Download PDF
Vet Comp Orthop Traumatol 2013; 26(04): 311-317
DOI: 10.3415/VCOT-12-09-0123
Case Report
Schattauer GmbH

Medullary decompression of the radius as treatment for lameness in a horse

L. M. Rubio-Marténez
1   Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, Republic of South Africa
,
A. Carstens
1   Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, Republic of South Africa
› Author Affiliations
Further Information

Publication History

Received 26 September 2012

Accepted 29 January 2013

Publication Date:
19 December 2017 (online)

Also available at
    Permissions and Reprints

Summary

Increased intraosseous pressure (IOP) is a well-characterized source of pain in humans that can be successfully treated by medullary decompression. This report describes the clinical and diagnostic findings, treatment and successful outcome of a horse with a four week long, non-weight bearing lameness secondary to suspected traumaticallyinduced increased IOP in the left radius. Scintigraphic examination characterized by severe increase in radiopharmaceutical uptake within the affected radius aided in the initial localization of the source of lameness. Decompression of the affected radius was performed by drilling two 3.2 mm tracts through the lateral bone cortex into the medullary cavity. Intramedullary pressure in the radius was measured (37-39 mmHg). Dramatic clinical improvement was observed after surgical decompression of the affected bone and the horse showed full recovery and returned to previous exercise use by 12 months after treatment. Gradual decrease in radial radiopharmaceutical uptake was observed during the following year. Increased IOP should be considered as a cause of lameness in horses and scintigraphic examination may aid in its diagnosis. Medullary decompression may be a successful treatment in some cases.

