Chapter 91 - Foot Flashcards
Trush refers to
an infection that leads to tissue necrosis in the frog area
which areas are most often affected by trush?
frog central and lateral sulci
what are the characteristics of trush?
soft and slimy and emit a characteristic foul-smelling odor
What are the predisposing factors of trush?
lack of conditions with manure and urine (poor stall hygiene)
contracted hoof and lack of exercise
poor horn quality
What is the treatment of trush?
hoof care and good stall hygiene
All damaged horn is removed + desinfecting solution
protective bandage with povidone-iodine sponges
what is the prognosis of trush?
depends on stall hygiene
White line disease is
a deterioration of the white line of the hoof capsule resulting in the loss of the bond between the hoof wall and the sole
cause of white line disease
poor quality of the horn which allows colonization of different bacteria and fungi
typical of warm and humid clime
Where does the lameness come from in the case of white line disease?
When the hoof wall begins to separate from the sole, the hoof wall is exposed to increased tensional forces, which leads to the development of inflammatory processes in the sensitive laminae and results in lameness - hoof wall may become undermined and eventually form a hollow wall
What is the treatment of white line disease?
debridement of affected tissues and hoof wall resection during the debridement
place nails higher than normal to prolong the duration
Hoof wall separation what is the cause?
common in working horses in chronic cases results from accumulation of soil, bacteria and fungi that separate the laminae in the hoof wall - can be an extension of white line disease
What is the therapy of the hollow wall separation
Successful therapy can be achieved only when all diseased and necrotic horn is removed
Replace the empty space with polimerized products that will be hornlike products and ca be reinforced by fiberglass webbing
Figure 91-2. Photo showing the sole of a hoof in a mule with severe white line disease. Necrotic and desiccated horn has been removed from the white line area.
Figure 91-3. Illustration showing hollow wall on the left side (dark area) of a hoof.
Hoof wall crack what is it?
occurs as a longitudinal disruption of the hoof wall parallel to the horn tubules and lamellae.
Hoof wall cracks can affect which areas of the hoof?
involve the entire length of the hoof wall,
only the proximal hoof wall near the coronary band,
or only the distal hoof wall
you can classify cracks into 2 types name them
superficial - only superficial hoof wall
deep - contacts sensitive laminae causing inflammation and lameness
Horizontally oriented hoof defects parallel to the coronary band are called
hoof crevices and are managed as cracks
Causes of hoof crack
diverse
Poor horn quality or a horn wall that is too thin are predisposing factors.
Abnormal hoof angles can produce significant tension gradients within the hoof wall, which develop into cracks.
what is the classification of the hoof wall cracks regarding the length?
proximal
distal
entire lenght
Describe the cause of proximal hoof cracks
local trauma (Figure 91-8),
inflammation,
or scar tissue formation near the coronary band. Because of this damage, poor quality horn is produced, promoting the development of a hoof wall crack. These cracks slowly extend distad as the horn grows.
Figure 91-5. (A) A hollow wall section limited to the proximal part of the hoof wall is removed with a Dremel tool. (B) The exposed desiccated laminae are shown.
Figure 91-6. Different locations of hoof wall cracks. a, Dorsal crack extending over the entire length of the dorsal hoof wall; b, proximal lateral hoof wall crack; c, distal lateral hoof wall crack.
Figure 91-8. Proximal medial hoof wall crack self-inflicted by the shoe of the contralateral foot.
describe the cause of distal hoof crack
Poor horn quality associated with excessive workload and poor hoof hygiene can lead to development of hoof cracks at the distal hoof wall (see Figure 91-6).
treatment of distal hoof crack
A horizontal groove may be cut at the most proximal aspect of the crack, and the foot should be trimmed very short to prevent proximal and deep extension of the crack. If these management practices do not stop the progression of the crack, more aggressive surgical techniques are required (see later).
Figure 91-7. Illustration of a hoof wall with a window inserted to show the depth to which cracks can penetrate. a, A deep or perforating hoof wall crack involving the sensitive laminae; b, superficial hoof wall crack
Figure 91-9. (A) Hoof with a crack attributable to a long and steep medial wall and uneven heels.
