This branch is an important part of the clinic’s work. Orthopaedic cases are referred, which, according to their characteristics, can be broken down as follows:
- Particularly serious cases (fractures, luxations, consequences of falls or significant traumas, serious tendon or ligament injuries, articular infections)
- Acute or chronic lameness
- Slight or sub-clinical lameness, sometimes characterised only by a drop in performance
- In-depth diagnosis of cases already treated by colleagues.
In the first case, the patient often requires an emergency intervention, because in cases of fractures or articular sepsis, the time between onset of the problem and the treatment itself can dramatically change the result. The purely diagnostic part (usually followed immediately by the medical or surgical procedure) generally includes the radiographic and ultrasonographic esamination and, possibly, some laboratory tests, such as an synovial fluid analysis. Race horses are most affected by these pathologies (especially as regards fractures of the proximal phalanx, of the metacarpus/metatarsus, and of the carpal bones), but cases of horses used for amateur activities or kept on pasture are by no means rare.
Cases of acute or chronic lameness are very frequent and call for careful clinical examination (inspection, palpation, examination of the horse in motion), often followed by diagnostic anaesthetic blocks and, finally, by instrumental examinations: radiography, ultrasonography and scintigraphy. Every type of horse is characterised by more frequent clinical disorders.
Here are a some examples: cases of lameness located in the palmar aspect of show jumpers’ ore eventers’ feet, in the carpus of Thoroughbreds, Quarter Horses and young Standardbreds, and those in the metatarsal-phalangeal joint of the Standardbred.
The third group includes disorders that are often not very clear, but which affect the horse’s performance. In these cases, in the absence of a certain diagnosis, some subjects undergo complete radiographic or scintigraphic screening.
The in-depth diagnostics requested by colleagues often refer to instrumental examinations. Very often, in-field work has made it possible to precisely locate the source of the problem. However this requires sophisticated diagnostics with the aid of images. In this sense, the availability of ecography, high powered radiology, scintigraphy and diagnostic arthroscopy complete the work already done.
70 percent of surgical operations concern orthopaedic cases. Most of them regard arthroscopic surgery, i.e. the removal of osteocondral fragments (OCD or chip fractures) from the following joints: tarso-crural, femoro-patellar, metacarpo- or metatarso-phalangeal. The following are also treated by arthroscopy: chip fractures from the extensor process of the third phalanx of the distal interphalangeal joint, dorsoproximal chip fractures of the proximal phalanx in the fetlock joint, chip and slab fractures of the carpal bones and subchondral bony cysts, especially located in the femoro-tibial joint.
Arthroscopy is also used for diagnostic purposes, particularly for ligament or cartilage injuries, and for surgical flushing and cleaning in cases of septic arthritis.
The main fractures are surgically treated through use of implants (generally screws and steel plates), by internal fixation techniques.
This method is frequently used for the following cases: fracture of the proximal phalanx, of the condyle of the metacarpus/metatarsus, of the third carpal bone and rarer long bone fractures, such as those of the metacarpus, radius and ulna.
Other situations receiving treatment are: fractures of the accessory metacarpi/metatarsi, fractures of the proximal sesamoid bones, and mandibular fractures.
Operations on tendons and ligaments are also part of orthopaedic surgery. The most common include: desmotomy of the fetlock annular ligament, desmotomy of the accessory ligament of the superficial digital flexor tendon in the treatment of tendinitis, desmotomy of the inferior check ligament in the treatment of contracted deep digital flexor tendon in the foal, fasciotomy for chronic desmitis of the suspensor ligament in the rear limb, mio-tenectomy of the lateral digital extensor muscle and tendon in the treatment of stringhalt.
This is a continuously expanding sector, now calling for maximum reliability and specificity. Its benefits are reaped by all orthopaedic cases, clinically examined at Bagnarola or sent by colleagues for in-depth study. However, in many cases, diagnostic imaging also concern non-orthopaedic cases such as neurological disorders, subjects with thoracic or abdominal problems as well as problems affecting the uro-genital tract.
The diagnostic imaging department embraces: radiology, ultrasonography and nuclear scintigraphy.
Radiography is still the most reliable investigating method, offering the greatest diagnostic detail. In spite of the advent of newer, more sophisticated methods, especially those focussed on investigating soft tissues in areas that cannot be reached with classic radiology, the radiographic examination represents a cornerstone of diagnostic imaging, and its present day evolution in the digital sphere enhances its versatility.
The Clinic has four radiological units, one of which is particularly high powered and thus able to examine areas that are usually inaccessible in the adult horse, such as the thorax, the thoracic-lumbar vertebral column, and the pelvis.
In the last twenty years, injuries to soft tissues - tendons and ligament in particular - have benefited from the advent and spread of diagnostic ultrasound. Today, ultrasonography provides an accurate diagnostic method, as well as monitoring orthopaedic lesions as they heal.
Ultrasonography has proved to be a crucial tool also in diagnosing non-orthopaedic disorders, especially those affecting the abdomen and thorax.
– Nuclear Scintigraphy
While radiology and ultrasonography provide a so-called anatomical 'photograph' of an injury, scintigraphy provides a 'metabolic' image of the area under examination, and is thus complementary to the other two methods. In the scintigraphic examination, a radioactive isotope (99mtechnetium) is injected in the patient. The isotope is linked to a substance which has a special trophism on the tissue to be investigated. In the case of the skeletal system, methylenediphosphonate is generally used. It fixes where a bone re-modelling process is in progress. At this point, the horse becomes a radioactive source and, according to the structures to be highlighted, examination times after injection vary: after a few seconds for the vascular phases, after thirty minutes for soft tissues, or after about three hours for the bone phase.
A gamma-camera measures radioactive emission and acquires data which it sends to a first computer, which then sends the first images - actual anatomical reconstructions of the skeleton - to a second computer, which processes the images by means of sophisticated software. With this method, one can, for example, diagnose certain fractures which are not yet radiographically visible. Scintigraphy is very highly sensitive but lacks specificity and, therefore, its response should always be examined in depth through radiology and ultrasonography.
The main indications for the use of scintigraphy are: early diagnosis of stress fractures, especially in race horses; diagnosis of cases of lameness the seat of which was identified through a clinical examination but lacking radiographic or ecographic evidence; diagnosis of 'obscure' cases of lameness, i.e. cases that cannot be diagnosed with common clinical means; improved understanding of radiographic patterns uncertainly correlated to clinical evidence; examination of not easily accessible anatomical areas such as the back and pelvis. Scintigraphy is also used in internal medicine, especially for identifying inflammatory focuses that cannot be accessed by other examinations. The gamma-camera at the Bagnarola Equine Clinic is of the latest generation, on the cutting-edge of technology, with a large screen, fully digital, and on a par with the best equipment available in specialised centres both in Europe and the USA.