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Racehorses are susceptible to underrun heel hoof conformation. Racehorses are often shod with nails placed toward the heel. It is unknown if palmar nails restrict or alter hoof deformation in a manner that could promote the development of underrun heel conformation over time with repeated loading. To determine how the addition of palmar nails affects heel deformation during limb loading, hoof expansion and hoof wall deformations were quantified using rosette strain gauges and kinematic markers during in the vitro limb loading of cadaveric limbs that simulated midstance for walk, trot, and canter loads. Nail treatments used to attach a horseshoe to the hoof included: toe nails (T), toe and quarter nails (TQ), and toe, quarter, and heel nails (TQH). The effects of nail treatment on heel expansion and hoof wall deformations were assessed using repeated measures analysis of variance (p < 0.05). Nails placed palmar to the quarters of the hoof decreased heel expansion (p < 0.001). Heel nails resulted in the largest changes in hoof wall principal strain directions distally. The application of nails palmar to the hoof quarters alters hoof wall deformation during limb loading. The continued loading of the hoof with palmer nails could alter hoof conformation over time.

Exercise-induced pulmonary hemorrhage (EIPH) is a common condition of Thoroughbred racehorses that is usually responsible for reduced performance, while exercise-associated fatal pulmonary hemorrhage (EAFPH) is characterized by severe pulmonary bleeding of unknown pathogenesis resulting in sudden death during strenuous exercise. The aim of the study was to characterize and compare anamnestic data together with pulmonary gross, histologic, and ultrastructural findings in racehorses with EIPH (n = 10), EAFPH (n = 10), and control horses (n = 5). No differences in anamnesis were identified between the 3 groups. Grossly cranial lobe reddening and edema scores were significantly more prevalent and severe in the EAFPH group compared with the EIPH and control groups. Histologically, hemorrhage scores were higher in the EAFPH group, while hemosiderophages, iron encrustations of collagen and elastin fibers, and vascular remodeling scores were significantly higher in EIPH group compared with the EAFPH and control groups. In all groups, caudal lung locations exhibited a significantly higher score for vascular remodeling, hemosiderophage accumulation, iron encrustation, and type II pneumocyte hyperplasia when compared with cranial, dorsal, and ventral locations. Ultrastructural analysis of perivascular collagen showed fibrils with significantly larger diameters in the EAFPH group compared with the EIPH group but not compared with the control group. This study demonstrates that lungs of horses that experienced EAFPH show significantly less vascular remodeling and other long-term pulmonary abnormalities that characterize horses with EIPH.

Strain parameters at injury prone sites of the equine third metacarpal (MC3) and proximal phalangeal (P1) bones were investigated with the aim of improving understanding of injury pathogenesis. We hypothesized that dorsal principal and shear strain patterns, magnitudes and directions would differ from proximal-to-distal; and would be similar from medial-to-lateral across each bone. Unilateral limbs from nine equine cadavers were instrumented with rosette strain gauges during limb loading to 10,500 N. Gauges were attached at seven dorsal sites: middle MC3, distal MC3 (medial, middle, lateral) and proximal P1 (medial, middle, lateral). Outcome measures were analysed with repeated measures analysis of variance. Distal MC3 had the greatest, and proximal P1 the smallest magnitude of minimum principal and shear strains. Directions of maximum and minimum principal strain were similar at the middle and distal MC3 sites with a 20-40° direction difference compared to proximal P1. The patterns of strain magnitude and direction were similar from medial-to-lateral on distal MC3 but varied in pattern and magnitude among the P1 sites. Overall, as load reached maximum, direction of minimum principal strain became more axial in orientation, converging from opposite directions between bones, potentially maximising stability of the distal limb. The difference in strain parameters and strain ratio for adjacent anatomic sites on distal MC3 and proximal P1 was not anticipated, in light of the anatomic congruity of the metacarpophalangeal joint. Based on the predominance of shear strain across proximal P1, shear forces are likely the predominant biomechanical contributor to sagittal fractures of P1.

BackgroundSerum amyloid A (SAA) concentrations in blood and synovial fluid of horses with synovial sepsis have diagnostic value. Studies suggest serial blood SAA measurements could act as a prognostic indicator. This study evaluated the use of serial blood SAA concentrations for monitoring of horses with synovial sepsis.MethodsA prospective clinical trial was performed of horses referred to a single hospital with synovial sepsis that survived (n=17), synovial sepsis that were euthanised (n=5), non-septic intrasynovial pathologies (n=14) or extensive extrasynovial lacerations (n=5). SAA concentrations were determined on admission and every 24 hours thereafter. The area under the concentration–time curve from 0 to 144 hours of each group was compared by Kruskal-Wallis and post hoc Dunn’s tests (PResultsSignificant difference in mean blood concentration of SAA was found between synovial sepsis that survived and non-septic pathologies in the first 48 hours, as well as between non-septic intrasynovial pathologies and non-responsive sepsis requiring euthanasia. No difference was found between extensive extrasynovial lacerations and any septic group.ConclusionsWhile serial blood SAA is useful for monitoring clinical response of intrasynovial septic pathologies, interpretation should consider other clinical findings since blood SAA is not a specific marker for synovial sepsis.

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.