(B) Illustration of a contracted hoof with a distorted coronary band and a hoof crack.
Hoof cracks are more medial or lateral?
More lateral
What is the cause of entire lenght hoof crack?
Usually is trauma in the coronary band
Often this type of hoof crack is found in hooves with particularly ________ ______________(2w)
long sidewalls (Figure 91-9).
Predisposing factors of entire length hoof cracks
- Uneven heels and displacement of the heel bulbs are predisposing factors.
- Hoof wall cracks can also be caused by faulty shoeing practices, such as shoes that are too short, branches that are too narrow, side clips applied too far back, uneven hoof soles, and hoof nails inserted too far caudally.
Diagnosis of hoof crack
The diagnosis is usually made on close visual inspection of the hoof.
Difference of treatment between superficial and deep cracks
Deeper layers of the crack often are filled with dirt and manure. Lameness is a prominent feature of deep or perforating hoof wall cracks. Conversely, superficial horn cracks are not associated with lameness and many do not require treatment.
Figure 91-10. Illustrations: (A) and (B) The hoof horn surrounding the cracks is carefully removed and smooth transitions from the laminae to the horn are established before each crack is covered with artificial horn (C).
Treatment of hoof cracks
symmetry of the hoof - trimm the heels on affected side short –> reduce pressure
The old shoe is removed, and the hoof is properly trimmed.
shod with a bar shoe, and the sole is filled with silicone and covered with a metal plate. This reduces pressure in the heel region, which is especially beneficial when the crack is located in this area
Trimm the hoof wall short in the exact place of crack in coronary band to avoid movement
Fixation device is placed after debridement (Figure 91-11)
If you place exotermic components you should wait for a thin layer of horn before applying directly in the sensitive laminae
Figure 91-11. Illustration showing various devices applied to the hoof to repair cracks. a, Umbilical tape laced around small protruding screws in the hoof wall; b and c, clamps of various designs inserted into the hoof wall; d, a metal plate glued over the crack; e, a metal plate spanning the crack and fixed to the hoof wall with small screws.
what is the principle in the treatment of cracks?
The hoof wall must be covered with artificial horn material over almost its entire length to prevent recurrence of a crack (Figure 91-12). patient should have stall rest few month
Figure 91-12. Lateral hoof crack in which the involved hoof wall has been removed and the defect filled with artificial horn.
Prognosis of hoof cracks
Good to guarded
What is a keratoma?
keratoma is a thickening of the hoof horn that extends toward the inside of the hoof (Figure 91-14).
Figure 91-14. Illustration of a keratoma of the hoof capsule. (A) First manifestation close to the white line (arrow). (B) View from within the hoof capsule; note the extra horn tissue that has formed near the toe.
What is the cause of keratoma?
The most common cause is localized inflammation or trauma at the transition between new horn produced at the coronary band and the hoof wall. This results in the formation of scar tissue in that location, which gradually grows distad as new horn is produced.
What is the treatment of keratoma?
how many types of keratoma exist?
3 types
1 - cylindrical - columnar shap - protrusion parallel to the horn tubules
2 - spherical - anywhere in the hoof
3 - epidermical cysts
where is common locations of keratoma?
dorsal, dorsolateral, or dorsomedial aspect of the wall.
The keratoma consists of poor quality horn (Figure 91-15), which decays early, allowing bacteria and fungi access to the inside of the hoof wall. - True or false?
True
how do you diagnose keratoma?
recognize the abnormal configuration of the white line. Typically, the lamellar horn of the white line is replaced by tubular horn and scar tissue (Figure 91-16, A).
recognize the abnormal configuration of the white line. Typically, the lamellar horn of the white line is replaced by tubular horn and scar tissue (Figure 91-16, A).
Radiograph (Fig 91-16 B)
CT and MRI to do minimal invasive intervention
diferential diagnosis of keratoma
calcified hematoma, fibroma, squamous cell carcinoma, and malignant melanoma
what is the radiographic description of keratoma?
