Prejudicial findings regarding suitability for intended purpose during pre-purchase examinations in a mixed horse population-A retrospective observational study in the United Kingdom.

BACKGROUND: Pre-purchase examinations (PPEs) are performed for prospective purchasers of horses to identify prejudicial findings that could make animals unsuitable for an intended use. Although this examination process is often standardised, PPEs remain, in large parts, a subjective procedure. In the United Kingdom, PPEs generally consist of either a two stage (two stage vetting [2SV], i.e., general physical examination at rest and basic trot in-hand) or a five stage-examination (five stage vetting [5SV], i.e., general physical exam at rest and after exercise, lameness evaluation including strenuous exercise with re-evaluation after a period of recovery). OBJECTIVES: To identify the proportion of PPEs with prejudicial findings in a mixed horse population in the United Kingdom and to determine those findings. STUDY DESIGN: Retrospective observational study. METHODS: PPE certificates from three first opinion equine practices were reviewed. Data collected included practice identity, examination format (i.e., 2SV or 5SV), PPE outcome, radiographs obtained (yes/no), purchase price, animal signalment, intended use and prejudicial PPE findings, if indicated. Prejudicial findings were grouped in 10 subcategories. Descriptive statistics were obtained for all parameters. Non-normally distributed numeric data between groups were compared using Wilcoxon rank-sum test. Categorical data were compared between groups using Pearson's chi-squared test or Fisher's exact test. RESULTS: Overall, 133 pre-purchase examination certificates were analysed. Seventy-six horses (57.1%) had prejudicial findings: Sixty-one (68.5%) horses undergoing 5SV and 15 (34.1%) of horses undergoing 2SV. Most horses had lameness as the primary prejudicial finding. Horses with a higher purchase price were more likely to undergo 5SV, undergo pre-purchase radiography, and were more likely to have prejudicial findings identified. MAIN LIMITATIONS: Data were obtained retrospectively from PPE certificates from a single mixed horse population and different results may have been obtained by analysing a larger number of animals or PPEs of horses intended for different uses, from different geographical regions or undergoing a different PPE format. The level of competition in the intended discipline for horses was not recorded. Analysed data were limited to the information recorded on the PPE certificates, and the original radiographs, ultrasonography images and other additional diagnostic data were not reviewed. CONCLUSIONS: Lameness was the most common prejudicial PPE finding. More expensive horses were more likely to undergo a 5SV, have pre-purchase radiographs obtained and have prejudicial findings identified. These results may help inform prospective studies examining the merits of 5SV versus 2SV formats and the value of inclusion of additional diagnostic imaging in PPEs in the general horse population.

Changes in Head and Pelvic Movement Symmetry after Diagnostic Anaesthesia: Interactions between Subjective Judgement Categories and Commonly Applied Blocks.

Limited evidence is available relating gait changes to diagnostic anaesthesia. We investigated associations between specific movement patterns and diagnostic anaesthesia of different anatomical structures in a retrospective analysis. Referral-level lameness cases were included with the following criteria: presence of diagnostic anaesthesia of a forelimb and/or hind limb; subjective efficacy classified as "negative", "partially positive", or "positive"; quantitative gait data available from inertial measurement units. Gait changes were calculated for three forelimb (palmar digital, abaxial sesamoid, low 4-point nerve block) and five hind limb diagnostic blocks (tarso-metatarsal, metatarsophalangeal joint block, deep branch of lateral plantar, low 6-point, abaxial sesamoid nerve block). Mixed models (random factor "case", fixed factors "diagnostic anaesthesia type" and "efficacy", two-way interaction) assessed the head and pelvic movement (p < 0.05, Bonferroni correction). Four parameters were significantly affected by forelimb anaesthesia (N = 265) (all p ≤ 0.031) and six by hind limb anaesthesia (N = 342) efficacy (all p ≤ 0.001). All head movement parameters and pelvic push-off asymmetry were significantly affected by the two-way interaction after forelimb anaesthesia (all p ≤ 0.023) and two pelvic movement symmetry parameters by the two-way interaction after hind limb anaesthesia (all p ≤ 0.020). There are interactions between block efficacy and type resulting in changes in weight-bearing and push-off-associated head and pelvic movement symmetry after diagnostic anaesthesia.