This is the second article in a two-part series that aims to describe the principles of investigating and treating common back pathologies in riding horses. The first article (Findley and others 2015) discussed the various diagnostic techniques available to aid the clinician in diagnosing back pain of the thoracolumbar and sacroiliac regions. The strengths and limitations associated with each technique and the challenges involved with reaching a specific diagnosis were outlined. This second article focuses on the techniques, indications and evidence available for both conservative and surgical treatment options following a diagnosis of equine back pain.

Potential back pain is frequently investigated as a cause of poor performance or behavioural problems in horses. The term ‘back pain’ encompasses a range of osseous, muscular and ligamentous pathologies and it is often challenging for the equine veterinarian to determine whether a horse has primary back pain, back pain secondary to lameness and an alteration in gait pattern, or has a training or behavioural issue. Careful examination and analysis is essential to reach an accurate diagnosis in these cases. This article, the first in a two-part series, will discuss the approach to investigating suspected back pain, including the appropriate choice of diagnostic tests and imaging modalities to aid decision making in these potentially difficult cases. The second article, to be published in a subsequent issue of In Practice , will describe the conservative and surgical treatment options for the management of thoracolumbar and sacroiliac region pain.

Sagittal fractures of the proximal phalanx (P1) in the racehorse appear to be associated with turf racing surfaces, which are known to restrict forward slide of the foot at impact. We hypothesized that restriction of forward foot slip would result in higher P1 bone strains during metacarpophalangeal joint (MCPJ) hyperextension. Unilateral limbs from six equine cadavers were instrumented with strain gauges and bone reference markers to measure dorsoproximal P1 bone strains and MCPJ extension, collateromotion and axial rotation during in vitro limb loading to 10,500 N. By limiting movement of the distal actuator platform, three different foot conditions (forward, free, and restricted) were applied in a randomised block design. Bone reference markers, recorded by video, were analyzed to determine motion of P1 relative to MC3. Rosette strain data were reduced to principal and shear magnitudes and directions. A mixed model ANOVA determined the effect of foot position on P1 bone strains and MCPJ angles. At 10,000 N load, the restricted condition resulted in higher P1 axial compressive (p=0.015), maximum shear (p=0.043) and engineering shear (p=0.046) strains compared to the forward condition. The restricted condition had higher compressive (p=0.025) and lower tensile (p=0.043) principal strains compared to the free condition. For the same magnitude of principal or shear strains, axial rotation and collateromotion angles were greatest for the restricted condition. Therefore, the increase in P1 principal compressive and shear bone strains associated with restricted foot slip indicate that alterations in foot:ground interaction may play a role in fracture occurrence in horses.

The stifle is a complex joint and, when faced with a patient suffering from pain in this area, a veterinary surgeon will often use radiography as the first port of call. This article describes the radiographic projections routinely acquired of the stifle region, and the common conditions diagnosed with this imaging modality, while acknowledging that additional imaging modalities are often required to reach a final diagnosis.

Summary Pain related to the osseous thoracolumbar spine is common in the equine athlete, with minimal information available regarding soft tissue pathology. The aims of this study were to describe the anatomy of the equine SSL and ISL (supraspinous and interspinous ligaments) in detail and to assess the innervation of the ligaments and their myofascial attachments including the thoracolumbar fascia. Ten equine thoracolumbar spines (T15-L1) were dissected to define structure and anatomy of the SSL, ISL and adjacent myofascial attachments. Morphological evaluation included histology, electron microscopy and immunohistochemistry (S100 and Substance P) of the SSL, ISL, adjacent fascial attachments, connective tissue and musculature. The anatomical study demonstrated that the SSL and ISL tissues merge with the adjacent myofascia. The ISL has a crossing fibre arrangement consisting of four ligamentous layers with adipose tissue axially. A high proportion of single nerve fibres were detected in the SSL (mean = 2.08 fibres/mm2) and ISL (mean = 0.75 fibres/mm2), with the larger nerves located between the ligamentous and muscular tissue. The oblique crossing arrangement of the fibres of the ISL likely functions to resist distractive and rotational forces, therefore stabilizing the equine thoracolumbar spine. The dense sensory innervation within the SSL and ISL could explain the severe pain experienced by some horses with impinging dorsal spinous processes. Documentation of the nervous supply of the soft tissues associated with the dorsal spinous processes is a key step towards improving our understanding of equine back pain.

Soft tissue swelling and synovial distension associated with the tarsus is very common in horses and may be associated with pain and lameness. In this case, a fluid swelling of synovial origin that initially appeared to be completely separate from any other synovial structure was present in a mare with severe intermittent hind limb lameness. Nuclear scintigraphy, diagnostic analgesia, contrast radiography, and ultrasonography were used to confirm the synovial swelling as the source of lameness. Surgical en-bloc resection of the synovial swelling has been curative. It is hypothesized that an acute trauma caused herniation of the tarsocrural joint synovial membrane. The fistula then sealed but became patent during specific phases of movement, resulting in a sudden influx of synovial fluid and a buildup of pressure. Ultrasonographic examination, contrast radiography, and distension of the tarsocrural joint at surgery all failed to identify this fistula. The associated severe pain and lameness could have been the result of physical distension of the fluid swelling or pressure applied to the surrounding nerves.