In advanced cases, a circular lytic area in the distal phalanx can be recognized radiographically (see Figure 91-16, B). This area should not be mistaken for the naturally occurring toe crena at the dorsal aspect of the distal margin of the distal phalanx. Often, a sclerotic border delineates the lytic area (see Figure 91-16, B)
Figure 91-15. Photographic views of a transverse section of a hoof with a keratoma. (A) Solar view of the keratoma, (B) Transverse cut through the bone and the hoof capsule. a, Keratoma and surrounding bone; b, normal pedal bone.
Figure 91-16. (A) Photograph of the sole of a foot with a keratoma showing focal chronic infection near the toe. (B) Dorsoproximal-palmarodistal oblique radiographic view of the same hoof showing a lytic area in the distal phalanx extending proximally along the hoof wall (surrounded by arrows), which is characteristic of a keratoma.
Figure 91-17. Three-dimensional reconstruction of a computed tomography image of a distal phalanx affected by a keratoma. Note the large bone defect caused by the keratoma.
Figure 91-18. Partial hoof wall resection for keratoma removal. The portion of hoof wall left near the ground surface provides stability.
What are two surgical techniques for keratoma removal?
Complete hoof wall removal
Partial wall removal
What is the main goal of the surgery?
Remove: abnormal horn as well as the abnormal sensitive laminae
The hoof wall defect may be filled with artificial horn as soon as the sensitive laminae have healed.
A special shoe with large clips placed on either side of the defect should be applied to the foot
describe the surgical procedure
Tourniquet - the horn just above the origin of the keratoma is first removed in the standing horse with the help of a Dremel tool. The second stage of the procedure is best carried out under aseptic conditions with the horse under GA where the altered laminae and the keratoma are removed at their origins (Figure 91-18). This procedure may also be carried out in the standing horse if a ring block is carried out at the level of the metacarpophalangeal (MCP) joint.
Antiseptic pressure bandage is applied to the phalangeal region, and the tourniquet is removed.
In how many days of interval you should change the bandage of keratoma?
Every 3 - 4 days intervals
How much time should the horse be confed to a box stall in keratoma case?
The horse should be confined to a box stall for 4 to 6 weeks, during which time routine bandage changes are done
Hand walking for approximately 2 to 3 months, followed by light exercise under saddle
In keratoma case after 4 - 6 weeks when the horse develops horn what can you apply in the hoof wall?
If healing progresses normally, the defect may be filled with artificial horn - wall defect with an amikacin-impregnated polymethyl methacrylate (PMMA) plug
Hand walking for approximately 2 to 3 months, followed by light exercise under saddle
What is the prognosis for keratoma treatment?
Surgical treatment is associated with a significantly better prognosis than conservative treatment and a success rate of 83% compared with 43% for conservative management was reporte
Hoof abcess has predispostions?
No breed or age predispositions are known.
Hoof abcess causes
1 . Placement of a horseshoe nail too close to the sensitive laminae causing bacterial infection in close proximity to the sensitive laminae.
2. Insertion of a horseshoe nail directly into the sensitive laminae resulting in infection.
3. Small pointed rocks penetrating the sole horn.
4. A penetrating foreign object, for instance a street nail.28
5. A sole bruise, creating an optimum environment for bacteria that normally enter the horn tubules.
cardinal signs of hoof abcess
“fracture” type pain
warmth on the hoof
digitaal pulse
fever sometimes
swelling of the limb often misdiagnosed with septic tenosynovitis
diagnosis of hoof abcess
positive hoof tester
radiografy
regional nerve block
Treatment of hoof abcess
removal of the shoe
placement of povidine- iodine or creosote bandage to clean and debride the abcess in the next day
Debridement of the necrotic tissue
Lavage with iodine solution or H2O2 (max. 3%) and covered with a povidone-iodine–soaked gauze sponge and a hoof bandage
The bandage is changed every 2-3 days and when finally dry the horse should be shod
AINS
Figure 91-22. Septic arthritis of the DIP joint is a potential complication of a hoof abscess. The opening into the DIP joint is clearly visible (gray arrow). The diseased bone was curetted (black arrow). It was necessary to lance the abscess proximal to the coronary band to allow flushing (white arrow).