Community Asset Mapping in Public Health: A Review of Applications and Approaches.

Though Community Asset Mapping (CAM) has been widely used in community-development and applied to public health interventions, little has been done to synthesize the current state of this approach. This paper reports the findings from a scoping review of research where CAM was applied to public health practice and research initiatives. We identified and reviewed 28 articles featuring studies that used asset mapping for public health purposes. Overall, we found that the purpose and methods related to asset mapping varied widely across studies. Given the potential benefits of asset mapping and its relevance to social work principles, researchers and public health professionals should approach asset mapping with the same level of attention, rigor, and ethics as other research methodologies or intervention design. There is an obligation to engage in asset mapping in ways that promote our ethical principles of service, dignity, integrity, and competence.

Changes in Head, Withers, and Pelvis Movement Asymmetry in Lame Horses as a Function of Diagnostic Anesthesia Outcome, Surface and Direction.

Evaluation of diagnostic anesthesia during equine lameness examination requires comparison of complex movement patterns and can be influenced by expectation bias. There is limited research about how changes in movement asymmetries after successful analgesia are affected by different exercise conditions. Movement asymmetry of head, withers and pelvis was quantified in N = 31 horses undergoing forelimb or hindlimb diagnostic anesthesia. Evaluation on a straight line and a circle was performed with subjective diagnostic anesthesia outcome and quantitative changes recorded. Mixed linear models (P < .05) analyzed the differences in movement asymmetry before/after diagnostic anesthesia - random factor: horse, fixed factors: surface (soft, hard), direction (straight, inside, outside, inside-outside average), diagnostic anesthesia outcome (negative, partially positive, positive) and two-way interactions. Forelimb diagnostic anesthesia influenced primary movement asymmetry (all head and withers parameters) and compensatory movement asymmetry (two pelvic parameters) either individually (P≤.009) or in interaction with surface (P≤.03). Hindlimb diagnostic anesthesia influenced primary movement asymmetry (all pelvic parameters) and compensatory movement asymmetry (two head and two withers parameters) either individually (P≤.04) or in interaction with surface (P≤.01;) or direction (P≤.006). Direction was also significant individually for two pelvic parameters (P≤.04). Changes in primary movement asymmetries after partially positive or positive outcomes indicated improvement in the blocked limb. Compensatory changes were mostly in agreement with the 'law of sides'. The changes were more pronounced on the hard surface for hindlimb lameness and on the soft surface for forelimb lameness. Withers asymmetry showed distinct patterns for forelimb and hindlimb lameness potentially aiding clinical decision-making.

Linear Discriminant Analysis for Investigating Differences in Upper Body Movement Symmetry in Horses before/after Diagnostic Analgesia in Relation to Expert Judgement.

Diagnostic analgesia and lunging are parts of the equine lameness examination, aiding veterinarians in localizing the anatomical region(s) causing pain-related movement deficits. Expectation bias of visual assessment and complex movement asymmetry changes in lame horses on the lunge highlight the need to investigate data-driven approaches for optimally integrating quantitative gait data into veterinary decision-making to remove bias. A retrospective analysis was conducted with inertial sensor movement symmetry data before/after diagnostic analgesia relative to subjective judgement of efficacy of diagnostic analgesia in 53 horses. Horses were trotted on the straight and on the lunge. Linear discriminant analysis (LDA) applied to ten movement asymmetry features quantified the accuracy of classifying negative, partial and complete responses to diagnostic analgesia and investigated the influence of movement direction and surface type on the quality of the data-driven separation between diagnostic analgesia categories. The contribution of movement asymmetry features to decision-making was also studied. Leave-one-out classification accuracy varied considerably (38.3-57.4% for forelimb and 36.1-56.1% for hindlimb diagnostic analgesia). The highest inter-category distances (best separation) were found with the blocked limb on the inside of the circle, on hard ground for forelimb diagnostic analgesia and on soft ground for hindlimb diagnostic analgesia. These exercises deserve special attention when consulting quantitative gait data in lame horses. Head and pelvic upward movement and withers minimum differences were the features with the highest weighting within the first canonical LDA function across exercises and forelimb and hindlimb diagnostic analgesia. This highlights that movement changes after diagnostic analgesia affect the whole upper body. Classification accuracies based on quantitative movement asymmetry changes indicate considerable overlap between subjective diagnostic analgesia categories.