Objective—To determine cellular changes associated with secondary epidermal laminae (SEL) in forefeet and hind feet of ponies with insulin-induced laminitis. Animals—8 ponies. Procedures—Laminitis was induced in 4 ponies by IV administration of insulin and glucose; 4 control ponies received saline (0.9% NaCl) solution IV. Laminar tissue samples obtained from the dorsal aspects of the hooves were histologically evaluated. Primary epidermal lamina (PEL) length and width and SEL length, width, and angle were determined. Numbers of epidermal cell nuclei per micrometer and per total length of SEL and numbers of apoptotic and proliferative cells in axial, middle, and abaxial laminar regions were determined. Results—SEL in treatment group ponies were significantly longer, were significantly narrower, and had a smaller angle relative to PEL in all laminar regions versus control ponies. In treatment group ponies, the number of epidermal cell nuclei per SEL was typically higher and the number of cells per micrometer of SEL was lower in laminar regions, apoptotic cell numbers were higher in abaxial and middle regions in forefeet and hind feet, and proliferating cell numbers were higher in axial laminar regions in forefeet and all laminar regions in hind feet, versus control ponies. Conclusions and Clinical Relevance—Results indicated SEL elongation, narrowing, and alteration in orientation developed in all feet of ponies with insulin-induced laminitis. This was primarily attributable to cell stretching that developed at the same time as an accelerated cell death–proliferation cycle; differences in cell cycle responses among laminar regions between forefeet and hind feet may have been attributable to differences in load bearing.

SummaryObjectives: To investigate the specificity of anaesthesia of the deep branch of the lateral plantar nerve (DB-LPN).Methods: Twenty horses had DB-LPN anaesthesia performed by a single injection technique as part of a lameness investigation. The mechanical nociceptive threshold (NT) was measured using a handheld force meter at six points on the lateral aspect of the limb: before diagnostic anaesthesia (T0), and at 15 (T15) and 30 (T30) minutes post anaesthesia. Paired t-tests were performed and significance was set at p Results: Compared with T0, there was a significant decrease in NT for all points combined at T15 (p = 0.008) and also at T30 (p = 0.007). There was a significant decrease in NT at T15 on the lateral third metatarsal bone (p = 0.012). At T30 there was a significant decrease in NT at the lateral sesamoid (p = 0.007), lateral third metatarsal bone (p = 0.031), and mid metatarsus (p = 0.033). Four out of 20 horses had a NT greater than 10 N at the lateral heel bulb at T30. In the cadaveric limbs, the total diffusion distance for all limbs (mean ± SD) was 70.4 ± 20.5 mm. Dye surrounded the DB-LPN in all limbs and the lateral plantar nerve (LPN) in nine out of 10 limbs.Clinical significance: Concurrent anaesthesia of the LPN is likely to occur when DBLPN anaesthesia is performed using a single injection technique.

†‡ § # 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.

Summary This report describes a case of severe supracondylar lysis of the third metatarsal bone of a mature Cob gelding. The gelding presented with moderate to severe lameness and soft tissue swelling in the distal metatarsal region. A mass was present plantar to the third metatarsal bone and dorsal to the suspensory ligament branches. The mass was removed surgically, and was found to be a large blood coagulum within an enlargement of the plantar pouch of the metatarsophalangeal joint. The mass was pedunculated and attached to a region of abnormal synovium. This synovium was identified histologically as being an area of villonodular synovitis. The lesion had similarities with human pigmented villonodular synovitis. Removal of the abnormal tissue resulted in resolution of the lameness and of the lysis of the third metatarsal bone. Haemarthrosis should be considered in the list of differential diagnoses for focally mineralised soft tissue masses found within an articulation, and may be associated with pigmented villonodular synovitis.

The following report documents an unusual anatomical finding in two cases of aseptic tenosynovitis of the digital flexor tendon sheath. Disruption of the vinculum attachment between the palmar/plantar border of the superficial digital flexor tendon and the adjacent palmar/plantar annular ligament was identified in combination with other tendon pathology within the digital flexor tendon sheath. This tenoscopic finding has not been described previously in the literature.

Sagittal fractures of the first phalanx are a common, potentially catastrophic injury in racehorses. These fractures are often linked to an acute, one time, biomechanical event; however, recent evidence implies that chronic exposure to stress can lead to the accumulation of bony changes that affect the structural integrity of the bone and increase the likelihood of fracture. The aim of the study was to compare variations of two common metrics of bone adaptation - subchondral bone density and thickness across the proximal articular surface of the first phalanx in Thoroughbred horses that (1) raced but never experienced a first phalanx fracture (Raced Control); (2) raced and had experienced fracture of the contralateral first phalanx (Contralateral to Fracture); (3) had never raced or experienced a first phalanx fracture (Unraced Control). A total of 22 first phalangeal bones were sampled post-mortem and imaged using micro-computed tomography calibrated for mineral density measures. Measurements of volumetric subchondral bone mineral density and thickness were taken from images at five sites from medial to lateral, in three coronal planes (25, 50 and 75% dorsal-palmar). At each of the 15 sites, measurements were repeated and averaged across 10 adjacent micro-computed tomography slices of bone, spanning 0.75 mm. The magnitude and variance of these measurements were compared between sites and between cohorts with non-parametric statistical tests. Across the proximal osteochondral surface of the first phalanx, the pattern of subchondral bone volumetric bone mineral density and thickness varied with each coronal section studied. The subchondral bone thickness was greater for the central and dorsal coronal sections, compared with the palmar section. For the race-fit groups (Raced Control and Contralateral to Fracture), the highest volumetric bone mineral density was in the central sagittal groove. The volumetric bone mineral density was significantly greater in the sagittal groove in the central coronal section in the raced than the unraced group. The Contralateral to Fracture group demonstrated significantly greater variance of volumetric bone mineral density compared with the Raced Control and Unraced Control (P

