Metacarpophalangeal joint luxation with joint capsule rupture and bone exposure in a horse

https://doi.org/10.17221/170/2019-VETMEDCitation:Borges L., Santos G., Oliveira R., Silva L., de Souza L., Perdigao H., Guimaraes M., Silveira J., Duarte M., Teixeira P. (2020): Metacarpophalangeal joint luxation with joint capsule rupture and bone exposure in a horse. Veterinarni Medicina, 65: 309-313.
download PDF

A 300 kg, 11-month-old quarter horse filly was presented with a joint dislocation in the right anterior limb. The animal was attended at the Federal University of Pará (UFPA) Veterinary Hospital in September 2016, where it was reported that the horse was injured on a fence. On clinical examination, the dislocation of the metacarpophalangeal joint with a rupture of the joint capsule and exposure of bone surfaces was observed, however, with no rupture of the extensor and flexor tendons. Surgery was recommended and the patient was anaesthetised with detomidine (Dormiun V; Agener União, São Paulo, Brazil; 0.04 mg/kg), ketamine (Cetamin; Syntec, São Paulo, Brazil; 0.03 mg/kg/h) and guaiacol glyceryl ether (JA Saúde Animal, São Paulo, Brasil, 0.5 ml/kg/h) i.v. The reconstitution of the joint capsule, lateral collateral ligament (LCL) and the other soft tissues around the injury was performed. A chemical arthrodesis was performed, then the tissue approximation and finally the skin suture. Bandages were applied on the wound with hydrophobic cotton and a Robert-Jones dressing. Systemic treatment was performed with enrofloxacin (Zelotril 10%; Agener União, São Paulo, Brazil; 5 mg/kg) i.m., meloxicam (Maxicam 2%; São Paulo, Brasil; 0.6 mg/kg) i.v. during 10 and 20 days, respectively, then replacing the antibiotic with ceftiofur (Cef 50; Agener União, São Paulo, Brasil; 2.2 mg/kg) i.m. for another 22 days. An iodine solution was applied to the joint optimising arthrodesis. After three and a half months, the lesion was entirely healed and with good movement, so the patient was discharged. This case demonstrates that, with adequate treatment and attention, it is possible to recover the patient’s quality of life.

References:
Ahern BJ, Richardson DW, Boston RC, Schaer TP. Orthopedic infections in equine long bone fractures and arthrodeses treated by internal fixation: 192 cases (1990–2006). Vet Surg. 2010 Jul;39(5):588-93. https://doi.org/10.1111/j.1532-950X.2010.00705.x
 
Jahromi AR, Vajdi N. Successful management of severe open metacarpophalangeal joint dorsal luxation in a horse. J Equine Vet Sci. 2017 Jan 1;48:48-51. https://doi.org/10.1016/j.jevs.2016.08.011
 
Bailey CJ, Reid SW, Hodgson DR, Rose RJ. Impact of injuries and disease on a cohort of two- and three-year-old thoroughbreds in training. Vet Rec. 1999 Oct 23;145(17):487-93.  https://doi.org/10.1136/vr.145.17.487
 
Bischofberger AS, Furst A, Auer J, Lischer C. Surgical management of complete diaphyseal third metacarpal and metatarsal bone fractures: Clinical outcome in 10 mature horses and 11 foals. Equine Vet J. 2009 May;41(5):465-73. https://doi.org/10.2746/042516409X389388
 
Brommer H, Weisler S, Tatz AJ. Facilitated ankylosis of a juvenile, flexurally deformed, open, luxated and infected metacarpophalangeal joint using an alternative approach. Equine Vet Educ. 2010 Aug;22(8):412-9. https://doi.org/10.1111/j.2042-3292.2010.00073.x
 
Bussieres G, Jacques C, Lainay O, Beauchamp G, Leblond A, Cadore JL, Desmaizieres LM, Cuvelliez SG, Troncy E. Development of a composite orthopaedic pain scale in horses. Res Vet Sci. 2008 Oct;85(2):294-306. https://doi.org/10.1016/j.rvsc.2007.10.011
 