Measurement accuracy of foot conformation parameters on low-field magnetic resonance images in horses.

Foot imbalance and malalignment of the digits are common in horses. Angle and distance measurements performed on bones, joints and hoof wall on radiographs provide essential guidance for precise corrective trimming and shoeing. This study aimed to investigate, if selected standing low-field magnetic resonance (MR) images can be used to accurately measure dorsopalmar and lateromedial foot conformation parameters in comparison to the radiographic gold standard. Images of 100 horses referred for standing low-field MR examination were selected. Foot conformation angles and distances were measured and compared between radiographs and MR images. Measurements from most imaging sources were significantly different from each other. Moderate to high correlation of foot conformation angles between radiographs and MR images in the lateromedial and dorsopalmar planes was found, with exception of the proximal interphalangeal joint angle, where there was only moderate agreement between radiographs and the 5-plane MR pilot (0.47, P < .001) and between radiographs and the 3-plane MR pilot (0.4, P < .001), respectively. Measurement of foot conformation parameters from low-field MR images should be used with caution in clinical practice and acquisition of current foot radiographs immediately before or after MR examination should be considered to facilitate precise trimming and shoeing.

Retrospective analysis of oblique and straight distal sesamoidean ligament desmitis in 52 horses.

BACKGROUND: Injuries to the oblique (ODSL) or straight (SDSL) distal sesamoidean ligaments are a recognised cause of distal limb lameness in the horse. However, there are only limited publications addressing common diagnostic features and prognosis. OBJECTIVES: (a) Report findings on ultrasonography and standing low-field magnetic resonance imaging (sMRI) in horses with ODSL or SDSL injury; (b) Identify clinical variables associated with lesion type and (c) Identify factors associated with return to soundness in horses with ODSL or SDSL injury. STUDY DESIGN: Retrospective case series. METHODS: Horses with a primary diagnosis of ODSL or SDSL injury confirmed with a combination of diagnostic analgesia and detection of a lesion on imaging (ultrasonographic ± advanced imaging) were included. Return to soundness and performance follow-up data were obtained. RESULTS: Fifty-one horses were included. SDSL injuries were more common in the forelimb (13/21, 62%), while ODSL injuries had equal frequency in fore- (15/30, 50%) and hindlimbs (15/30, 50%). ODSL injuries were more likely than SDSL injuries to affect the proximal third of the ligament (OR =13; 95% CI 2.3-74.3; p = 0.004) and often presented with periligamentar swelling (20/30;67%) and focal pain (22/28;79%). Lesions were frequently detected using ultrasonography (35/42;83%) and sMRI examination (18/25;72%). Only 27/49 cases (55%) returned to soundness, with only 15/49 (31%) returning to intended use. There were no significant associations between outcome and clinical features or treatment. MAIN LIMITATIONS: There was no comparative "gold standard" to validate lesions such as high-field MRI or histopathology. CONCLUSIONS: In contrast to previous studies, ODSL and SDSL injuries were readily identified ultrasonographically using appropriate views, and with sMRI. Given the limited availability, cost and general anaesthetic risks associated with high-field MRI, more focus should be placed on optimising the ultrasonographic examination. Owners of affected horses should be informed of the guarded prognosis for return to full use.

Ultrasonographic visualisation of the mesenteric vasculature in horses with large colon colic.