Summary Reasons for performing study To improve understanding of the internal structure of the proximal phalanx (P1), response of the bone to load and possible relation to the pathogenesis of fractures in P1. Objectives To model the P1 and replicate the loads experienced by the bone in stance, walk, trot and gallop using finite element analysis. Methods The geometry of the P1 was captured using micro-computed tomography (μCT) and was reconstructed in 3 dimensions. Values for material properties and forces experienced at stance, walk, trot and gallop were taken from the literature and were applied to the reconstructed model. Using the same total load across the proximal articular surface, the model was solved with and without loading of the sagittal groove. Biomechanical performance was then simulated with finite element analysis and evaluated in terms of von Mises stress maps. Results Compared with the lowest force simulation equivalent to stance, the effects of the gallop force showed higher levels of stress along the sagittal groove and on the palmar surface just distal to the sagittal groove in both models, with and without the sagittal groove loaded. The results highlighted an area of bone on the dorsal aspect of P1 that experiences lower stress compared with the rest of the dorsal surface, an effect that was much more apparent when the sagittal groove was not loaded. Qualitative comparison of the models revealed minimal difference in the pattern of von Mises stress between the loaded and unloaded groove models. Conclusions The study demonstrates a finite element model of P1 that produces results consistent with clinical observation. The simulated high stress levels associated with the sagittal groove correspond to the most common site for fractures in the equine P1. Potential relevance With refinement of the model and further investigation, it may be possible to improve understanding of the behaviour of P1 under loading conditions that more closely simulate those experienced in the living animal, leading to a more solid understanding of fractures of P1.

This study aimed to assess the effect of lateral heel studs on foot-ground interaction in the horse by quantifying foot slip during stance whilst cantering on a grass surface. It was hypothesised that using studs would decrease foot slip distance on the ground conditions tested. Nine horses were ridden with and without a stud placed laterally in the shoe of each of the 4 feet. High speed video-analysis was used to track hoof markers and to provide data quantifying foot slip distance, slip duration and stance duration. Using studs resulted in a significant decrease in foot slip distance in all four limbs (all P values0.004). The magnitude of the difference in slip distance with and without studs was greatest in the trailing limbs. The results supported the hypothesis that using studs will decrease foot slip distance in horses cantering on a grass surface, and additionally, highlights that stud efficacy may vary between limbs. The decrease in slip distance with studs demonstrated increased traction and a more stable foot-ground interaction, although this may cause a concomitant increase in the required energy dissipation, either within the limb or via surface deformation. The effect of repetitive usage of studs in the aetiology of musculoskeletal conditions should therefore be investigated further.

Summary Reasons for performing study: Traumatic injuries are a major cause of morbidity and mortality in the horse and consequently pose a serious threat to horses' wellbeing. To date, there have been no published studies assessing the frequency of injuries in the general horse population of the UK. Objectives: To obtain information regarding husbandry management strategies and injury prevalence in horses aged ≤15 years, with the aim of identifying predisposing risk factors for injury. Methods: A postal questionnaire was distributed to a randomly selected sample of horse owners across north-west England, Midlands and north Wales. Factors associated with injury were assessed using univariable and multivariable logistic regression analysis performed with the binary outcome variable defined as whether or not the horse had sustained an injury within the previous 12 months. Results: A usable questionnaire response rate of 68% (652/953) was achieved. Forty percent of horses had sustained a traumatic injury within the past year, of which 62% occurred in the field and 13% during ridden exercise. Factors identified as being associated with an increased risk of traumatic injury included the following: breed other than cob or pony (P = 0.001), shorter duration of ownership (P = 0.002), being turned out with an increasing number of horses (P = 0.001), being used for competitive (P = 0.001) or Parelli (P = 0.006) purposes. Stabling at all times during the spring (P = 0.005), the use of wood fencing in paddocks (P = 0.05) and being prone to becoming distressed if left alone in a field (P = 0.04) were also found to be associated with an increased risk of injury. Stabling at all times during winter was associated with a decreased risk of injury (P = 0.006). Conclusions and potential relevance: Risk factors for sustaining injuries have been identified in association with management practices. This information may be used to educate owners regarding management of their horse(s) in order to prevent injury.

Acute pancreatitis is considered a rare condition in equines (1, 10, 13). It has been suggested that it is under-diagnosed, perhaps due to the equine clinician’s unfamiliarity with the clinical presentation and the perceived rarity of the condition (1–2, 9, 10, 15). The clinical signs of acute pancreatitis resemble other gastrointestinal diseases, especially small intestinal strangulating obstructions and anterior enteritis, making ante mortem diagnosis difficult (13). Markedly elevated serum and peritoneal amylase levels suggest acute pancreatitis but they are not specific for the condition (2, 10, 15). This report describes some consistent clinical features and surgical findings for three ponies with acute necrotising pancrea titis which the authors consider may assist the practitioner in the recognition of future cases. The diagnosis was confirmed by post mortem examination.

