternatives such as retropulsion, endodontic therapy and periapical curettage.

There is limited information on the treatment of lateral malleolus (LM) fractures in the horse, with no previously published case series for the outcome following arthroscopic removal of such fractures. This report reviews and evaluates findings of a retrospective study of 13 horses admitted to a private equine referral hospital over a 10 year period (1999-2009) that underwent arthroscopic removal of fractures of the LM. Hospital records were reviewed and details including patient history, aetiology of the fracture and limb affected, results of all diagnostic tests and surgical reports were documented. Performance information concerning Thoroughbred horses that went onto race post operatively was collected using an online database. Owners and trainers were contacted regarding the return to performance for non-Thoroughbred cases or those that did not go onto race post operatively. Of the 13 horses presented, 12 were Thoroughbreds, 9 of which were National Hunt racehorses and 3 were Flat racehorses. The other horse in the study was used for general purpose riding. All cases presented with an acute unilateral fracture. Eleven of the 13 had6 months post operative follow-up and all were nonlame. Of the 12 Thoroughbreds, 10 have raced again, a total of 104 times (median 5 times). The median time from surgery to return to racing was 241 days (180-366 days). It is concluded that horses with fractures of the LM have an excellent prognosis for return to full athletic performance following arthroscopic debridement; and that arthroscopic fragment removal is an appropriate treatment method for fractures of the LM.

Increased radio-isotope uptake (IRU) in the subchondral bone of the plantaro-lateral condyle of the third metatarsus (MTIII) is a commonly reported scintigraphic finding and potential cause of lameness in UK Thoroughbred racehorses in training and has not been fully documented.To characterise lameness attributable to IRU of the subchondral bone of MTIII, compare the scintigraphic findings of these horses with a normal population and evaluate the use of scintigraphy as an indicator of prognosis.IRU will be in significantly higher in horses with subchondral bone injury and will be related to prognosis and future racing performance.Data were analysed from 48 horses in which subchondral bone injury of the plantaro-lateral condyle of MTIII had been diagnosed using nuclear scintigraphy and that met the inclusion criteria. Data recorded included age, sex, trainer, racing discipline, lameness assessment, treatment regimes, radiographic and scintigraphic findings, response to diagnostic analgesia where performed and racing performance pre- and post diagnosis. Region of interest (ROI) counts were obtained for the plantar condyle and the mid diaphysis from the latero-medial view, the ratio calculated and then compared with a control group of clinically unaffected horses.The mean condyle mid-diaphysis ROI ratio was significantly (P0.001) higher in the affected population and with positively correlation (P = 0.024) with the level of lameness. The presence of radiographic findings had no significant effect on the ROI ratio.Subchondral bone injury of the plantar lateral condyles of MTIII is a significant cause of lameness in UK Thoroughbred racehorses. Nuclear scintigraphy is a useful diagnostic imaging modality in the detection of affected horses but is a poor indicator of prognosis for the condition.Better understanding of the clinical manifestations, diagnosis of and prognosis for subchondral bone injury will benefit the Thoroughbred industry in the UK.

Summary Reasons for performing the study: There have been no reports of the efficacy of thermocautery of the soft palate (TSP) assessed objectively as a treatment of intermittent dorsal displacement of the soft palate (DDSP). Objective: To compare: racing performance of horses that underwent thermocautery of the soft palate with matched controls; and ‘Racing Post ratings’ (RPR) with prize money won (RE) and a performance index (PI) for each of the horses in the study. Hypothesis: Thermocautery of the soft palate has no beneficial effect on racing performance and the 3 measures of performance are significantly related. Methods: The inclusion criteria were fulfilled by 110 horses and each was matched with 2 controls. Changes in performance were compared statistically. RPR, RE and PI were analysed using a regression model. Results: The percentage of horses that improved in performance following the procedure was 28–51% for the 3 measures of performance, compared to 21–53% for the matched controls. There was no significant effect of the procedure on the changes in RPR or RE. There was a significant effect of the procedure on the change in PI (P = 0.015) with more treated horses achieving an improved PI and fewer acquiring a worse PI than matched control horses. The measures of performance showed significant correlation. Conclusions: Thermocautery of the soft palate alone may not be the most efficacious treatment of DDSP. Potential relevance: Production of a reliable measure of racehorse performance may be possible.

