Equine bone disorders

Physeal disorders

Most, but not all bones have both a proximal and distal physis.  Growth of the long bone occurs in the physis as most of the cells in the physis are cartilage. Physeal growth also adds to the width of the bone.

https://hoofcare.blogspot.com/2011/06/video-fix-my-crooked-foal-reality-time.html

Growth plate trauma (overload) can lead to fractures but more often impacts growth. If the physis is traumatized, it doesn’t grow as well. Often the trauma is not uniformly distributed. If one side of the physis grows well but the other doesn’t, the limb grows crookedly (angular limb deformities).

In young animals, rapid growth and exuberant exercise can be enough to damage the physis. If the physis is evenly damaged, the limb is just shorter but straight. This is rare. Generally one side of the physis is affected more than the other. The leg then deviates toward the compressed side, creating an angular limb deformity. [Note: ALDs can develop through other pathways too.]

 

Physitis

Physitis= inflammation of the physis.

Physitis can occur due to excessive trauma on a normal physis or to normal trauma on an abnormal physis. Causes include rapid growth due to genetics and/or diet, excessive exercise, uneven weight due to an angular limb deformity (ALD), or abnormal cartilage. If the cause is exercise or growth, the physitis is usually symmetrical. If the physitis is asymmetrical, look for ALDs.

Affected animals show signs of pain – recumbency, knuckling, shaking. The physeal area is swollen and painful on palpation.

Radiographs show mixed density in the physis – a combination of sclerosis and increased lucency.

Physitis is treated with NSAIDs and removing the risk factors (decreased exercise, adjust diet, fix any angular limb deformity).

Angular limb deformities (ALDs)

Angular limb deformities are changes in the frontal plane. Angular limb deformities (ALDs) are named according to the joint that is deviated and describe how the distal limb is moving compared to the proximal limb. (Stand at the shoulder or hock and look down to see what joint is deviating).

  • Valgus = deviation to the lateral side (note both “L”s)
  • Varus = deviation to the medial side
both forelimbs deviate at the carpus and move laterally = carpal valgus

 

bilateral carpal varus

Windswept foals have both a valgus and varus deformity:

The most common versions are carpal valgus, tarsal valgus and fetlock varus. Mild carpal valgus can be protective; <5 degrees in a foal is considered normal. Varus is problematic and needs correction.

Many foals have external rotation of the forelimbs. The toes point outward. However, the limb is straight but is rotated from the shoulder.

This will correct as the horse develops a broader chest. It is important to not diagnose or misdiagnose an ALD if the limb is rotated but straight. Line up with the foot and/or look down from the shoulder.

Not all ALDs come from a physeal abnormality. Other causes include ligamentous laxity and cuboidal bone abnormalities. Newborn foals can just have weak ligaments. These limbs can be straightened manually and you may be able to see changes as they move. These foals should not be lame.

Premature foals often have immature cuboidal bones (the carpal and tarsal bones are still mostly cartilage). Immature bones squash and then ossify in an abnormal shape. 

note how the third tarsal bone squished out the front and ossified that way in the far right image

Diagnosis

To determine the cause of the ALD, radiographs are taken using long plates. Draw a line down the middle of each long bone. Where they intersect is typically the cause of the problem (joint or physis). Radiographs also let you assess the cuboidal bone development.

Treatment

Different physes grow at different rates and for different times.  For correction to work, the physis still needs to be growing. Monitor the more distal joints closely as you have a smaller window of growth.

  • Distal radial physis – most growth by 6 months; closes at 3.5 years.
  • Distal tibia – most growth by 4 months; closes at 2 years
  • Distal MC III/MTIII – most growth by 2 months; closes at 1.5 years
  • The stages of equine skeletal development
    https://equineink.com/2019/08/10/the-stages-of-equine-skeletal-development/

Medical management requires active growth! 

  • control exercise
    • Some weight bearing is fine but more exercise is more trauma. Stall rest is generally indicated.
  • adjust the load on the foot through trimming or hoof wall extensions
    • varus – trim medial aspect or add lateral extension
    • valgus – trim lateral aspect or add medial extension
    • trim to the side of the deformity or put extension on the opposite side
    • increase load on the affected side so increases bone growth
    • more effective for fetlock (whether you want it to be or not)

Surgery is needed if

  • severe angulation (>15 degrees)
  • not enough growth potential left
  • foal is developing a secondary conformational abnormality  (carpus valgus is developing a fetlock varus)
  • economically important

Implants are put on the faster growing side to slow it’s growth and let the other side “catch up”. It is possible to overcorrect so implants need to be removed. Historically we performed periosteal stripping to stimulate the slower growing side. These may or may not have done anything (mother nature fixed them?) but overcorrection was not an issue.  Implants may be a combination of screws and wire as seen in this image (transphyseal bridging) or a single screw placed across the physis (transphyseal screw).

These implants need to be removed if the limb becomes straight and the foal is still growing as the limb can overcorrect.

Physeal fractures

Key Takeaways

Angular limb deformities can occur due to tendon laxity in newborn foals, due to crushed cuboidal bones (due to prematurity and poor ossification), or due to trauma and/or inflammation of the growth plate. Mother nature will fix some of these but success depends on the physis involved and due to the degree of angulation. If the fetlock is involved, surgery is indicated earlier rather than later as this physis closes very early in life. Newborn foals with ALDs should be radiographed to assess cuboidal bone maturity.

Growth plate fusion chart

 

License

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Large Animal Surgery - Supplemental Notes by Erin Malone, DVM, PhD; Elaine Norton, DVM PhD; Erica Dobbs, DVM; and Ashley Ezzo, DVM is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.