Summary Reason for performing study: Catastrophic biaxial proximal sesamoid bone fractures (PSBF) have not yet been described in detail in the UK racing population. Objectives: To determine the incidence and relative risk (RR) of PSBF in different types of racing in the UK; and to describe horse-level characteristics and racing histories of horses sustaining these injuries. Methods: Distal limbs were collected from all racehorses suffering catastrophic fractures during racing at all 59 racecourses in the UK, in a prospective study from February 1999 to December 2004. Post mortem investigation identified the anatomical location and type of fracture. Horse, racing history, race and racecourse details were obtained. Characteristics of the horses that sustained PSBF were described. The incidence and RR of PSBF in the different types of racing in the UK were calculated. Results: Thirty-one horses suffered PSBF during the study period. The incidence of PSBF in all types of race was 0.63 per 10,000 starts (31/494,744). The incidence was highest in flat races on all weather surfaces (1.63 per 10,000 starts: 12/73,467; RR = 4.4 when compared to turf flat racing). Affected horses had an average age of 5.6 years and had started a mean of 28 races at the time of fracture. Conclusion and potential relevance: There is a strong association between type of racing surface and PSBF. Horses competing in flat races on all weather surfaces have an increased risk of PSBF. These fractures appear to happen in experienced horses with several starts, with few fractures occurring within the first season of racing. Further research should focus on identification of underlying pathology of these fractures. Epidemiological studies aimed at the identification of risk factors for PSBF in the UK racing population would require a large number of cases acquired over many years given the relatively low incidence of PSBF.

REASONS FOR PERFORMING STUDY: Fatalities resulting from horse falls occurring during the cross-country phase of eventing competitions initiated epidemiological investigation of the risk factors associated with horse falls. OBJECTIVES: To identify variables that increased or decreased the risk of a horse fall during the cross-country phase of an eventing competition. METHODS: Data were collected from randomly selected British Eventing competitions held in Great Britain during 2001 and 2002. Data were obtained for 173 cases (jumping efforts resulting in a fall of the horse-and-rider partnership) and 503 matched controls (jumping efforts not resulting in a fall). The risk of falling was modelled using conditional logistic regression. RESULTS: An increased risk of a horse fall was associated with jumping into or out of water; taking off from good-to-soft, soft or heavy ground; fences with a drop landing; nonangled fences with a spread > or =2 m; and angled fences. Other risk factors included riders who knew that they were in the lead within the competition before the cross-country phase; an inappropriate speed of approach to the fence (too fast or too slow); horse-and-rider partnerships that had not incurred refusals at earlier fences; and riders who received cross-country tuition. CONCLUSIONS: This study has identified modifiable course- and fence-level risk factors for horse falls during the cross-country phase of eventing competitions. The risk of horse and rider injury at eventing competitions should be reduced by 3 simple measures; maintaining good to firm take-off surfaces at fences, reducing the base spread of fences to

Summary Reasons for performing study: There are no data on the frequency of post operative complications following keratoma removal, such as recurrence, hoof wall instability and excessive granulation tissue formation, or their relation to the method of surgical removal. Objective: To identify important factors in the outcome for horses undergoing surgical removal of a keratoma and compare the post operative complications encountered following keratoma removal by complete hoof wall resection (CR) and partial hoof wall resection (PR). Hypothesis: Horses undergoing PR would have fewer post operative complications and would return to work more quickly than those undergoing CR. Methods: A retrospective review of medical records from one equine hospital identified 26 horses that underwent removal of a keratoma by CR or PR. Clinical, radiological and surgical findings and outcome were analysed. Results: Common clinical signs included lameness and the presence of a subsolar abscess. Fourteen horses underwent CR and 12 PR. The complication rate following CR (71%) was significantly lower than that following PR (25%) (P

Summary Reasons for performing study: Serious injuries to horses and riders in horse trials (HT) and three-day events (3DE) are usually associated with falls of horses, which invariably involve falls of the riders. Many potential causes for these falls have been discussed. Objectives: The aim of this case-control study was to investigate the risk factors for horse falls on the cross-country phase of horse trials and three-day events. Methods: Using retrospective data, significant risk factors identified with unvariable analysis (P value

Summary Reasons for performing study: Subchondral cystic lesions of the medial femoral condyle (SCMFC) are well documented in horses 3 years; arthroscopic debridement or enucleation of the cyst is currently the surgical treatment of choice. However, studies of occurence and outcome following surgery in older horses are lacking. Objective: To identify factors important in outcome for horses with SCMFC treated by arthroscopic debridement. Hypothesis: Age of horse at presentation has a significant influence on return to work following arthroscopic treatment for SCMFC. Clinical and diagnostic findings are also significant with respect to prognosis. Methods: A retrospective review of medical records from 6 equine referral centres identified 85 horses that underwent arthroscopic debridement of SCMFC. Clinical examination, radiographic and arthroscopic findings were analysed together with follow-up data. Univariable analysis and multivariable logistic regression models were used to determine factors affecting return to soundness. Event-time analysis was performed to evaluate return to work. Results: Older horses (>3 years) were less likely to return to soundness (P = 0.02) or to work (P = 0.04) than younger horses (> 3 years). Of 39 horses age 0-3 years, 25 (64%, 95% CI 49-79%) returned to soundness. Of 46 horses age >3 years, 16 (35%, 95% CI 21-49%) returned to soundness. In addition, cartilage damage at sites other than the SCMFC negatively affected prognosis (P = 0.05). The hospital where treatment was performed had no influence on return to soundness. Conclusions: Older horses carry a worse prognosis for both return to soundness and return to work. Potential relevance: It is important for clients to be made aware of the difference in outcome between age groups.