BACKGROUND: Ultrasonographic visualisation of the mesenteric vasculature of the large colon (LC) from the right side of the abdomen in cases of displacement and volvulus has been described. However, the LC can move freely within the abdomen and its mesentery can potentially contact both sides of the abdominal wall. METHODS: Thirty-four horses presented with LC-related colic that had visible LC mesenteric vasculature visible on abdominal ultrasound were included. A control group was made including horses with confirmed small intestinal-related colic. The objective of this study was to evaluate the visibility of LC mesenteric vasculature with transabdominal ultrasonography in horses with LC-related colic and to determine its diagnostic value. RESULTS: The LC mesenteric vasculature was identified on the right side of the abdomen in 16/34 horses with right dorsal displacement of the LC (RDDLC), 180° LC volvulus (LCV), 540° LCV or LC impaction. On the left side of the abdomen, LC mesenteric vessels were identified in 17/34 horses with left dorsal displacement of the LC (LDDLC), 180° LCV or RDDLC. Vessels were visualised on both sides in one horse with a 180° LCV. Presence of LC mesenteric vasculature in the dorsal aspect on the left side of the abdomen was significantly associated with LDDLC. CONCLUSION: LC mesenteric vasculature can be visualised on transabdominal ultrasound from either side of the abdomen in horses with different forms of LC-related colic.

Prevalence of Electrolyte Disturbances and Perianesthetic Death Risk Factors in 120 Horses Undergoing Colic Surgery.

The objective of this study was to determine the prevalence of intraoperative electrolyte disturbances and risk factors associated with perianesthetic death in horses undergoing colic surgery. The files of 120 horses meeting the inclusion criteria were reviewed. Data retrieved from the medical records, including demographic data and the occurrence of electrolyte disturbances and other intraoperative complications, were analyzed with a two step-approach by univariate and multivariate logistic regression models. Hypocalcemia was the most represented electrolyte disturbance (52.5%), followed by hypokalemia (30.0%) that was associated with intraoperative administration of salbutamol (P = .045). Perianesthetic death occurred in 46 horses, accounting for an overall mortality rate of 38.3%. Risk factors associated with death were anesthetic duration (P = .001), body weight (P = .020), presence of gastric reflux before anesthesia (P = .021), and intraoperative tachycardia (P = .043) and acidosis (P = .025). The mortality in the study population was comparable to previously reported findings. Based on the study findings, it is advisable to optimize hemodynamics prior to anesthesia, in order to prevent intraoperative tachycardia that is associated with increased risk of death. Heavier horses and those with gastric reflux may have a higher risk of fatalities, and intraoperative salbutamol administration may contribute to hypokalemia.

THE MANAGEMENT OF AN ORAL ANAPLASTIC SARCOMA IN A PYGMY HIPPOPOTAMUS (CHOEROPSIS LIBERIENSIS) USING INTRALESIONAL CHEMOTHERAPY.

An adult female captive pygmy hippopotamus (Choeropsis liberiensis) was diagnosed with an oral anaplastic sarcoma. The tumor was surgically debulked and intralesional chemotherapy with mitomycin C (0.4 mg/cm3 of tumor) and cisplatin (1 mg/cm3 of tumor) was administered. Chemotherapeutic treatment proved difficult due to the risks of repeated anesthetics and unknown drug efficacies. Marked proliferation of the mass was observed during estrus, and chemotherapy was repeated as an experimental treatment to slow tumor progression in order for the animal to remain in the species breeding program. Tumor proliferation was detected during the first trimester of pregnancy; however, in the lactation period, the mass became quiescent. No adverse reactions to chemotherapeutic drugs were observed and the animal continues to be monitored for tumor progression. This is the first report of an anaplastic sarcoma and of chemotherapy use in a pygmy hippopotamus and it highlights logistical considerations for treating neoplasia in this species.

A pilot study of the effects of acupuncture treatment on objective and subjective gait parameters in horses.

