EQUINE VETERINARY EDUCATION Equine vet. Educ. (2020) 32 (11) 571 doi: 10.1111/eve.13117_1
Case Report
Surgical treatment of a second metacarpal bone exostosis with associated desmitis of the body of the suspensory ligament in a horse
K. R. Owen* , G. J. Hinnigan, C. E. Smith and M. Smith
Oakhill Veterinary Centre, Preston, UK *Corresponding author email:
rosie.owen@oakhill-vets.com Keywords: horse; suspensory ligament; suspensory body; splint; exostosis; MRI
Summary
This report outlines the diagnosis, surgical treatment and successful outcome following treatment of second metacarpal bone (McII) exostosis with concurrent suspensory ligament desmitis, and persistent lameness in a 5-year-old event horse.
a)
1410 689
–32 c)
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–32 Clinical examination revealed a swelling of the medial, mid-
metacarpal region of the left forelimb (LF), which was painful on palpation with the limb held in flexion. A moderate degree of lameness was observed in trot. Diagnostic analgesia was used to confirm the swelling as the cause of lameness. Ultrasound examination of the limb was performed with
the limb in flexion. Evaluation of the extent of bone pathology and concurrent injury within the body of the suspensory ligament using conventional imaging modalities had its limitations. Conservative management was employed initially, and comprised non-steroidal anti-inflammatory drugs combined with rest. The horse responded favourably for a short period of time, but the swelling and lameness promptly returned following minimal exercise. Low-field, magnetic resonance imaging (MRI) was then
used to determine the full extent of pathology within the suspensory ligament (SL) and adjacent osseous structures and the images were used for surgical planning (Fig 1). Partial ostectomy of McII was performed under general
b)
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anaesthesia. The abnormal portion of McII was transected horizontally, proximal to the level of SL body adherence and impingement, and the affected portion of bone removed. MRI examination was repeated 6 months post-operatively. Images revealed smooth margins to the ostectomised portion of McII and a significant reduction in the degree of inflammation and disruption to the body of the SL. The horse made a gradual return to ridden work and reached its previous level of athletic activity by 9 months following surgery.
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Fig 1: A pre-operative transverse image from T1-weighted gradient echo (GRE) pulse sequence of the proximal metacarpal region of the left forelimb is shown. Lateral is to the right of the image. There is significant enlargement of the mid portion of the second metacarpal bone (McII). There is abnormal increased signal within the abaxial margin of McII and the third metacarpal bone (McIII) either side of the syndesmosis between these bones (oval). There is irregularity of the axial contour of McII with new bone formation evident within the dorsal aspect of the axial margin including an osseous projection which is impinging and extending axially into the dorsomedial body of the suspensory ligament (SLB), evidenced by an abnormal contour of the dorsomedial SLB (arrow). There is abnormal increased signal within both the collagenous and adipose components of the medial aspect of the SLB (arrowhead).
Key points
• Bone exostoses of the small metacarpal bones can be associated with injury of the body of the suspensory ligament, which may result in persistent lameness of the horse.
• Low-field MRI examination can be useful to aid complete evaluation of the bone exostoses and associated body of the suspensory ligament, accurately depicting the extent of pathology affecting both tissues.
• Partial ostectomy of affected second metacarpal bones can result in the resolution of lameness and return to full athletic function.
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