Figure 91-20. Some hoof abscesses drain from the coronary ban
What is the medication you should give in case of abcess?
Administration of nonsteroidal antiinflammatory drugs (NSAIDs; e.g., phenylbutazone) is advised. Antimicrobial therapy is only indicated when involvement of deeper structures is suspected.
what is the prognosis of hoof abcess?
Generally, a good prognosis can be given, even though advanced abscesses can take weeks to heal completely
If an abcess is not well managed where can it break through?
it can break through at the coronary band (Figure 91-20) or extend deeper into the foot.
In case of coronary band affection what should you do?
Lavage daily from coronary to distal wwith iodine povidone 3%
How can chronic abcess be missed?
especially if the horse has been treated with analgesics, which can mask clinical signs and prevent timely recognition + avoid maturing of the abcess
How do you diagnose a chronic hoof abcess?
During physical examination of the foot you can follow the tract with a probe
radiographic exam
What are the radiographic changes visible in chronic hoof abcess?
Lytic changes in the distal phalanx, also known as the pedal bone, can develop as a result of a chronic abscess as well as after aseptic local inflammation.
In chronic cases where can the hoof abcess can go?
the dorsal and lateral hoof wall in a proximal direction, eventually breaking out at the coronary band (see Figure 91-20) or invading the coffin joint (see Figure 91-22); the sole, potentially undermining it completely; and the distal phalanx, resulting in septic pedal osteitis
What is aseptic pododermatitis?
poor shoeing technique, excessive use of the horse under difficult conditions, such as hard, uneven ground, and frequent kicking against a stall wall
Figure 91-24. Marked reddening (surrounded by arrows) of the sole near the frog in a horse with aseptic pododermatitis (severe bruising).
How do you diagnose aseptic pododermatitis?
The signs are typical but not very specific, which occasionally leads to misdiagnosis of the problem (Figure 91-24). The hoof is slightly warmer than normal, pulsation of the palmar arteries is usually increased, and a positive pain reaction can be elicited with the hoof testers. In most cases, palmar digital nerve anesthesia relieves the lameness. Radiography helps to differentiate the problem from laminitis or a fracture in this region. Keratoma is part of the differential diagnosis in cases of chronic persistent pododermatitis.
How do you treat aseptic pododermattis?
- shoe must be removed
- Application of creosote bandages for 3 or more days followed by dry bandages for several weeks is very effective.
- NSAIDs may be required if there is persistent pain.
- Hand walking on soft ground for short periods is optional, and after 7 to 10 days the horse is reshod.
Nail prick refers to an injury caused by
an injury caused by inadvertent insertion of a nail through the sole and sensitive laminae during shoeing.
Street nail refers to puncture
to puncture of the solar surface of the hoof by nails or other sharp objects, such as screws
A hoof is nail bound when a
a horseshoe nail is driven too deep into the horn, causing excessive pressure on the corium.
All 3 conditons of street nail, hoof nail and nail prick result in 3 things, name them:
result in pain, inflammation, and infection.
which structures can be affected by the nail?
are often deep and can have disastrous effects when structures such as the distal phalanx, distal sesamoid bone, DIP joint, navicular bursa, deep digital flexor tendon (DDFT), or tendon sheath are penetrated (Figure 91-25).
Figure 91-25. Depending on the site of entry of a sharp foreign body into the foot, different anatomic structures may be affected. a, The distal phalanx at the toe; b, the insertion of the DDFT at the dorsal third of the frog; c, the DDFT, impar ligament, and possibly DIP joint at the middle of the frog; d, the DDFT, distal sesamoid bone, and navicular bursa at the palmar/plantar third of the frog; e, the hoof cushion, DDFT, and tendon sheath at the palmar/plantar aspect of the frog; f, the hoof cushion at the palmar/plantar-most part of the frog.