OBJECTIVES: To investigate whether acupuncture can alter gait in horses as assessed by objective and subjective parameters. STUDY DESIGN: Prospective, randomized, singleblinded, crossover study. ANIMALS: Eight adult horses. METHODS: Horses were randomly assigned to a treatment (three acupuncture treatments in 8 days) or control group. Subjective and objective gait analyses were performed before and after each treatment and at 1, 3 and 7 days after the last treatment (time-points 1-9, respectively). Horses were assessed at the trot in a straight line on a hard surface and on the lunge on the left and right reins on a soft surface (conditions 1-3, respectively). After 12 weeks, groups were reversed. Objective gait analysis was performed using inertial sensors and subjective analysis by two board- certified surgeons who reviewed video-recordings. Each limb was assessed for lameness before and after treatment. Lameness and global scores were assigned using 4-point scales. Assessors were blinded to treatment status. The effects of treatment (yes/no), time (1-9) and horse under conditions 1 -3 were compared using a linear mixed-effects model and a generalized estimating equation. RESULTS: Treatment decreased hip hike difference under all conditions [condition 1: control, 6.3 ± 6.4 mm versus treatment, -0.2 ± 6.4 mm (p = 0.007); condition 2: control, 9.7 ± 7.8 mm versus treatment, 2.8 ± 7.8 mm (p = 0.032); condition 3: control, 7.3 ± 6.3 mm versus treatment, -2.7 ± 6.4 mm (p = 0.003)]. Other parameters also improved significantly under conditions 1 and 3. Based on subjective gait analysis, treatment decreased lameness [odds ratio (OR) 0.51, 95% confidence interval (CI) 0.34-0.78; p = 0.002] but not global (OR 0.53, 95% CI 0.24-1.10; p = 0.12) scores. CONCLUSIONS AND CLINICAL RELEVANCE: Acupuncture can change horses' gaits to a degree appreciable by objective and subjective analyses.

Indications, complications, and outcome of horses undergoing repeated celiotomy within 14 days after the first colic surgery: 95 cases (2005-2013).

OBJECTIVE: To examine factors associated with short- and long-term prognosis for horses undergoing repeated celiotomy within 14 days after the first colic surgery. DESIGN: Retrospective case series. ANIMALS: 95 horses that had undergone 2 celiotomies within a 14-day period between 2005 and 2013 at 3 equine referral hospitals. PROCEDURES: Historical, clinical, and laboratory data were compared between horses that did not survive and horses that did survive to hospital discharge (short-term survival rate) and to > 3 and > 6 months after hospital discharge (long-term survival rates). RESULTS: Strangulating small intestinal lesions were the most common finding during the first celiotomy (60/95 [63.2%]), and persistent gastric reflux was the most common reason for the second celiotomy (56/95 [58.9%]). Reasons for a second celiotomy were not associated with survival rate. For horses that had long-term follow-up, 22 of 92 (23.9%) survived > 6 months after hospital discharge. Two of 13 horses with intestinal resections during both surgeries survived to > 6 months after hospital discharge. Compared with horses not undergoing intestinal resection, significantly fewer horses requiring resection during 1 or both surgeries survived to hospital discharge and to > 3 and > 6 months after hospital discharge. Incisional infections occurred in 68.4% (26/38) of horses that survived to hospital discharge, and 31.6% (12/38) developed incisional hernias or dehiscence. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that the prognosis for horses undergoing repeated celiotomy is guarded, and intestinal resection negatively affects the long-term survival rate.

Design and validation of a computer-aided learning program to enhance students' ability to recognize lameness in the horse.

