Ex vivo study shows novel, rapid, suture-free tenotomy technique for the equine deep digital flexor tendon

OBJECTIVE

To describe the feasibility of a novel thread-transecting technique for the tenotomy of the equine deep digital flexor tendon (DDFT).

ANIMALS

39 equine distal limb specimens.

METHODS

Under ultrasonographic guidance, a surgical thread was percutaneously placed around the DDFT through 2 needle punctures (lateral and medial) using a Tuohy needle in equine limbs (22 forelimbs, 17 hindlimbs). The DDFT was transected by a back-and-forth motion of the thread until the loop emerged from the entry puncture site. Each specimen was dissected and assessed for completeness of transection and iatrogenic damage under direct visualization. Descriptive statistics were reported.

RESULTS

Complete DDFT transection was achieved in all 39 limbs, taking an average of 8.6 minutes per procedure. Iatrogenic damage to surrounding structures occurred in 17 (44%) limbs, with 6 (15%) limbs having more than 1 structure damaged. Damage to the communicating branch of the palmar or plantar nerves was the most commonly seen.

CLINICAL RELEVANCE

DDFT tenotomy in equine limb specimens was effectively performed using a novel thread-transecting technique. The procedure is quick, and no suturing is needed, but damage to surrounding structures is possible. Further assessment of the procedure and clinical significance of its potential iatrogenic damage in clinical cases is needed.

Repair of femoral fractures in calves via external skeletal fixator with intramedullary pin tie-in

OBJECTIVE

To describe the success rate and associated complications of external skeletal fixator/intramedullary pin tie-in for calf femoral fracture fixation.

STUDY DESIGN

Clinical retrospective.

ANIMALS

Ten calves, less than 30 days old, with diaphyseal/metaphyseal femoral fractures.

METHODS

Medical records were reviewed from the University of Wisconsin from 2000 to 2020. Fractures were repaired using open reduction and fixation. An intramedullary Steinman pin was placed, exiting near the greater trochanter, and utilized for fracture reduction. Bicortical transfixation pins were placed distal and proximal to the fracture site. Poly(methyl methacrylate) (PMMA)-filled tubing connected the transfixation pins and proximal intramedullary pin, creating a Type 1a external skeletal fixator (ESF) tie-in. Follow up was obtained via medical records and phone interviews.

RESULTS

Short-term survival rate was 7/10 (70%). Postanesthetic death occurred once. Postoperative complications occurred in all remaining cases. The most common findings were transfixation pin tract lucency and lameness (6/9 cases), implant dysfunction (5/9 cases), and infection (4/9 cases). Three of five cases with long-term follow up survived; all went on to productive careers.

CONCLUSION

Although patients were prone to postoperative complications, short-term survival was comparable to previous reports.

CLINICAL SIGNIFICANCE

The external skeletal fixator/intramedullary (ESF/IM) pin tie-in is less expensive and offers comparable success rates to other methods, providing a lower cost option for calf femoral fracture repair.

Ex vivo evaluation of a percutaneous thread-transecting technique for desmotomy of normal palmar/plantar annular ligaments in horses

OBJECTIVE

To develop and describe a minimally invasive, ultrasound-guided, percutaneous technique for the desmotomy of equine palmar/plantar annular ligaments (PALs) using a transecting thread.

STUDY DESIGN

Ex vivo study.

SAMPLE POPULATION

Twenty-one normal equine distal limb specimens.

METHODS

Under ultrasonographic guidance, a surgical thread was percutaneously placed around the PAL through 2 skin punctures (proximal and distal) using a 18 gauge spinal needle in equine limbs (11 forelimbs, 10 hindlimbs) with normal PALs. The ligament was transected by a back-and-forth motion of the thread until the loop emerged from the proximal skin puncture site. Each specimen was dissected and assessed for completeness of transection and iatrogenic damage under direct visualization. Descriptive statistics were reported.

RESULTS

The PAL was completely transected in 17/21 limbs. The mean duration of the procedure was 16 minutes. Superficial needle puncture or subtle abrasion of the superficial digital flexor tendon was noticed in 4 limbs. No iatrogenic injury to other intrathecal structures was identified. After PAL division, the needle entry and exit points had a mean diameter of 1.2 and 1 mm, respectively.

CONCLUSION

Desmotomy of normal PALs in equine limb specimens was performed effectively using the percutaneous thread-transecting technique with minimal iatrogenic damage to adjacent structures.

CLINICAL SIGNIFICANCE

Information from this study will allow refinement of the technique for use in equine clinical cases either in standing or anesthetized horses.

