Page 80 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Musculoskeletal system: 1.2 The foal and developing animal 55

VetBooks.ir 1.99 1.100

Fig. 1.99 Severing the inferior check ligament Fig. 1.100 Postoperative results of surgical
(accessory ligament of the deep digital flexor tendon) treatment of the horse in 1.96.
for treatment of the flexural deformity of the distal
interphalangeal joint of the horse in 1.96.

check ligament desmotomy) is recommended reports of success using heel wedges in early
if no improvement occurs in a few weeks, cases. Application of a toe extension combined
depending on the severity of the deformity with a vertical bar (‘fetlock brace’) shoe can
(Figs. 1.99, 1.100). If the deformity is be useful (Fig. 1.101). Dietary restriction to
particularly severe, DDFT tenotomy may lower the carbohydrate and protein intake
be used, although it is emphasised that this and decrease the growth rate is essential, as
is a salvage procedure only. Fortunately this many of these cases are in a period of excessive
is seldom necessary with DIP joint flexural compensatory growth. The use of supplements
deformities as the prognosis following to ensure correct trace element and mineral
accessory ligament section is typically excellent. intake is important. Effective pain control,
by addressing and treating any specific
Postoperative management consists of continuing orthopaedic disease, as well as the careful
with the conservative management techniques out- use of NSAIDs as analgesics, will help the
lined above. Note that it is not uncommon to have a animal to weight bear more normally on the
cosmetic blemish at these incision sites. affected limb(s).
• Surgical. As surgery is frequently unsuccessful
Metacarpophalangeal flexural deformities in correcting this deformity, it is usual
• Conservative. These are among the most practice to take a radical approach and section
frustrating developmental orthopaedic both the AL-DDFT, via the previously
conditions to deal with and neither described open approach, and the accessory
conservative nor surgical treatment is ligament of the superficial digital flexor tendon
particularly effective. Conservative treatment (‘superior check ligament’), via a tenoscopic
is usually only effective in mild deformities. approach. Even when both procedures are
A controlled exercise programme (walking on performed simultaneously and combined
level ground with secure footing) and small- with aggressive management, including
area free exercise are less helpful than with forced exercise on the limb and hopping
DIP joint flexural deformity. The feet should exercises, or use of a fetlock brace, the result
be balanced in both planes and there are some is disappointing.