Page 218 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Musculoskeletal system: 1.5 The hindlimb 193

VetBooks.ir 1.371 1.372

1.373

Figs. 1.371–1.373 Bone scan (1.371) and standing
low-field MR image (1.372) of the right hock of a
5-year-old eventer that presented with sudden-onset,
moderately severe, right hindlimb lameness. No
abnormalities were seen radiographically. The bone
scan reveals a focal marked radiopharmaceutical uptake
on the two views, which was confirmed on the MR
image as a complete fracture of the central tarsal bone.
This was repaired with a single lag screw (1.373).

internal fixation. Complete sagittal fractures of the resection either by tenoscopy or open approaches
talus can be repaired by internal fixation, whereas and long-term antibiotic treatment. With large bone
incomplete fractures can be treated conservatively. chips where a significant portion of the flexor surface
Severely comminuted fractures are inoperable and is affected, the fragment should be stabilised using
often lead to euthanasia. Small bone fragments that screws. Slab fractures of the small tarsal bones can
have fractured off the calcaneus should be removed be treated either by box rest or internal fixation, with
or fixed internally. Transverse fractures require similar success rates (Fig. 1.373). In cases where the
internal fixation using bone plates and screws. Open fragments are too small or osteoarthritic changes
comminuted fractures carry a grave prognosis, are evident, surgical drilling to facilitate arthrodesis
and euthanasia is recommended. Chip fractures of of the joints is an alternative option. Attempts can be
the sustentaculum tali require removal via tenos- made to reduce luxations, but this, especially with
copy of the tarsal sheath. Some of these are associ- TC luxation, can be extremely difficult to achieve. If
ated with wounds, with possible tarsal sheath sepsis reduction is successful, the limb should be placed in
and/or focal osteomyelitis requiring more extensive a full limb cast for 4–8 weeks.