EQUINE VETERINARY EDUCATION / AE / SEPTEMBER 2017


473


a)


b)


c)


d)


Fig 1: a) Wound at the dorsomedial aspect of the left hind metatarsus in Case 1 on admission. b) and c) Hoof slough at Day 10 after initial injury. Wound dehiscence, marked cellulitis of the distal limb and necrotic lamellae of the foot. d) Day 21 after the hoof sloughed. Advanced necrosis of the lamellae and complete exposure of the distal phalanx.


nasogastric intubation). On Day 21 there was complete lack of dermal lamellae at the solar aspect of the distal phalanx (Figs 1c,d). Follow-up radiographic examination revealed sequestrum formation at the dorsomedial aspect of MtIII of the left hindlimb on Day 22. On the 23rd day the filly was subjected to euthanasia on humane grounds because of development of contralateral limb laminitis and deterioration of comfort.


Case 2 A 4-year-old Quarter Horse gelding suffered from a traumatic laceration to the plantaromedial aspect of the pastern of the right hindlimb 10 days prior to presentation. The horse was treated conservatively at the farm with NSAIDs (phenylbutazone5 2.2 mg/kg bwt per os q. 12 h) for an unspecified period of time, antimicrobials (Trimethoprim sulfadiazine [Uniprim]6 30 mg/kg bwt per os q. 12 h) and topical antimicrobial cream (nitrofurazone) and with daily hydrotherapy since the initial injury.


On Day 9, after the injury, the owner noticed a discharge


from the coronary band and progressive deterioration of the lameness. On admission, the horse sloughed its hoof capsule (Figs 2a,b). Necrosis of the lamellae at heels, frog and toe was present. The tip of the distal phalanx was completely exposed (Fig 2a). An ultrasonographic examination of the distal limb


revealed a synovitis of the digital flexor tendon sheath and a laceration of the distal plantar annular ligament. Synoviocentesis of the digital flexor tendon sheath and analysis of the synovial fluid revealed a total protein of 38 g/l and WBC 0.270 9 109/l (neutrophils 14%). Distal limb venography (10 ml of iopamidol [Isovue-30]7 in the medial and lateral plantar digital vein) was performed and demonstrated a lack of perfusion at the distomedial portion of the distal phalanx (Fig 2c). Medical treatment with enrofloxacin4 (7.5 mg/kg bwt per


os q. 24 h), phenylbutazone5 (2.2 mg/kg bwt per os q. 12 h) and acepromazine (Atravet)8 (0.01 mg/kg bwt i.m. q. 8 h)


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