Standing Intraoral Extraction of the Right Mandibular Third Molar Tooth in a Cow Utilizing Tooth Sectioning

A 2-year-old Holstein heifer presented to a university teaching hospital with an apical tooth infection of the right mandibular third molar. A standing oral extraction technique was attempted for tooth removal; however, the molar could not be delivered intact. A tooth sectioning technique was performed, and the affected molar was successfully delivered. Three months postextraction, the heifer had fully recovered, and the extraction site had healed. To the authors' knowledge, this is the first description of a tooth extraction in a cow using a tooth sectioning technique. This case describes an alternative technique for tooth removal in cattle with an apical tooth infection. The clinical, diagnostic, and therapeutic features of this case may be helpful to clinicians when they approach similar cases in the future.

Impact of endotracheal tube size and cuff pressure on tracheal and laryngeal mucosa of adult horses

OBJECTIVE

To assess the effects of two sizes of silicone endotracheal tubes with internal diameter 26 mm (ETT₂₆) and 30 mm (ETT₃₀) inflated to minimum occlusive volume on tracheal and laryngeal mucosa of adult horses anesthetized for 2 hours with isoflurane.

STUDY DESIGN

Prospective, randomized, blinded, crossover experimental study.

ANIMALS

A total of eight healthy adult mares.

METHODS

Upper airway endoscopy and ultrasound measurements of internal tracheal diameter were performed the day before anesthesia. Horses were anesthetized and orotracheally intubated with ETT₂₆ or ETT₃₀. Ease of intubation was scored. The cuff was inflated in 10 mL increments to produce a seal. Final volume of air used and intracuff (IC) pressure (measured by pressure transducer) were recorded. At the end of anesthesia, a manometer was used to measure IC pressure and these measurements compared against measurements from the pressure transducer. Laryngeal and tracheal mucosa were assessed via endoscopy and assigned a score 0-3 before anesthesia, and at 2 and 24 hours following extubation.

RESULTS

Data are from seven horses because one horse with laryngeal hemiplegia was excluded. Mean tracheal ultrasound measurement was 3.5 ± 0.4 cm. No significant differences were noted between endotracheal tube sizes for intubation score, IC pressures, inflation volumes or tracheal or laryngeal injury scores at any time point. IC pressure measured by manometer was slightly higher than that by transducer (+1.0 ± 2.8 mmHg).

CONCLUSIONS AND CLINICAL RELEVANCE

Results identified no clear advantage of one endotracheal tube size over the other in the population of horses studied, when endotracheal intubation is properly applied and IC pressure is carefully monitored. However, given that ETT₂₆ was associated with the highest observed IC pressures and the only observed incidents of tracheal circumferential erythema, the larger ETT₃₀ may be the better choice in most cases where tracheal size is sufficient.

In vivo evaluation of effects of sedation on results of acoustoelastography of the superficial digital flexor tendons in clinically normal horses

OBJECTIVE To assess the effects of sedation on results of acoustoelastography of the superficial digital flexor tendons (SDFTs) in clinically normal horses. ANIMALS 27 clinically normal horses. PROCEDURES For each horse, the pathology index (PI) for the SDFT of each thoracic limb was determined by use of acoustoelastography at 4 locations (5, 10, 15, and 20 cm distal to the accessory carpal bone). Horses were evaluated before and after they were sedated with a combination of detomidine hydrochloride (0.01 mg/kg, IV) and butorphanol tartrate (0.01 mg/kg, IV). A repeated-measures ANOVA was used for statistical analysis. RESULTS Overall, the PI was lower after sedation than before sedation. In addition, the PI was lower at more distal locations than at more proximal locations. There was not a significant effect of limb (left or right). Differences among individual horses accounted for the largest variance effect. CONCLUSIONS AND CLINICAL RELEVANCE Sedation with detomidine and butorphanol facilitated acoustoelastography; however, it decreased the SDFT PI in clinically normal horses and should be used consistently in prospective studies. Variance associated with each individual horse in the sample population had the greatest effect on the PI.

Horses naturally infected by Trypanosoma vivax in southern Brazil

In this study, we reported the first outbreak of the infection by Trypanosoma vivax in horses in southern Brazil, a non-endemic region where bovines have only recently been found infected by this trypanosome species. We evaluated 12 horses from a farm in southern Brazil, where four horses displayed pale mucous membranes, fever, weight loss, and swelling of abdomen, prepuce, or vulva. The diagnosis of T. vivax was confirmed in four horses by morphological parameters of trypomastigotes in blood smears and species-specific PCR. All T. vivax-infected animals showed anemia, and most showed increased levels of beta-1, beta-2, and gamma globulins. Horses were treated with diminazene aceturate, but cure was not achieved, and the disease relapsed after therapy. These findings demonstrated that Brazilian T. vivax isolates, which were already reported infecting cattle, buffaloes, goats, and sheep, can be highly pathogenic for horses, causing severe disease and even death of the animals due to the recurrence of the infection.