Objectives— To establish an injection site for the gastrocnemius calcaneal bursa (GCB), to identify communication patterns between the calcaneal bursae, to estimate the proximal and distal extents of the intertendinous calcaneal bursa (ICB) and to identify variations from previous anatomic descriptions. Study Design— Descriptive anatomic study. Animals— Cadaveric equine hindlimbs (n=18) from 9 adult horses. Methods— Communication between the ICB and GCB was determined in 18 cadaveric hindlimbs by injection of a latex mixture, followed by examination of sequential sagittal sections and documentation of the distribution of the latex mixture and communication sites. The distal and proximal extents of the ICB and subcutaneous calcaneal bursa (SCB), relative to the tuber calcanei (TC) were recorded. Results— Communication between the ICB and the GCB was confirmed on the medial and lateral aspect in 100% and 50% of limbs, respectively. Communication between the SCB and the ICB, and therefore the GCB, was identified in 39% of limbs. Plantar reflections of the ICB existed in 33% of limbs. Mean extent of the ICB relative to the TC was 7.0 cm distally and 9.6 cm proximally. The SCB often occupies a more distal position than previously reported. Conclusions— The ICB and the GCB should be considered 1 synovial structure with 2 communicating compartments. Clinical Relevance— The GCB may be an alternative site for synoviocentesis when there is septic calcaneal bursitis. Improved knowledge of calcaneal bursae anatomy may aid in diagnosis and treatment of lesions involving these structures.

Summary Reasons for performing study: Short format 3-day events were introduced in 2004. Anecdotal reports suggested that horses were more tired on completion of the cross-country phase of short format events when compared with horses completing the cross-country phase of long format competitions, despite the absence of Phases A, B and C. Objectives: To compare the physiological parameters and haematological parameters of horses that had completed the cross-country phase of a short format (SF) and a long format (LF) CCI 2* competition. Methods: During a CCI 2* competition 69 competitors took part in the short format and 74 in the long format competition. Long format competitors completed Phases A, B, C and D and short format competitors completed Phase D only. Phase D (the cross-country course) was identical for both competitions. Two-way ANOVA for repeated measures and post hoc tests were used to compare temperature, pulse and respiration rates of horses competing in both types of competition. T tests were used to compare mean lactate and electrolyte concentrations, while U-Mann Whitney tests were used to compare CK and AST levels measured in horses competing in the short and long formats of the event. Results: Training schedules, age and previous competition experience were not significantly different between horses competing in the SF and LF competitions. On completion of Phase D, SF horses had significantly higher PCV and significantly lower ionised calcium concentrations when compared with LF horses. LF horses had significantly higher heart rates than SF horses 10 min prior to starting Phase D and immediately after completing Phase D; however, no other significant differences were found between the 2 groups of horses. Conclusions: Only weak evidence was found to support the hypothesis that the workload for the horse in a SF CCI 2* competition is significantly different when compared to the LF CCI 2* competition. Potential relevance: There is no beneficial or detrimental effect on horses that complete short format CCI 2* competitions as compared to those that complete long format CCI 2* competitions but further research is required into the physiological response of horses at CCI 3* and CCI 4* short format competitions.

The objective of this study was to identify risk factors, during racing, associated with imminent fatal distal limb fracture in Thoroughbreds. One hundred and nine cases of fatal distal limb fracture were identified from all 59 UK racecourses over a 2-year period (February 1999-January 2001). Three uninjured control horses were randomly selected from the same race as the case horse. Videos of races in which fractures occurred were viewed using a defined protocol. Fractures in flat races occurred at any time during the race, whereas 74% (45/61) of cases in national hunt type races occurred in the second half of races. More than 75% (79/103) of cases were spontaneous, i.e. there was no obvious external influence such as a fall at a fence or collision with another horse. Sixty-six percent (44/67) of horses, sustaining a forelimb fracture, fractured the forelimb they were using as lead leg at the time of fracture. When case and control horses were compared, horses that were: (a) making good progress through the race, (b) reluctant to start and (c) received encouragement in the final 10s before the time of fracture, were more likely to sustain a fracture.

We used data from a case-control study investigating risk factors for horse falls in the cross-country phase of eventing in Great Britain (GB) to examine evidence for memory decay and information bias. Responses to two questions obtained by telephone for 173 cases and 521 controls were examined for evidence of differential reporting according to the respondent's case-control status and performance in the dressage and cross-country phases of competitions. Information bias was found in the accuracy of reporting dressage penalty scores when analysed as a function of performance level (good/poor). Poor dressage performers were less likely to report accurate dressage scores than good performers. The accuracy of reporting dressage scores decreased as the time between the event and questionnaire completion increased, with no case-control interaction. Competitors who incurred cross-country jumping penalties at the event preceding the selected event reported their cross-country scores with less accuracy when compared with competitors who incurred no penalties. No information bias was found when the reporting of dressage and cross-country scores were analysed as a function of respondent category (case/control).

