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Reasons for performing study: The flexion test is routinely used in lameness and prepurchase examinations. There is no accepted standard for duration of flexion or evidence that interpretation of results would differ with different durations of flexion. Hypothesis: There will be no difference in interpretation of proximal hindlimb flexion for 5 or 60 s. Methods: Video recordings of lameness examinations of 34 client-owned horses were performed that included: baseline lameness, proximal hindlimb flexion for 60 s, and flexion of the same limb for 5 s. Videos were edited to blind reviewers to the hypothesis being tested. The baseline lameness video from each horse was paired with each flexion to make 2 pairs of videos for each case. Twenty video pairs were repeated to assess intraobserver repeatability. Fifteen experienced equine clinicians were asked to review the baseline lameness video followed by the flexion test and grade the response to flexion as either positive or negative. Potential associations between the duration of flexion and the likelihood of a positive flexion test were evaluated using generalised linear mixed models. A kappa value was calculated to assess the degree of intraobserver agreement on the repeated videos. Significance level was set at P<0.05. Results: Proximal hindlimb flexion of 60 s was more likely to be called positive than flexion of 5 s (P<0.0001), with the likelihood of the same interpretation 74% of the time. The first flexion performed was more likely to be called positive than subsequent flexions (P = 0.029). Intra-assessor agreement averaged 75% with κ= 0.49. Conclusions: Proximal hindlimb flexion of a limb for 5 s does not yield the same result as flexing a limb for 60 s. Potential relevance: Shorter durations of flexion may be useful for clinicians that have good agreement with flexions of 5 and 60 s. [ABSTRACT FROM AUTHOR]

Objective Describe the use of a phalangeal cast as treatment for wounds in the pastern and foot region of horses. Secondly, to evaluate the healing and soundness of horses treated with phalangeal casts. Design Retrospective study of 49 horses. Procedures Medical records of 49 horses that were treated with a phalangeal cast for 50 cases of wounds in the pastern and foot region at equine referral hospitals from 1995 to 2006 were reviewed and follow-up information was obtained. Results Treatment consisted of wound debridement, lavage, wound closure (28 wounds), cast application and antibiotics (84%). At follow-up, the majority of horses were sound (42 of 47 wounds, 89.4%), three horses were still lame and one horse was euthanased because of persistent lameness. Three horses were lost to follow-up. There was no statistical difference between the outcomes of horses treated acutely (<24 h) or after a 24-h delay. Similarly, the involvement of synovial structures in the wound did not significantly influence outcome. Conclusions In this study, wounds involving the pastern and foot that were treated with a phalangeal cast carried a good prognosis for soundness (89.4%) and cosmetic healing (89.5%). The phalangeal casts were well-tolerated and effective. [ABSTRACT FROM AUTHOR]

Osteoarthritis of the proximal interphalangeal joint (PIPJ) is a common cause of chronic lameness in the horse that requires surgical arthrodesis when medical management is no longer able to alleviate pain. Surgical principles for successful PIPJ arthrodesis include articular cartilage debridement and rigid fixation. To completely debride articular cartilage, the collateral ligaments and extensor tendon are transected, disarticulating the joint. The purpose of this study was to demonstrate that in chronically lame horses with periarticular new-bone formation and osteoarthritis, successful arthrodesis occurs without joint disarticulation and complete articular cartilage debridement. We hypothesised that complete articular debridement is not necessary, thus allowing for a less invasive surgical approach that decreases surgical time and hospitalisation with comparable success rates to previous reports. Medical records from 2000-2007 were reviewed for PIPJ disease. Information regarding lameness, surgical time and hospitalisation were retrieved from 11 horses (12 limbs). Follow-up information was obtained via a telephone interview and a re-evaluation. Average hospital and surgery times were shorter than previous reports at 19 days and 111 minutes respectively. Lameness decreased at least one grade in 92% of limbs. 73% of owners would elect to operate again. The data suggests that successful arthrodesis occurs without joint disarticulation and complete articular cartilage debridement.

Formalin was injected into an ethmoidal hematoma in an 18-year-old Arabian gelding. Abnormal neurologic signs were observed within minutes of the injection. The horse did not respond favorably to medical treatment of the neurologic signs and was euthanatized. Postmortem examination revealed erosion and necrosis of the ventral cribriform plate, which appeared to have allowed the injected formalin to reach the rostral portion of the frontal lobe of the brain. Endoscopy and radiography had been performed prior to euthanasia, but neither delineated the cribriform lesion. Before treating large progressive ethmoidal hematomas with formalin, it may be beneficial to perform computed tomography to assess the extent of damage caused by the lesion.