Keywords

Horse - intramedullary pressure - scintigraphy - bone decompression
 

  • References

  • 1 Hungerford DS, Lennox DW. The importance of increased intraosseous pressure in the development of osteonecrosis of the femoral head: implications for treatment. Orthop Clin North Am 1985; 16: 635-654.
    PubMedSearch in Google Scholar
  • 2 Arnoldi CC, Linderholm H, Mussbichler H. Venous engorgement and intraosseous hypertension in osteoarthritis of the hip. J Bone Joint Surg Br 1972; 54: 409-421.
    CrossrefPubMedSearch in Google Scholar
  • 3 Arnoldi CC, Lemperg K, Linderholm H. Intraosseous hypertension and pain in the knee. J Bone Joint Surg Br 1975; 57: 360-363.
    PubMedSearch in Google Scholar
  • 4 Pleasant RS, Baker GJ, Foreman JH. et al. Intraosseous pressure and pathologic changes in horses with navicular disease. Am J Vet Res 1993; 54: 7-12.
    PubMedSearch in Google Scholar
  • 5 Svalastoga E, Smith M. Navicular disease in the horse. The subchondral bone pressure. Nord Vet Med 1983; 35: 31-37.
    PubMedSearch in Google Scholar
  • 6 Wright IM, Kidd L, Thorp BH. Gross, histological and histomorphometric features of the navicular bone and related structures in the horse. Equine Vet J 1998; 30: 220-234.
    CrossrefPubMedSearch in Google Scholar
  • 7 Ostblom L, Lund C, Melsen F. Histological study of navicular bone disease. Equine Vet J 1982; 14: 199-202.
    CrossrefPubMedSearch in Google Scholar
  • 8 Svalastoga E, Reimann I, Nielsen K. Changes of the fibrocartilage in navicular disease in horses. A histological and histochemical investigation of navicular bones. Nord Vet Med 1983; 35: 372-378.
    PubMedSearch in Google Scholar
  • 9 Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br 1985; 67: 3-9.
    PubMedSearch in Google Scholar
  • 10 Mont MA, Ragland PS, Etienne G. Core decompression of the femoral head for osteonecrosis using percutaneous multiple small-diameter drilling. Clin Orthop Relat Res 2004; (429): 131-138.
    PubMedSearch in Google Scholar
  • 11 Mont MA, Tomek IM, Hungerford DS. Core decompression for avascular necrosis of the distal femur: long term followup. Clin Orthop Relat Res 1997; (334): 124-130.
    PubMedSearch in Google Scholar
  • 12 Song WS, Yoo JJ, Kim YM. et al. Results of multiple drilling compared with those of conventional methods of core decompression. Clin Orthop Relat Res 2007; 454: 139-146.
    CrossrefPubMedSearch in Google Scholar
  • 13 Hungerford DS. [Role of core decompression as treatment method for ischemic femur head necrosis]. Orthopade 1990; 19: 219-223.
    PubMedSearch in Google Scholar
  • 14 Jenner F, Kirker-Head C. Core decompression of the equine navicular bone: an in vivo study in healthy horses. Vet Surg 2011; 40: 151-162.
    CrossrefPubMedSearch in Google Scholar
  • 15 Jenner F, Kirker-Head C. Core decompression of the equine navicular bone: an in vitro biomechanical study. Vet Surg 2011; 40: 163-170.
    CrossrefPubMedSearch in Google Scholar
  • 16 Morisset S, Hawkins JF, Kooreman K. High intraosseous pressure as a cause of lameness in a horse with a degloving injury of the metatarsus. J Am Vet Med Assoc 1999; 215: 1478-1480 1448
    PubMedSearch in Google Scholar
  • 17 Anon Lameness scale. Definition and classification of lameness. In: Practitioners AAoE. editor. Guide for Veterinary Service and Judging Equestrian Events. Lexington, Kentucky, USA: Amer Assn of Equine; 1991. p. 19.
    Search in Google Scholar
  • 18 Bassage LH, Ross MW. The antebrachium. In: Ross MW, Dyson SJ. editors. Diagnosis and management of lameness in the horse. St. Louis, Missouri, USA: Saunders Elsevier; 2011. p. 2011-450.
    Search in Google Scholar
  • 19 Whitehair KJ. editor. Regional limb perfusion with antibiotics. 23rd Annual Symposium of the American College of Veterinary Surgeons. 1995. October 29 - November 1 Chicago, IL, USA:
    Search in Google Scholar
  • 20 Mattson S, Boure L, Pearce S. et al. Intraosseous gentamicin perfusion of the distal metacarpus in standing horses. Vet Surg 2004; 33: 180-186.
    CrossrefPubMedSearch in Google Scholar
  • 21 Rubio-Martinez LM, Cruz AM. Antimicrobial regional limb perfusion in horses. J Am Vet Med Assoc 2006; 228: 706-712 655
    CrossrefPubMedSearch in Google Scholar
  • 22 Wilkes CH, Visscher MB. Some physiological aspects of bone marrow pressure. J Bone Joint Surg Am 1975; 57: 49-57.
    CrossrefPubMedSearch in Google Scholar
  • 23 Laroche M. Intraosseous circulation from physiology to disease. Joint Bone Spine 2002; 69: 262-269.
    CrossrefPubMedSearch in Google Scholar
  • 24 Welch RD, Waldron MJ, Hulse DA. et al. Intraosseous infusion using the osteoport implant in the caprine tibia. J Orthop Res 1992; 10: 789-799.
    CrossrefPubMedSearch in Google Scholar
  • 25 Miltner O, Siebert CH, Schneider U. et al. Patellar hypertension syndrome in adolescence: a three-year follow up. Arch Orthop Trauma Surg 2003; 123: 455-459.
    CrossrefPubMedSearch in Google Scholar
  • 26 Graf J, Christophers R, Schneider U. et al. [Chondromalacia of the patella and intraosseous pressure. A study of 43 patients]. Z Orthop Ihre Grenzgeb 1992; 130: 495-500.
    PubMedSearch in Google Scholar
  • 27 Schneider U, Breusch SJ, Thomsen M. et al. A new concept in the treatment of anterior knee pain: patellar hypertension syndrome. Orthopedics 2000; 23: 581-586.
    PubMedSearch in Google Scholar
  • 28 Wilson JW. Blood supply to developing, mature and pathologic conditions. In: Sumner-Smith G, Fackelman GE, editors. Bone in Clinical Orthopedics. Stuttgart: AO Publishing | Thieme; 2002; p. 2002-23.
    PubMedSearch in Google Scholar
  • 29 Stolk PW, Firth EC. Intra-osseous pressure of the equine third metatarsal bone. Cornell Vet 1988; 78: 191-206.
    PubMedSearch in Google Scholar
  • 30 Stolk PW, Firth EC. The relationship between intra-articular and juxta-articular intraosseous pressures in the metatarsophalangeal region of the pony. Vet Q 1994; 16 (Suppl. 02) S81-86.
    PubMedSearch in Google Scholar
  • 31 Simank HG, Graf J, Kerber A. et al. Long-term effects of core decompression by drilling. Demonstration of bone healing and vessel ingrowth in an animal study. Acta Anat (Basel) 1997; 158: 185-191.
    PubMedSearch in Google Scholar
  • 32 Mont MA, Carbone JJ, Fairbank AC. Core decompression versus nonoperative management for osteonecrosis of the hip. Clin Orthop Relat Res 1996; (324): 169-178.
    PubMedSearch in Google Scholar
  • 33 Hejgaard N, Diemer H. Bone scan in the patellofemoral pain syndrome. Int Orthop 1987; 11: 29-33.
    CrossrefPubMedSearch in Google Scholar
  • 34 Ahmad R, Kumar GS, Katam K. et al. Significance of a “hot patella” in total knee replacement without primary patellar resurfacing. Knee 2009; 16: 337-340.
    CrossrefPubMedSearch in Google Scholar
  • 35 Sakai T, Sugano N, Nishii T. et al. Bone scintigraphy for osteonecrosis of the knee in patients with non-traumatic osteonecrosis of the femoral head: comparison with magnetic resonance imaging. Ann Rheum Dis 2001; 60: 14-20.
    CrossrefPubMedSearch in Google Scholar
  • 36 Sakai T, Sugano N, Nishii T. et al. Bone scintigraphy screening for osteonecrosis of the shoulder in patients with non-traumatic osteonecrosis of the femoral head. Skeletal Radiol 2002; 31: 650-655.
    CrossrefPubMedSearch in Google Scholar
  • 37 Dyson S, Murray R. Verification of scintigraphic imaging for injury diagnosis in 264 horses with foot pain. Equine Vet J 2007; 39: 350-355.
    CrossrefPubMedSearch in Google Scholar
  • 38 Harriss FK, Galuppo LD, Decock HE. et al. Evaluation of a technique for collection of cancellous bone graft from the proximal humerus in horses. Vet Surg 2004; 33: 293-300.
    CrossrefPubMedSearch in Google Scholar
  • 39 Brooks DB, Burstein AH, Frankel VH. The biomechanics of torsional fractures. The stress concentration effect of a drill hole. J Bone Joint Surg Am 1970; 52: 507-514.
    CrossrefPubMedSearch in Google Scholar
  • 40 Edgerton BC, An KN, Morrey BF. Torsional strength reduction due to cortical defects in bone. J Orthop Res 1990; 8: 851-855.
    CrossrefPubMedSearch in Google Scholar