The risk of fatal distal limb fractures in thoroughbreds racing in the UK was calculated and shown to vary considerably between the different types of race. Flat turf racing was associated with the lowest risk (0.4 per 1000 starts) and national hunt flat racing was associated with the highest risk (2.2 per 1000 starts). The types of fracture were classified by detailed radiographic and postmortem examinations of all the cases recorded over two years, and the distribution of the different types of fracture in the five main types of racing was examined. Overall, lateral condylar fractures of the third metacarpus were the most common, and they were also the most common in national hunt-type races (hurdle, steeplechase and national hunt flat races). In all-weather flat racing biaxial proximal sesamoid fractures were most common, and in turf flat racing fractures of the first phalanx were most common. The risk of fractures of more than one bone was greater in national hunt-type races.

Synovial sepsis in horses is life threatening and accurate diagnosis allowing prompt treatment is warranted. This study assessed the diagnostic value of serum amyloid A (SAA) and D-lactate in blood and synovial fluid (SF) as diagnostic markers of synovial sepsis in horses and correlated them with total nucleated cell count (TNCC), percentage of neutrophils (%N) and total protein (TP) in SF. Blood and SF SAA and D-lactate concentrations were determined in a case-control observational study including 112 horses (38 with synovial contamination or sepsis (SCS), 66 with non-septic intra-synovial pathology (NSISP) and 8 controls). Blood and SF SAA were significantly higher in SCS than in NSISP and control horses. SAA values were similar in NSISP and control horses. SF SAA was moderately correlated with synovial TNCC, TP and blood SAA. Blood and SF SAA were 82.4 per cent and 80 per cent sensitive and 88.9 per cent and 73 per cent specific for diagnosis of SCS, with cut-off values of 60.7 and 1.14 mu g/ml, respectively. Blood and SF D-lactate concentrations were not significantly different between groups. This study shows that blood and SF SAA concentrations can aid to distinguish SCS from non-septic synovial pathology; however, D-lactate was not useful.

Laminitis in equids is a clinical syndrome usually associated with systemic disease. Endocrinopathies recently have been recognized as the most common cause of laminitis, with hyperinsulinemia playing a key role. Descriptions of laminitis-associated lesions have been confusing due to the wide range of experimental models used, failure of adequate clinical documentation for naturally occurring cases, lack of separate analysis of inflammatory and endocrinopathic laminitis, and uncertainty regarding normal morphological variation of lamellae. In this study, lamellar morphology and pathology were described in 14 laminitic horses and ponies that had hyperinsulinemia (>20 mIU/l), with reference to 25 age- and breed-matched controls. The type and severity of lesions noted had no correlation with reported clinical duration and in at least some cases must have preceded it. Lesions were largely localized abaxially within the lamellar tissue and included apoptotic cell death, as well as lamellar fusion, hyperplasia, and partial replacement with aberrant keratin containing nucleated debris and proteinaceous lakes. The lesions resulted in irregular margins between the inner horn and the lamellar tissue. Acute separation originated from the abaxial region, with minimal associated inflammation. Axially, epidermal lamellar tapering was the most frequent morphological observation. The lesions in these chronic cases of laminitis were similar to those described in some inflammatory laminitis models and contained features seen in developmental phases of hyperinsulinemic models. These findings support the theory that repeated episodes of subclinical laminitis occur prior to clinical presentation. In addition, the pathology does not include extensive basement membrane failure seen in some inflammatory models.

Soft tissue sarcomas of the equine distal limb associated with joints, sheaths, or bursae have rarely been reported. Accurate diagnosis of these tumors is challenging in both human beings and veterinary species. Immunohistochemical staining and transmission electron microscopy have been used in human beings to reduce misdiagnosis. The current report describes 2 mature horses presenting with lameness and swelling associated with the dorsal aspect of the metacarpo(tarso)phalangeal joint. In both cases, surgical excision was performed with subsequent histological analysis of the masses to determine the tissue of origin. In both cases, immunohistochemical staining and transmission electron microscopy aided the definitive diagnosis of fibrosarcoma associated with the fetlock joints of 2 horses.

Summary Gastric reflux is an important clinical parameter to evaluate when treating the equine acute abdomen. This statement applies equally to first opinion visits, preoperative evaluations and post operative evaluations. Although simply a ‚clinical sign’ the presence of gastric reflux often helps to decrease the length of our list of differential diagnoses and speeds our decision for exploratory laparotomy.