We report use of esophagomyotomy and esophagopexy to create a diverticulum for relief of chronic type I esophageal stricture in 2 horses. After esophagomyotomy, the mucosa was dissected free from the muscularis for approximately 180 degrees around the myotomy. Then, the tunica muscularis of esophagus was sutured to the sternocephalicus muscle ventrally and the periesophageal tissues dorsally to create a diverticulum without disruption of the esophageal mucosa. Clinical signs of esophageal stricture were relieved, and the horses were fed normal diets without further esophageal obstruction., (Copyright 2001 by The American College of Veterinary Surgeons)

A 9-year-old pregnant mare was referred for evaluation of a nonhealing wound of 8 weeks' duration on the lateral aspect of the left forelimb. A soft tissue mass encircled the proximal two thirds of the metacarpus; radiography revealed a moderate periosteal reaction affecting metacarpal bone i.v. Histologic and immunohistochemical examinations revealed eosinophilic granulomatous inflammation and Pythium sp in the soft tissues. The mare was treated for 12 days with antimicrobials, medicated wound dressings, debridement, and i.v. administration of sodium iodide; radiography revealed progression of the bone lesions. The mare was treated by regional arterial perfusion with miconazole and excision of affected soft tissues and the distal two thirds of metacarpal bone i.v. The mare recovered without complications and gave birth to a healthy foal. Regional perfusion of antifungal agents provides high concentrations in soft and osseous tissues and permits use of low dosages of agents administered by other routes, which reduces cost, adverse effects, and teratogenic effects.

Arthrodesis was performed to treat septic arthritis of the proximal interphalangeal joint of 8 horses. Records of the horses were reviewed to determine outcome and possible factors that influenced success or failure. All horses were female. Seven horses had 1 joint treated and 1 horse was treated for bilateral pelvic limb involvement. The duration of sepsis before surgery ranged from 1 to 66 days. Bone lysis and production was radiographically apparent in 7 horses before surgery. Six horses had multiple bacterial organisms cultured from bone or synovial tissues; 2 horses had single isolates identified. After aggressive curettage, arthrodesis was accomplished with 3 parallel screws in 1 horse, 2 divergent narrow dynamic compression plates in 3 horses, and a single broad dynamic compression plate in 4 horses. Casts were applied to all horses for 1 to 6 weeks. Four horses survived to successful brood mare status. Four horses were euthanized during hospitalization because of continued discomfort or complications of sepsis. Arthrodesis of the proximal interphalangeal joint affected with septic arthritis appears to be an acceptable alternative to euthanasia for some horses.

Objective: To estimate sensitivity and accuracy of subjective evaluation of mild lameness in horses during treadmill locomotion and to correlate subjective evaluation with kinematic analysis., Animals: 19 lame and 5 clinically normal horses., Procedure: Lameness was evaluated by subjective score and kinematic analysis before and after palmar digital nerve block (PDNB). Evaluations were made by 6 clinicians and 7 interns or residents. Within- and between-observer agreement analyses (kappa values) were calculated and compared, using a Student's t-test. Pearson's product-moment correlation coefficients were calculated between clinician's change in score and the change in kinematic variables after PDNB., Results: Within-observer agreement was within the range expected for conditions of moderate diagnostic difficulty. Within-observer agreement was higher for clinicians than for interns or residents. Between-observer agreement was acceptable for scores within 1 value of each other. Between-observer agreement of change in lameness score after PDNB was poor. When kinematic variables were ranked with each clinician's subjective change in score, only 2 were among the top 3 for the majority of clinicians. Asymmetry of vertical head movement between contralateral forelimb stance phases and the point of maximum hoof height during swing decreased as lameness subjectively improved., Conclusion: Mild lameness may be difficult to evaluate during treadmill locomotion. Although clinicians were more repeatable in their subjective evaluation of lameness than interns or residents, they were not more reliable at detecting the true state of lameness., Clinical Relevance: Lack of agreement between clinician scoring of mild lameness emphasizes the need to use more objective measures for quantifying lameness.

Both retrospective data and clinical experience indicate that complications of dental surgery are occasionally encountered and, to some extent, are inevitable. Many of the reported complications related to dental surgery such as incomplete removal of diseased teeth or removal of the wrong tooth can be avoided with sound preoperative planning and intraoperative technique. Diseased teeth should be properly identified prior to and during surgery. In addition, complete removal of the diseased tooth must be performed. Use of intraoperative radiographic examination to confirm the location of the diseased tooth and to document its removal cannot be overemphasized. Iatrogenic fracture of the maxillary or mandibular alveolar walls or palatine bone can be avoided by proper placement of the dental punch. The chances of developing incisional drainage or secondary sinusitis can be reduced by use of appropriate systemic antibiotics. These factors should guide the surgical approach to dental surgery to reduce the likelihood of developing common complications.

Medical records of 17 horses in which a distal sesamoid bone fracture was diagnosed between 1982 and 1992 were reviewed. There were 8 Standardbreds, 6 Quarter Horses, 2 Thoroughbreds, and 1 Arabian. Mean age was 4.7 years. A forelimb was affected in 15 horses, and a hind limb was affected in 2. All horses were lame, and most were grade III/V lame at the trot. In all horses, the diagnosis was confirmed by means of radiography. Five horses were treated with stall rest alone; 5 underwent neurectomy; 4 were treated with stall rest and corrective shoeing; and 1 was treated with stall rest and external coaptation. The other 2 horses were euthanatized. Two Quarter Horses, 1 treated with stall rest and corrective shoeing and the other treated with stall rest and external coaptation, returned to use as halter horses, and 2 Standardbreds treated with stall rest alone returned to racing, but at a lower level than they had raced prior to injury. One horse that underwent neurectomy could be used for pleasure riding. Long-term rest may be important in achieving a successful outcome. Pleasure horses would appear to have a better prognosis for return to use after a distal sesamoid bone fracture than do performance horses.