The penetrating object is often contaminated with soil, rust, or manure, which can lead to _____________ ____________ (2w)
serious infection
The superficial wound in the sole usually seals quickly, leaving no area for drainage, and the anaerobic environment created favors the growth of (name the organism)
Clostridium tetani, the cause of tetanus.
How do you diagnose street nail?
moderate to severe supporting-leg lameness - stand tip of toe
Fever
Hoof is warmer than normal
increased pulsation of the digital arteries
Severe pain. In horses with severe acute lameness, the hoof must be thoroughly cleaned and examined for a foreign body or puncture wound (see Figure 91-25).
Radiograph
How do you treat street nail
Note point of entry marked on the sole or recorded on paper, because it will rapidly become unapparent.
The point of entry is cleaned, and the entire hoof is bandaged.
If radiographic equipment is available, radiographic images are taken before the removal of the nail.
Based on the location, direction, and depth of the injury, the horse may be treated on site or referred to a clinic.
When there is suspicion of injury to deeper structures, such as the navicular bursa, DIP joint, or the digital flexor tendon sheath, the horse must be referred immediately for surgical treatment.
Broad-spectrum AB
Tetanus antitoxin
Clinical examination, the foot is desensitized by means of an abaxial sesamoid nerve block.
Remove shoe + entire hoof is trimmed.
The decision to pursue further treatment is based on the results of the clinical examination and radiography. The puncture tract is carefully cleaned and disinfected.
A sterile metal probe is inserted into the puncture tract, and the hoof is radiographed in two planes (Figure 91-26, A and B).
Contrast studies help in determining whether there is involvement of the DDFT and the adjacent synovial structures. Injection of contrast material into the navicular bursa, the DIP joint, and the digital flexor tendon sheath (DFTS) independently,
Describe the surgical tx of street nail
This procedure entails two parts:
1. initial débridement of the sole (horse is standing and sedated)
2. followed by aseptic treatment of the puncture wound and the involved deeper structures (under general anesthesia) (Figure 91-27).
With the horse sedated and standing, the hoof is cleaned and the horn around the puncture tract is carefully removed down to a thin layer of horn that can be cut with a scalpel blade.
The hair from the hoof to the fetlock joint is clipped.
The prepared area is cleaned with chlorhexidine scrub (Hibiscrub) and covered with a bandage.
The horse is subsequently positioned in LR GA + a tourniquet is applied. Occasionally, it is necessary to remove additional horn at this time. All affected tissues around the puncture tract are excised. The horn around the tract is removed in an area measuring approximately 3 × 3 cm. The corium and subcutis are then removed and the underlying structures are exposed. If the foreign body has penetrated the DDFT, a 1.5 × 1.5 cm area of the tendon
Curettage of FB has penetrated the P3 or the distal sesamoid bone (Figure 91-28). With perforation of the impar ligament and penetration of the DIP joint, the ligament must be resected and the joint as well as the navicular bursa must be lavaged. Involvement of the digital tendon sheath requires thorough lavage.
The affected synovial structures are lavaged with copious amounts (several liters) of lactated Ringer’s solution to which AB have been added. Endoscopic evaluation and flushing of the synovial structures is recommended. A pressure bandage is applied, followed by a hoof bandage and a wedge under the heel. Repeated regional intravenous perfusion with antimicrobials is recommended.
What is the size of horn around the tract you have to remove?
3 x 3 cm
If the foreigh body has penetrated the DDFT how much of tendon you have to remove?
1.5 x 1.5 vm are of tendon
Figure 91-27. Illustration of a street nail operation. (A) Localization of the entry point. (B) Subcutis and sensitive laminae are removed. (C) The DDFT is fenestrated. (D) Illustration of the puncture wound in a parasagittal plane.