Crawley GR, Grant BD, White KK, Barbee DD, Gallina AM, Ratzlaff MH. A modified Cloward’s technique for arthrodesis of the normal metacarpophalangeal joint in the horse. Vet Surg. 1988 May-Jun;17(3):117-27. https://doi.org/10.1111/j.1532-950X.1988.tb00289.x
 
Clutton RE. Opioid analgesia in horses. Vet Clin North Am Equine Pract. 2010 Dec;26(3):493-514.  https://doi.org/10.1016/j.cveq.2010.07.002
 
Davidson EJ. Lameness evaluation of the athletic horse. Vet Clin North Am Equine Pract. 2018 Aug;34(2):181-91. https://doi.org/10.1016/j.cveq.2018.04.013
 
Gao M, Rejaei D, Liu H. Ketamine use in current clinical practice. Acta Pharmacol Sin. 2016 Jul;37(7):865-72. https://doi.org/10.1038/aps.2016.5
 
Guedes AG, Matthews NS, Hood DM. Effect of ketamine hydrochloride on the analgesic effects of tramadol hydrochloride in horses with signs of chronic laminitis-associated pain. Am J Vet Res. 2012 May;73(5):610-9. https://doi.org/10.2460/ajvr.73.5.610
 
Javery KB, Ussery TW, Steger HG, Colclough GW. Comparison of morphine and morphine with ketamine for postoperative analgesia. Can J Anaesth. 1996 Mar;43(3):212-5. https://doi.org/10.1007/BF03011736
 
Leal BB, Alves GE, Douglas RH, Bringel B, Young RJ, Haddad JP, Viana WS, Faleiros RR. Cortisol circadian rhythm ratio: A simple method to detect stressed horses at higher risk of colic? J Equine Vet Sci. 2011 Apr 1;31(4):188-90. https://doi.org/10.1016/j.jevs.2011.02.005
 
Mama KR, Hector RC. Therapeutic developments in equine pain management. Vet J. 2019 May;247:50-6. https://doi.org/10.1016/j.tvjl.2019.02.010
 
Morresey PR, White GW, Poole HM, Hu T, Yin M, Sundman EA. Randomized blinded controlled trial of dipyrone as a treatment for pyrexia in horses. Am J Vet Res. 2019 Mar;80(3):294-99. https://doi.org/10.2460/ajvr.80.3.294
 
Muir WW. Pain therapy in horses. Equine Vet J. 2005 Mar;37(2):98-100. https://doi.org/10.2746/0425164054223831
 
Ruohoniemi M, Laukkanen H, Ojala M, Kangasniemi A, Tulamo RM. Effects of sex and age on the ossification of the collateral cartilages of the distal phalanx of the Finnhorse and the relationships between ossification and body size and type of horse. Res Vet Sci. 1997 Jan-Feb;62(1):34-8. https://doi.org/10.1016/S0034-5288(97)90177-6
 
Sanchez LC, Robertson SA. Pain control in horses: What do we really know? Equine Vet J. 2014 Jul;46(4):517-23. https://doi.org/10.1111/evj.12265
 
Wagner AE. Effects of stress on pain in horses and incorporating pain scales for equine practice. Vet Clin North Am Equine Pract. 2010 Dec;26(3):481-92. https://doi.org/10.1016/j.cveq.2010.07.001
 
Weishaupt MA. Adaptation strategies of horses with lameness. Vet Clin North Am Equine Pract. 2008 Apr;24(1):79-100. https://doi.org/10.1016/j.cveq.2007.11.010
 
Zamos DT, Honnas CM. Principles and applications of arthrodesis in horses. Compend Cont Educ Pract Vet. 1993;15(11):1533-40.
 
download PDF

© 2020 Czech Academy of Agricultural Sciences