To determine risk factors involved in survival to hospital discharge of cases of synovial sepsis.Investigate pre-, intra- and post operative factors involved in short-term survival of horses undergoing endoscopic treatment for synovial sepsis.Retrospective case series.Clinical data were obtained for horses (6 months old) undergoing endoscopic surgery as part of management for synovial sepsis over a 7-year period in a single hospital population. Descriptive data were generated for pre-, intra- and post operative variables. Multivariable logistic regression analysis was used to develop 3 models related to presurgical, surgical and post surgical stages of management with outcome defined as survival to hospital discharge.Two hundred and fourteen horses were included. In Model 1 (preoperative variables), increased preoperative synovial fluid total protein (TP) was associated with nonsurvival (OR 0.88, 95% CI 0.83-0.94, P0.001) whereas the presence of a wound on admission was associated with survival (OR 4.75, 95% CI 1.21-18.65, P = 0.02). Model 2 (intraoperative variables) revealed that factors associated with decreased survival were anaesthetic induction outside of normal working hours (OR 0.36, 95% CI 0.15-0.88 P = 0.02) and presence of moderate/severe synovial inflammation at surgery (OR 0.28, 95% CI 0.12-0.67, P = 0.004). Model 3 (post operative variables) showed that increased post operative synovial fluid TP (OR 0.94, 95% CI 0.90-0.98, P = 0.013) and undertaking more than one endoscopic surgery for treatment (OR 0.19, 95% CI 0.05-0.70, P = 0.005) were associated with nonsurvival. Cut-off values for predicting survival were 55-60 g/l for preoperative and 50-55 g/l for post operative TP measurements.This study has identified factors associated with altered likelihood of survival to hospital discharge following endoscopic surgery for synovial sepsis. Prognosis for survival to hospital discharge can be based on evidence from this study at the key stages of management of horses with synovial sepsis.

The purpose of this research was to ascertain the impact of an array of variables on the espoused teaching paradigms and instructional behaviors of college faculty. The study, which was exploratory and speculative, alternately analyzed espoused teaching paradigms as independent and dependent variables. Analyses were based on data collected from a large national sample of college faculty (N = 443) spread across 163 colleges and universities and compared across four academic disciplines (English, biology, mathematics, and psychology). The results of the inquiry demonstrated gender, academic discipline, and some contextual variables to be the most significant predictors of faculty teaching paradigms. Furthermore, manifestations of teaching paradigms were explicitly reflected in the frequencies of instructional behaviors reported by the faculty surveyed. It was concluded that contingency theories of leadership offer a framework that facilitates a multivariate analysis of teaching-learning.

The aim of this project was to develop a detailed, accessible set of reference images of the normal radiographic anatomy of the ovine digit up to and including the metacarpo/metatatarsophalangeal joints. The lower front and hind limbs of 5 Lleyn ewes were radiographed using portable radiography equipment, a digital image processer and standard projections. Twenty images, illustrating the normal radiographic anatomy of the limb were selected, labelled and presented along with a detailed description and corresponding images of the bony skeleton. These images are aimed to be of assistance to veterinary surgeons, veterinary students and veterinary researchers by enabling understanding of the normal anatomy of the ovine lower limb, and allowing comparison with the abnormal.

The biomechanical circumstances that promote sagittal fracture of the equine proximal phalanx (P1) are poorly understood. In order to improve our understanding of equine metacarpophalangeal joint (MCPJ) biomechanics and potential aetiologies of sagittal P1 fractures, the study objectives were to quantify P1 bone strains, collateromotion and axial rotation during MCPJ extension under controlled loading circumstances. Unilateral limbs from six cadavers were instrumented with bone reference markers for measurement of P1 movement relative to third metacarpal bone positions during axial limb loading to 10,500 N. Bone reference markers recorded by video were digitized and the movement analyzed during MCPJ extension. Concurrently, dorsoproximal P1 surface strains were measured with one uniaxial and one rosette strain gauge. Strain gauge data was reduced to determine principal and shear strain magnitude and direction. External axial rotation and collateromotion increased with increasing MCPJ extension. Maximum principal strain increased linearly as load increased from 2000 to 10,500 N. Minimum principal and maximum shear strains had curvilinear relationships with limb loading, with negligible strain magnitude until approximately 6000 N load, after which strain increased rapidly. The direction of P1 minimum principal strain shifted approximately 30–40° as load increased from 5400 N to 10,000 N, moving from proximolateral–distomedial to a nearly proximodistal direction. At near maximal MCPJ extension, with concurrent axial rotation and collateromotion, a rapid increase in dorsoproximal P1 bone strain and a change in principal strain direction occurred. The alterations in principal strain magnitude and direction associated with maximal MCPJ extension may support a biomechanical theory for sagittal P1 fracture occurrence in horses.

Objectives: To investigate whether microfractures and alterations in the trabecular bone area are associated with catastrophic bi-axial proximal sesamoid bone fractures (PSBF). Methods: Proximal sesamoid bones (PSB) from 10 racehorses with PSBF and from 10 control racehorses without musculoskeletal injury were examined using the bulk basic fuchsin method. Bone histomorphometric and microfracture analysis was performed, and cases and controls compared using two-sample t-test, paired t-test, and Mann-Whitney U test. Results: There was no significant difference in the microfracture density and the trabecular bone area between bones from case and control horses, and between fractured and non-fractured bones in case horses. Clinical relevance: Microfracture density was low in the areas of the PSB examined. Microfracture density was not significantly different between groups, indicating that propagation of micro-cracks is an unlikely predisposing pathologic alteration in PSBF in British racehorses. There was no significant difference in the bone surface area between groups, which one would expect if modelling, adaptation and an increase in bone density were associated with PSBF fracture in the case horses. Therefore, PSBF in the British racehorse does not appear to be associated with microfractures of the trabecular bone of the PSB. The PSB fractures might represent an acute monotonic fracture; however, the aetiology of the fractures remains unknown with additional research required.