Reasons for performing study Inflammation is key in the development of post operative ileus in rodents, with a similar pathogenesis likely occurring in other species. Dexamethasone reduces inflammation and therefore could help reduce post operative ileus in the horse. Objectives To determine if dexamethasone reduces post operative ileus in horses with small intestinal disease, and assess the effect on incisional health and short-term survival. Study design Retrospective case series. Methods Fifteen horses that underwent small intestinal resection and anastomosis were given 0.1 mg/kg bwt dexamethasone intravenously during surgery (DEX). Data from a comparable number of horses that did not receive dexamethasone (NoDEX) was collected retrospectively and sequentially. Horses were matched for the type of resection performed. Fisher's Exact and Student's t tests were used for data analysis. Results There was no significant difference in the amount of nasogastric reflux (litres) (DEX 8.06 ± 17.12, NoDEX 10.02 ± 24.03, P = 0.39) produced or in the number of horses that produced nasogastric reflux post operatively. There was no difference in survival to discharge. The severity of incisional discharge/infection was significantly different between groups when scored 0–3 (0 being no discharge and 3 being severe discharge/infection), (P = 0.01), in favour of DEX (2/15 horses affected) vs. NoDEX (7/15). Conclusions Dexamethasone did not appear to have a beneficial effect on the incidence of post-operative ileus. Administration of a single dose of dexamethasone does not appear to have a detrimental effect on short-term survival or on incisional complications. Ethical animal research: Research ethics committee oversight not currently required by this conference: procedures were performed as part of clinical investigations. Explicit owner informed consent for participation in this study was not stated. Source of funding: None. Competing interests: None declared.

Summary Reasons for performing study: The reliability of diagnoses of obstructive conditions of the upper respiratory tract (URT) based on examinations performed at rest vs. at exercise is controversial. Objective: To compare diagnosis of URT by endoscopy at rest with that achieved during high-speed treadmill exercise (HSTE). Hypothesis: Endoscopy of URT at rest, when performed in isolation from other simpler techniques is unreliable in the prediction of dynamic respiratory obstructions. Methods: Endoscopic findings of 600 Thoroughbred racehorses during quiet breathing were compared with findings during high-speed treadmill exercise. Other parameters were also assessed for their specificity in diagnosis. Results: Endoscopy of the resting horse showed low sensitivity (0.15) in the diagnosis of dorsal displacement of the soft palate (DDSP) and palatal instability (PI). When endoscopy and reported noises were taken together there was still a 35% misdiagnosis rate. Although there was significant association between resting laryngeal function score (LFS) and dynamic vocal cord and/or arytenoid cartilage collapse at exercise, 19% of horses with a grade 4/5 LFS were able to attain and maintain full abduction during exercise and 7% of those with ‘normal’grades 1 or 2 LFS at rest showed dynamic laryngeal collapse when exerted. Sensitivity of the diagnostic model was greatly increased (80%) when a history of inspiratory noise and palpable intrinsic muscle atrophy were included. Conclusions and potential relevance: Endoscopy of the upper respiratory tract of static horses is unreliable in the diagnosis of dynamic obstructions of the URT and should not be used in isolation in surgical decision-making or in the assessment of horses at the time of sale.

THE enigma of foot lameness in the horse has puzzled veterinary surgeons since the dawn of the profession. Navicular disease emerged as a recognised disease back in the mid-19th century, but understanding of the precise pathophysiology has proved elusive. There have been many false dawns. The description of the thrombosis theory as a unifying explanation for lameness and ‘navicular changes’ as seen on radiographs was one such example (Colles 1982). Another was the discovery that intra-articular analgesia of the coffin (distal interphalangeal) joint abolished lameness in a large proportion of horses with foot lameness (Dyson 1991). Surely, this was the problem – it was osteoarthritis of the coffin joint all along. However, first, a poor response to medication was documented (Dyson 1991). This was followed by clinical evidence that horses with lameness localised to the navicular bursa by local analgesia also responded in approximately 90 per cent of cases to intra-articular analgesia of the coffin joint (Dyson and Kidd 1993). Then there was the discovery that intra-articular analgesia of the coffin joint consistently resulted in analgesia of the heel of the foot, and further, if a large volume of local anaesthetic was used, this would result in analgesia of the whole of the sole (Schumacher and others 2006). Finally, experimental evidence confirmed unequivocally that amphotericin-induced synovitis of the navicular bursa could be alleviated by intra-articular analgesia of the coffin joint (Pleasant and others 1997). In 1998, Wright and others described core lesions of the deep digital flexor tendon, and fibrillation of …