The ability to recognize lameness in the horse is an important skill for veterinary graduates; however, opportunities to develop this skill at the undergraduate level are limited. Computer-aided learning programs (CALs) have been successful in supplementing practical skills teaching. The aim of this study was to design and validate a CAL for the teaching of equine lameness recognition (CAL1). A control CAL was designed to simulate learning by experience (CAL2). Student volunteers were randomly assigned to either CAL and tested to establish their current ability to recognize lameness. Retesting occurred both immediately following exposure and 1 week later. At each test point, the number of correct responses for forelimb and hind limb cases was determined. Student confidence was assessed before and after CAL exposure, with previous opportunities to recognize lameness taken into account. Immediately following exposure, the number of correct responses was significantly higher for CAL1 than for CAL2, both overall and for forelimb cases but not for hind limb cases. After 1 week, the CAL1 group performed significantly better overall compared to the CAL2 group, with no significant difference between forelimb and hind limb cases. Student confidence and ability to recognize lameness were significantly improved following exposure to CAL1. When considered as one category, students in years 4 and 5 performed significantly better than year 3 students. Gender did not significantly affect performance. CAL1 could be used to supplement current lameness recognition opportunities. CAL1 is, however, limited in its ability to improve lameness recognition, especially in relation to hind limb lameness where it was unable to attain a significant difference from CAL2.

Design and validation of a simulator for equine joint injections.

Joint injections are commonly used in equine practice for diagnosis and treatment of joint disorders. Performing joint injections is hence an essential skill for equine practitioners. However, opportunities for veterinary students to practice this skill are often scarce in veterinary curricula. The aim of this study was to design and validate an equine joint injection simulator. We hypothesized that the simulator will enhance student ability and confidence in performing joint injections. The simulator was constructed around an equine forelimb skeleton with soft tissues rebuilt using building foam and rubber bands. An electrical circuit including a buzzer, a battery, wire wool in the joints, and a hypodermic needle at the end of the cable was incorporated. If the students placed the needle into the joint correctly, instant auditory feedback was provided by the buzzer. To validate the simulator, 45 veterinary students were allocated to three groups: cadaver limb, textbook, or simulator. Students' ability to perform joint injections was tested and students' opinions were evaluated with a questionnaire. The proportion of students performing a metacarpophalangeal (MCP) joint injection correctly was significantly higher in the cadaver (93%) and simulator (76%) groups compared to the textbook group (50%). There was no significant difference between groups for performing a distal interphalangeal (DIP) joint injection correctly. Students rated the learning experience with the cadaver and simulator group high and with the textbook group low. The joint injection simulator represents an affordable teaching aid that allows students to repeatedly practice this skill in their own time with immediate feedback.

Variation in foot conformation in lame horses with different foot lesions.

Foot conformation in the horse is commonly thought to be associated with lameness but scientific evidence is scarce although it has been shown in biomechanical studies that foot conformation does influence the forces acting on the deep digital flexor tendon (DDFT) and the navicular bone (NB). The aim of this study was to determine the relationships between foot conformation and different types of lesion within the foot in lame horses. It was hypothesised that certain conformation parameters differ significantly between different types of foot lesions. Conformation parameters were measured on magnetic resonance images in the mid-sagittal plane of 179 lame horses with lesions of their deep digital flexor tendon (DDFT), navicular bone (NB), collateral ligaments of the distal interphalangeal joints and other structures. Conformation parameters differed significantly between lesion groups. A larger sole angle was associated with combined DDFT and NB lesions, but not with NB lesions alone. A more acute angle of the DDFT round the NB was associated with DDFT and NB lesions, and a lower heel height index with DDFT injury. The larger the sole angle the smaller the likelihood of a DDFT or NB lesion with odds ratios of 0.86 and 0.90, respectively. This study shows an association between foot conformation and lesions but it does not allow the identification of conformation as causative factor since foot conformation may change as a consequence of lameness. Future studies will investigate foot-surface interaction in lame vs. sound horses, which may open a preventative and/or therapeutic window in foot lame horses.

The complex role of veterinary clinical teachers: how is their role perceived and what is expected of them?

