Treatment of three mature horses with subchondral cystic lesions in the proximal radius: Computertomographical diagnostic and transcortical filling with bone cement

Abstract

Zusammenfassung: Die Verwendung der computertomographischen Schnittbildtechnik hat sich in der Pferdemedizin bewährt und wird in spezialisierten Pferdekliniken routinemäßig eingesetzt. In der orthopädischen Diagnostik wird diese Technik am Vorderbein des Pferdes normalerweise an der distalen Gliedmaße bis zur Karpalregion eingesetzt. The use of computer tomography has proved successful in equine medicine and surgery and is used routinely in specialized equine clinics. In orthopedic diagnostics of the equine forelimb, this technology is most commonly used on the distal limb up to the carpal region. The surgical therapy of subchondral cystic lesions (SCL) in horses involves surgical debridement and if necessary even filling of the cystic cavities to achieve a revascularization and ossification of the defect. This is done via arthroscopy or arthrotomy depending on the localization. Alternatively the technique of transcortical drilling of SCL either under radiographic or fluoroscopic control has been described.. This paper describes the clinical situation and the CT-guided diagnosis in three horses with subchondral cystic lesions in the proximal radius. All horses were clinically examined including diagnostic anesthesia and radiographic images in more than one plane. However, in all horses only the CT-images showed a thin communicating tract to the elbow joint and multiple micro fractures in the proximal radius. The subchondral cystic lesions were subsequently approached via transcortical drilling under radigraphic control, debridement and flushing using specially manufactured surgical instruments, followed by filling the cystic lesions and drilled hole with bone cement. In conclusion the exactly preoperative CT-diagnosis and operation planning with extra articular bone drilling and filling of subchondral lesions serves as a useful alternative method to arthroscopic or arthrotomic procedure. The advantage of this operative procedure is seen in the conservation of the articular cartilage and the immediate stabilization of the subchondral bone. All three horses are healthy and without lameness after this intervention. One horse competes in tournaments at intermediate level, another horse takes part in international show-jumping and the third one in advanced level dressage.

Radiographic Identification of Osseous Cyst- Like Lesions in the Distal Phalanx in 22 Lame Thoroughbred Horses Managed Conservatively and Their Racing Performance

“…OCLLs are described at various locations such as in the middle and proximal phalanx, the carpal bones, the third metacarpal/metatarsal bones, the tibia, radius, talus, sesamoid bones, humerus, patella, scapula, tarsal bones, femoral head, and hemimandible ( 4 – 12 ), but the most common location in horses is the medial femoral condyle, followed by the distal phalanx ( 8 ). Within the distal phalanx, OCLLs may develop at various locations but are most commonly located adjacent to the articular surface, with or without a communication to the joint and often found at the center of the proximal aspect of the distal phalanx.…”

Polish Journal of Veterinary Sciences

“…In the use of the conservative therapies on animal patients, there was a significant reduction in lameness but the cyst remained visible in radiological images ( Jackson et al 2008). Some of the surgical techniques that have been used in the studies we reviewed are: 1) Mettenleitner used bone cement for replacement of SBCs after drilling the bones of ulnar joints (Mettenleiter 2014), 2) Santschi stabilized the bone surrounding the cyst using lag screw fixation of the femur condyle (Santschi et al 2015), where there was a 75% success rate in horses within 120 days (complete soundness), 3) arthroscopical techniques in combination with triamcinolone or stem cell administration and/or filling the cyst with bone cement were also described ( Nixon 2010), 4) administration of Total RNA was isolated using the phenol-chloroform method previously described by Chomczynski and Sacchi (Chomczynski andSacchi 1987, Suszynska et al 2007). Genomic DNA digestion and cDNA synthesis were performed using a PrimeScript TM RT Reagent kit with a gDNA Eraser (Takara).…”

“…Most of the cyst communicates with the joint space and this is believed to negatively influence the prognosis. These morphological changes are frequently found in the medial femur condyle, but are not limited to this location and can also be seen in places such as the phalangeal bones, navicular bone, metacarpal or metatarsal bones and many others (von Rechenberg and Auer 2006, Baxter 2011, Mettenleiter 2014. Not only can SBCs be found in different bones but they can also be distributed asymmetrically either in unilateral or bilateral joints (von Rechenberg and Auer 2006, Baxter 2011, McIlwraith 2015.…”