Figure 91-28. (A) Photo showing the appearance of the surgical wound 10 days after removal of a foreign body (street nail operation) that penetrated the distal sesamoid bone. (B) Intraoperative view showing the site of penetration of a nail into the impar ligament
Figure 91-29. Navicular bursoscopy in the horse in lateral recumbency using the direct approach. (A) Illustration of the surgical portals. (B) Close-up view showing the anatomic structures involved. (C) Intraoperative view of the navicular bursa. AP, Arthroscopic probe; NB, navicular bone.
Figure 91-30. Medication-plate shoe used for postoperative protection of a foot after surgery. The wound can be dressed daily by removing the plate.
What is the % prognosis of puncture wound of the sole of synovial structures?
only 29% become sound after synovial treatment - prognosis guarded
What was the % of horses that with navicular bursotomy for treatment of contaminated/septic bursitis returned to their previous level of use?
75 - 84 % Navicular bursotomy for treatment of contaminated/septic bursitis, mostly arising from street nail puncture wounds, was performed in 19 horses, showed a better outcome. All horses in this study survived to discharge and 84% returned to their previous level of use.
Additionally, another case series of 16 horses with contaminated and septic bursae that were treated with bursoscopy reported a success rate of 75%.
Horses with septic bursae are reported to have better prognosis in the fore foot or hind foot injury?
Equids with a hind foot injury have a more favourable outcome than those with a forefoot injury. One suggested reason for this may be the fact that more weight is carried on the FL
Which condition may require neurectomy in case puncture of the sole?
Injury to the distal sesamoid bone can eventually result in adhesions between the bone and the DDFT, necessitating neurectomy.
Scalping injuries are
Coronary band and heel injuries occur at the transition between the skin and hoof capsule
Scalping injuries are caused by
They are usually caused by over-reaching, where one foot treads on the coronary band or heel of another foot. Heel calks on shoes can result in very deep injuries as well.
Figure 91-31. (A and B) Deep coronary band injury. (C and D) Primary wound closure was used for the skin.
Figure 91-33. Illustration of a sagittal view of a hoof with canker. The dotted line represents the level of the surgical cut needed for removal of the frog.
Figure 91-35. Photograph taken 4 months after removal of the entire frog showing good healing.
Figure 91-34. Postoperativ
Figure 91-38. Oblique radiographic projection of the distal phalanx of an Arabian horse with a 6-month-old fracture of the medial side bone. Healing is progressing but the fracture line (arrow) is still visible.
Figure 91-39. Illustration showing the surgical treatment for quittor, also known as necrosis of the collateral cartilage. A hole must be drilled into the hoof wall for adequate drainage if infection and necrosis extend distally to the coronary band. (A) The dotted line represents the surgical incision line. (B) A slightly curved incision beginning just dorsal to the coronary band over the diseased collateral cartilage produces a skin flap that allows removal of the proximal part of the necrotic cartilage.
Change bandage daily followed by short limb cast 8-10 once infection is controlled
Figure 91-40. Illustration showing the classification of distal phalangeal fractures: I, Abaxial nonarticular fracture; II, abaxial articular fracture; III, axial and periaxial articular fracture; IV, extensor process fracture; V, multifragment articular fracture; VI, solar margin fractu
Figure 91-41. Illustration showing a bar shoe with large side clips to limit hoof expansion laterally during weight bearing. This shoe is often used after hoof wall resection is carried out to access the interior of the hoof capsule, as well as for pedal bone fractures.
Figure 91-43. Slightly oblique view of a slightly displaced abaxial fracture of the distal phalanx with joint involvement 6 weeks after fracture occurrence. Displacement of the fracture is easily recognized at the palmar articular edge (arrow).
Figure 91-42. (A) Palmaro-45-degree proximal-45-degree lateral-dorsodistal oblique radiographic view of a lateral Type I fracture of the pedal bone 2 days after fracture occurrence. (B) Palmaro-45-degree proximal-45-degree lateral-dorsodistal oblique radiographic view of a lateral Type I fracture of the pedal bone 2 months after fracture occurrence.
