NAVLE Equine Surgery and Lameness 5 — Questions and Answers
Question 1: A 6-year-old warmblood gelding has MRI findings consistent with a deep digital flexor tendon (DDFT) lesion within the hoof capsule. Which treatment has shown the most promise for core lesions of the DDFT in the foot?
- Palmar digital neurectomy alone
- Intralesional injection of platelet-rich plasma (PRP) combined with corrective shoeing (Correct answer)
- Full-limb casting for 6 months
- Deep digital flexor tenotomy
Correct answer: Intralesional injection of platelet-rich plasma (PRP) combined with corrective shoeing
Intralesional PRP combined with corrective shoeing (heel elevation and/or egg bar shoe) is the current evidence-based approach for DDFT core lesions within the foot.
Question 2: A 9-year-old Paint Horse gelding presents with a 3-month history of weight loss, fever of unknown origin, and a firm, non-painful enlargement in the inguinal region. Aspiration reveals thick, greenish pus. What is the most likely diagnosis?
- Inguinal hernia strangulation
- Ulcerative lymphangitis (Corynebacterium pseudotuberculosis abscess) (Correct answer)
- Squamous cell carcinoma of the inguinal lymph node
- Strangles (Streptococcus equi subsp. equi) abscessation
Correct answer: Ulcerative lymphangitis (Corynebacterium pseudotuberculosis abscess)
Corynebacterium pseudotuberculosis causes caseous lymphadenitis (pigeon fever) with characteristic thick, greenish pus in firm subcutaneous or inguinal abscesses, often with systemic signs.
Question 3: When performing an arthroscopic procedure on the equine tarsocrural (tibiotarsal) joint, the surgeon must be aware that the dorsolateral portal is placed just lateral to which tendon?
- Peroneus tertius tendon
- Long digital extensor tendon (Correct answer)
- Lateral digital extensor tendon
- Cranial tibial tendon
Correct answer: Long digital extensor tendon
The dorsolateral portal of the tarsocrural joint is placed lateral to the long digital extensor tendon, which serves as the key anatomical landmark to avoid during portal placement.
Question 4: A 7-year-old Thoroughbred mare undergoes emergency celiotomy for small colon impaction. The surgeon identifies a mesenteric rent through which small intestine has passed and become strangulated. After reducing the hernia and assessing the intestine, the surgeon should:
- Leave the mesenteric rent open to prevent recurrence
- Close the mesenteric rent with simple interrupted sutures after intestinal assessment (Correct answer)
- Perform a bypass anastomosis without closing the rent
- Pack the rent with omentum and close the abdomen
Correct answer: Close the mesenteric rent with simple interrupted sutures after intestinal assessment
Mesenteric rents must be closed after reducing the herniated intestine to prevent recurrence of internal herniation and strangulation.
Question 5: A 4-year-old Quarter Horse shows reluctance to extend the left forelimb fully when walking. On observation, there is a characteristic 'catching' of the hindlimb with the hoof dragging during protraction. Which condition best explains the hindlimb gait abnormality?
- Fibrotic myopathy of the semitendinosus/semimembranosus (Correct answer)
- Upward fixation of the patella
- Stringhalt (Australian stringhalt)
- Shivers
Correct answer: Fibrotic myopathy of the semitendinosus/semimembranosus
Fibrotic myopathy following injury to the caudal thigh muscles causes a characteristic mechanical gait with a sudden caudal 'flip' of the foot during the cranial phase of the stride.
Question 6: A 3-year-old Thoroughbred filly sustained a non-displaced condylar fracture of the third metacarpus during a race. What is the recommended surgical treatment to allow return to racing?
- Stall rest with a full limb cast for 12 weeks
- Internal fixation with cortical lag screws placed perpendicular to the fracture line (Correct answer)
- Condylar resection
- Robert Jones bandage and controlled exercise
Correct answer: Internal fixation with cortical lag screws placed perpendicular to the fracture line
Non-displaced condylar fractures of the third metacarpus are best managed with internal fixation using cortical lag screws to provide interfragmentary compression and allow earlier return to training.
Question 7: Which statement most accurately describes the use of bisphosphonates (e.g., tiludronate) in equine lameness management?
- They are first-line treatment for acute septic arthritis
- They inhibit osteoclast activity and are approved for navicular syndrome and other bone remodeling disorders in horses (Correct answer)
- They stimulate cartilage repair in osteoarthritic joints
- They are contraindicated in horses under 4 years due to growth plate interference
Correct answer: They inhibit osteoclast activity and are approved for navicular syndrome and other bone remodeling disorders in horses
Tiludronate (Tildren) and clodronate (Osphos) are bisphosphonates approved in horses that inhibit osteoclast-mediated bone resorption and are indicated for navicular syndrome and other conditions with pathologic bone remodeling.
NAVLE Equine Surgery and Lameness 5
A 6-year-old warmblood gelding has MRI findings consistent with a deep digital flexor tendon (DDFT) lesion within the hoof capsule.
Which treatment has shown the most promise for core lesions of the DDFT in the foot?