Reasons for performing study Little exists in the literature regarding the outcome of endoscopically-guided desmotomy of the palmar/plantar annular ligament (PAL) where injury to the PAL was the only diagnosis. Objectives To report the return to previous level of exercise in horses treated with endoscopically guided PAL resection in which PAL injury was considered to be the primary condition. Study design Retrospective case series. Methods Medical records of surgical cases at Donnington Grove Veterinary Surgery between 2005 and 2013 were reviewed. The inclusion criteria were cases that had undergone surgical transection of the palmar/plantar annular ligament under general anaesthesia and endoscopic guidance using a No. 12 scalpel blade where annular ligament injury was the only notable finding at surgery. Follow-up was obtained by a telephone questionnaire. Results Twenty-three horses were included in the study. Twenty horses were noted to have restriction to passage of the arthroscope within the digital flexor tendon sheath at the time of surgery. Following the initial 3-month post operative rest period 21 horses were sound. Three horses did not return to their previous level of activity due to unrelated lameness issues and 2 returned to a lower level of competition due to owner preference. Of the remaining 18 horses, 16 returned to their previous level of athletic performance. Two horses had recurrent or persistent lameness associated with the residual PAL desmopathy. Conclusions In this case series surgical treatment of primary PAL injury carries a good prognosis (89% return to previous level of exercise) in contrast to a previously reported study (

Summary Extensive resection of the ileum of the horse, using automated stapling equipment followed by a stapled jejunocaecostomy, without closure of the mesenteric defect, was evaluated prospectively as a surgical treatment for lesions involving the distal small intestine. Of 153 horses treated surgically for colic, 10 horses with strangulating lesions involving the distal ileum were treated by extensive resection and jejunocaecal anastomosis leaving a residual mesenteric defect. These were compared with 12 horses with jejunoileal lesions treated by jejunocaecal anastomosis with closure of the mesentery, and 19 horses with distal jejunal lesions treated with an end-to-end jejunojejunal anastomosis and mesenteric closure. Long-term (>7 months) and short-term survival, duration of surgery, length of intestine resected, time from completion of surgery until the horse first defaecated and the highest recorded postoperative plasma fibrinogen level were assessed. There were no significant differences between the surgical techniques for any of the assessed parameters, but there was a trend to significance with a higher death rate following discharge from the hospital when cases of jejunocaecal anastomosis with a residual mesenteric defect were compared to cases of end-to-end jejunojejunal anastomosis with closure of the mesentery (P = 0.06). This study suggests that a stapled distal ileal resection and jejunocaecal anastomosis leaving a residual mesenteric defect is a satisfactory technique when pathological changes necessitate resection of the distal ileum. However, in this study, jejunocaecal anastomosis with or without mesenteric closure produced inferior results compared to jejunojejunal anastomosis.

Reasons for performing study: There has been no objectively assessed case-control study of the efficacy of surgery to correct dorsal displacement of the soft palate (DDSP) previously reported. Hypothesis: Composite surgery has a beneficial result on racing performance in horses affected with DDSP as compared to a matched control population. Methods: Race records were obtained for 53 racing Thoroughbreds which underwent composite staphylectomy, sternothyrohyoideus myectomy and ventriculectomy for correction of idiopathic DDSP at the University of Bristol between 1990 and 1996. Each surgical case was matched for age, sex and training yard with 2 control horses. The racing performance, based on prize money won, of surgical cases and control horses were compared for 3 races run before and after the date of surgery. Results: Ninety-two percent of the surgical cases returned to racing after surgery. There was a significant increase in earnings of the surgical group before and after surgery (P = 0.011), but there was no significant difference in earnings of the control group before and after the date of surgery (P = 0335). Sixty percent of the surgical group had higher earnings after surgery than before, compared to 40% of controls. When horses which underwent surgery were ranked relative to their 2 matched controls, surgical cases did not significantly change in rank (P = 033), whereas control horses significantly decreased in rank (P = 0.012). Additionally, horses within the surgical group were more likely (P