This week we had our usual menagerie of different farm calls
and cases. Two that really stuck out to
me were a surgery and a very unusual lameness exam.
I’ll start with the surgery.
This was an apical fracture of
the medial sesamoid bone on a 3 year old standard bred. The radiographs show that it is a complete
fracture and based on measurements it comprised about 25% of the sesamoid. Surgery was done to remove the fractured
portion. This was done under general
anesthesia, and an arthrotomy was performed versus arthroscopy. The fetlock joint is saturated with sterile
saline to allow it to increase in size, as a way to better know where to
incise. An incision is made on the medial side of the fetlock joint, and enters
the joint. The fracture is located and the ligaments connecting the fracture to
P1 are incised. The intersesamoidean
ligament is also incised. Once ligaments
are split, gentle traction is used to separate the fractured portion away. Lavaging of the area is done intermittently
throughout the procedure. The fragment was removed successfully. The joint was
lavaged one last time, and the incisions were sutured. First the synovium of the joint was sutured
using simple interrupted, care being taken to not actually pierce the synovial
membrane. Then the musculature was sutured, simple interrupting. Lastly the skin was sutured with 0-ethylene,
again, simple interrupted. The
procedure from incision to closing took a total of 25 minutes. From induction to being placed in the
recovery stall was a total of 1 hour.
This horse has a good prognosis for life and for his racing career. Articles I read before the surgery stated
that among horses that had already raced, there was a 65% return rate to
racing. In this horses case he has not
raced yet, so his odds may be different, but he still will be able to live a
full life regardless.
| The sesamoid chip after removal |
The next unusual case was a lameness exam that is still
ongoing. This horse has a history of
right hind (RH) stifle issues. These
have generally been resolved as his stifles were injected, although he still
circumducts the RH. We saw him this week
for a 3/5 lameness of the right front (RF).
There were no significant findings on palpation. So we proceeded with
diagnostic nerve blocks(DNB). The
following blocks were done: Palmar
digital nerve (PDN), low 4-point, origin of suspensory (OSL), carpal joints,
and lastly elbow joint. This is the
highest I have ever seen DNBs done, as this horse never improved with any of
the blocks. We decided to then block the
RH stifle in case this was the worst compensatory lameness to be seen. Most compensatory lamenesses will not cause a
3/5 lameness in the compensating leg.
Alas, blocking the RH stifle did not yield any changes, the horse was
still lame. At this point we had
invested about 3 hours on this horse. We
now decided to perform cervical radiographs to see if there were any abnormalities
in the spine. I helped by holding the
plate, and it is crucial that both the one shooting and the person holding the
plate are perfectly in line with the spine, as any obliquity can cause
artifacts and skew the images leading to missed or wrong diagnoses. There was nothing significant seen on those
radiographs, so the plan was to send them to a board certified radiologist for
their interpretation. As of right now,
we still don’t know what is causing this horse to be lame. But he was placed on
some dexamethasone and bute for the next week to calm down any possible
inflammation, soft tissue or otherwise. This could be a transient lameness, as they do
occur, however this horse has a history of different lameness issues and the
client would like to get to the bottom of them.
I helped with some emergency calls this weekend too. We had a few scheduled calls, a repro exam
and caslicks placement. And a scheduled
euthanasia for a gelding with an invasive sarcoid on his penis and sheath that
had created a fistula and some necrosis.
The owners and vet on that case decided it would be the most humane
option for him. We had a shoe-boil that
we cultured for a sensitivity and are treating currently with SMZ’s and SSD
cream. After that I came back to the clinic
ate some dinner and then we got called back out for a choke on a 24 year
old. We resolved it, but because we
heard harsher lung sounds on the right the veterinarian decided to give the
horse gentacin, and place him on SMZs.
Bute was also prescribed to reduce inflammation in the esophagus from
the bolus that caused the choke.
In all it was a busy week and I always learn something new
with each case we see. I’m enjoying my
time here and always learning, I couldn’t have asked for a better summer
experience.
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