Figure 91-44. (A) Radiograph of a Type II pedal bone fracture 4 days after fracture occurrence.
(B) Radiograph of a Type II pedal bone fracture 12 months after fracture occurrence; there is delayed union and malunion. Frequently, a delayed union, malunion or nonunion with chronic lameness can be observed after conservative therapy (Figure 91-44).
Figure 91-45. Preparation of the hoof for fixation of a pedal bone fracture. (A) The leg must be fixed in a stable horizontal position. (B) Illustration showing how the leg must be positioned. (C) Draping of the hoof for surgery.
Figure 91-46. Arthroscopic view of a displaced axial fracture of the distal phalanx via a dorsal approach. Anatomical reduction of the fragments can be directly observed and adjusted if necessary by repositioning of the pointed reduction clamps.
Figure 91-48 cont’d (G and H) Illustrations of the technique of an axial articular pedal bone fracture repair.
Figure
Figure 91-49. (A) Dorsal-65-degree proximal-palmarodistal oblique radiographic view of a parasagittal pedal bone fracture. (B) Location of the first screw. (C) Location of the second screw. (D) Dorsal-65-proximal-palmarodistal oblique radiographic view of the parasagittal bone fracture after surgery.
E) Postmortem view of the surgically fixed pedal bone after removal of the hoof capsule and soft tissue. This horse was euthanized 6 weeks after the surgical fixation of the pedal bone fracture because of a femur fracture.
Figure 91-51. Arthroscopic view of a fractured extensor process (a). The arrow indicates the fragment.
Figure 91-50. (A) Preoperative lateromedial radiographic view of an extensor process fracture. (B) Postoperative lateromedial radiographic view of the same horse after removal of the fracture fragment
Figure 91-52. (A) Lateromedial radiographic view of a fractured extensor process. (B) Fixation of the fracture with a 4.5-mm cortex screw applied in lag fashion.
Figure 91-53. (A) Lateromedial radiographic view of a fractured extensor process of the pedal bone.
(B) Conservative treatment of the fracture with a cast was unsuccessful and resulted in dislocation of the fragment.
Figure
Figure 91-54. Lateromedial radiographic view of a large fragment of the extensor process in a 3-year-old Friesian horse.
Figure 91-56. Oxspring view of a mildly displaced axial fracture of the distal sesamoid bone (simple).
Figure 15.1 Radiographs of a right front navicular bone lateral parasagittal fracture. (A) Dorsoproximal‐palmarodistal oblique and
(B) palmaroproximal‐palmarodistal skyline views confirm the fracture in two projections. The fracture is less than two weeks old. There is
minimal displacement and the fracture margins are relatively sharply delineated.
Figure 15.2 Dorsoproximal‐palmarodistal oblique view of the
right front foot of a three‐year‐old Quarter Horse with foot
lameness. There is a large, separate osseous fragment (arrows) at
the distolateral border of the navicular bone.
Figure 15.5 Dorsoproximal‐palmarodistal oblique views of both
front feet of a five‐year‐old Warmblood. The horse passed a
prepurchase examination four weeks previously, but had become
slightly lame, especially on circles, as training was gradually
increased. There are parasagittal defects in both navicular bones
with evidence of chronic remodeling. This presentation is strongly
suggestive of multipartite navicular bones.
Figure 91-57. Lateromedial radiographic view of a frontal plane fracture (between the arrows) of the distal sesamoid bone.
Figure 91-58. Oxspring view of a pathologic fracture of the distal sesamoid bone. Note the large radiolucent area at the center of the fracture (arrow).
Comminuted fractures of navicular have what type of shape?
Figure 91-59. (A) Oxspring view of a fracture of the navicular bone. (B) There is complete nonunion of the fracture 6 months later.
Figure 91-60. (A) Skyline view of a navicular fracture. (B) Skyline view of navicular bone fracture fixation with a 3.5-mm cortex screw applied in lag fashion. (C) Oxspring view of a navicular bone fracture
fixation with a 3.5-mm cortex screw applied in lag fashion.