The purpose of this study was to identify personal attributes in veterinary clinical teachers that are valued most by members of their work environment (fellow faculty, clinical training scholars [CTS; residents], undergraduate students, and referring veterinary surgeons) and to determine whether the opinions of these subgroups differed. Faculty (n=50), CTS (n=35), students (n=200), and referring veterinary surgeons (n=25) were presented with a list of 15 potentially desirable attributes. Respondents were asked to rank the three most important and the three least important attributes of effective clinical teachers. Respondents were also asked to select in which of the three main activities (clinical service, teaching, or research) in which clinical teachers currently invest the most and the least effort and in which they should invest the most and the least effort. All respondent groups agreed that "competence-knowledge" was among the most desirable attributes. Faculty, undergraduate students, and referring veterinary surgeons additionally included "enthusiasm" in the top three, whereas CTS regarded "respects independence" as more important. All respondent groups consistently chose "scholarly activity" as one of the three least important characteristics. A similar number of faculty members (38%) expressed that the greatest effort should be invested in clinical service or teaching, and the greatest proportions of CTS (44%) and students (56%) felt that most emphasis should be put on teaching alone. The differences in opinion between respondent groups regarding importance of attributes and emphasis of activity indicate that what is perceived as effective performance of clinical teachers differs depending on the role of those who engage with them.

Diagnosis, management, and outcome in 19 horses with deltoid tuberosity fractures.

OBJECTIVE: To describe the diagnosis and treatment of fractures of the deltoid tuberosity. STUDY DESIGN: Case series. METHODS: Medical records (1992-2009) of 19 horses with radiographic confirmation of deltoid tuberosity fractures were reviewed. Data retrieved included signalment, clinical and diagnostic imaging findings, and treatment. Outcome was determined by telephone questionnaire of owners and referring veterinarians. RESULTS: Most horses were markedly lame on admission and 53% had reduced protraction of the affected limb. All fractures were identified on a cranio45° medial-caudolateral oblique projection; however, only 32% (6 horses) were detected on a mediolateral projection whereas 86% were evident ultrasonographically. Treatment by local wound care and stall rest resulted in return to athletic function without lameness for 13 of 14 horses that had follow-up. CONCLUSIONS: A cranio45° medial-caudolateral oblique radiographic view was better than a mediolateral projection for identification of deltoid tuberosity fractures. Ultrasonographic detection of fractures was similar except when gas accumulation obscured the fracture site. Deltoid tuberosity fractures can cause severe lameness but can be treated successfully with conservative management.

Anti-inflammatory and analgesic effects of intra-articular injection of triamcinolone acetonide, mepivacaine hydrochloride, or both on lipopolysaccharide-induced lameness in horses.

OBJECTIVE: To assess analgesia, inflammation, potency, and duration of action associated with intra-articular injection of triamcinolone acetonide (TA), mepivacaine hydrochloride, or both in metacarpophalangeal (MCP) joints of horses with experimentally induced acute synovitis. ANIMALS: 18 horses. PROCEDURES: Both forelimbs of each horse were injected with lipopolysaccharide (LPS) 3 times. After the first LPS injection, 1 forelimb of each horse was treated with intra-articular injection of mepivacaine (80 mg; n=6), TA (9 mg; 6), or mepivacaine with TA (same doses of each; 6) 12 hours after the initial LPS injection. Contralateral limbs served as control limbs. Joint pain was assessed via lameness score and measurements of vertical force peak and pain-free range of motion of the MCP joint. Periarticular edema was evaluated. Degree of synovial inflammation was determined via synovial fluid analysis for WBC count and total protein concentration. Samples of plasma and synovial fluid were analyzed for TA and mepivacaine concentrations. RESULTS: Each injection of LPS induced lameness and joint inflammation. Mepivacaine effectively eliminated lameness within 45 minutes after injection, regardless of whether TA was also administered, whereas TA reduced lameness, edema, and concentration of synovial fluid protein after the second LPS injection, regardless of whether mepivacaine was also injected. Treatment with TA also induced higher WBC counts and mepivacaine concentrations in synovial fluid, compared with results for mepivacaine alone. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested TA is a potent analgesic and anti-inflammatory medication for acute synovitis in horses and that simultaneous administration of mepivacaine does not alter the potency or duration of action of TA.