Page 89 - Manual of Equine Field Surgery
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Distal Check Ligament Desmotomy 85
scar tissue formed may be partly related to the size desrnotomy." Radiographs are useful for evaluat-
of gap between the ends of the check ligament ing the position and architecture of the third
after transection. Excessive scar tissue formation phalanx.
can be minimized by adequate hemostasis, careful Before proceeding with surgery, the horse
and minimal dissection during surgery, and should be examined for sources of pain that are
appropriate bandaging after surgery. Recurrent contributing to the contracture through a pain
contracture is usually due to inadequate hand- withdrawal reflex. In most cases, sources of pain
•
walking during the recovery period, or persistent are related to physitis or foot pathology and are
pain from uncorrected underlying problems ( e.g., treated in conjunction with distal check ligament
severe developmental orthopedic disease, recur- desmotomy. Rarely, other sources of pain such as
rent toe abscesses). shoulder osteochondrosis are present and affect
the prognosis .
.
ALTERNATIVE PROCEDURES
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REFERENCES
Ultrasound Guided Transection
·
Ultrasound guided transection of the distal check 1. Owens JM: Abnormal flexion of the corono-pedal
8
ligament has been described. The technique is joint or "contracted tendons" in unwearied foals,
Equine Vet J 7:40, 1975.
technically more difficult than the traditional 2. Adams SB, Santschi EM: Management of congeni-
technique but can be performed with the horse tal and acquired flexural deformities, Proc Ani Assoc
standing. Equine Pract 46: 117, 2000.
3. Mcilwraith CW, Fessler JF: Evaluation of inferior
check ligament desmotomy for treatment of
Corrective Trimming and Shoeing acquired flexor tendon contracture in the horse, J
Mild cases of DDFT contracture often respond to Am Vet Med Assoc 172:293, 1978.
lowering the heels. The toe then acts as a fulcrum 4. Stick JA, Nickels FA, Williams MA: Long-term
and the weight of the foal forces the coffin joint effects of desmotomy of the accessory ligament of
9
to extend. In some cases treated conservatively, the deep digital flexor muscle in Standardbreds: 23
cases (1979-1989), J Am Vet Med Assoc 200:1131,
lowering the heel alone results in continued pro- 1992.
gression of contracture. This is presumably due to 5. Wagner PC, Grant BD, Kaneps AJ, et al: Long term
pain or damage in the dorsal lamina and third results of desmotomy of the accessory ligament of
phalanx secondary to abnormal weight-bearing the deep digital flexor tendon ( distal check liga-
forces. This is particularly true when after trim- ment) in horses, J Am Vet Med Assoc 187:1351,
ming, the heels do not contact the ground during 1985.
normal weight bearing (Figure 13-12). Select 6. Blackwell RB: Response of acquired flexural defor-
cases of this type have been treated without mity of the metacarpophalangeal joint to desrno-
surgery by lowering the heel and applying a shoe tomy of the inferior check ligament, Proc A1n Assoc
Equine Pract 28:107, 1982.
with a raised heel. The rationale behind this 7. Turner TA, Rosenstein DS: Inferior check desmo-
approach is that it allows for decreased tension on tomy as a treatment for caudal hoof lameness, Proc
the DDFT while allowing the entire foot to be Am Assoc Equine Pract 38:157, 1992.
trimmed and bear weight normally.'? 8. White NA: U1trasound guided transection of the
accessory ligament of the deep digital flexor muscle
( distal check ligament desrnotomy) in horses, Vet
COMMENTS Surg 24:373, 1995.
9. Curtis SJ: Farriery in treatment of acquired
With DDFT contracture, excessive stress on the flexural deformities and a discussion on apply-
toe causes widening of the white line, excessive ing shoes to young horses, Equine Vet Ed 4:193,
1992.
wear of the toe, and in some cases remodeling of 10. Redden RF: A method for treating club feet, Proc
the tip of the third phalanx. Before surgery, the Am Assoc Equine Pract 34:321, 1988.
foot should be checked carefully for subsolar 11. Adams SB, Fessler JF: Distal check desmotomy. In
abscesses near the toe. If abscesses are present, Adams SB, Fessler JF, editors: Atlas of equine
treatment is preferred before distal check ligament surgery, Philadelphia, 2000, WB Saunders.
