Peer-reviewed veterinary case report
Medial malleolus fragmentation following talocalcaneal arthrodesis by a dorsomedial approach in a horse.
- Journal:
- The Canadian veterinary journal = La revue veterinaire canadienne
- Year:
- 2021
- Authors:
- Espinosa-Mur, Pablo et al.
- Affiliation:
- Department of Clinical Studies · United States
- Species:
- horse
Plain-English summary
A 16-year-old Quarter Horse mare was brought in because she was limping on her right hind leg due to arthritis in her talocalcaneal joint, which is located in her ankle. After some imaging tests, the vet performed surgery to stabilize the joint using screws. Unfortunately, eight weeks later, her condition worsened, and further tests showed that a part of her tibia had broken due to the screws causing repeated stress. The screws were removed, and after a long recovery period, including a check-up two years later, the joint had fully healed, and she was no longer limping.
Abstract
A 16-year-old, Quarter Horse mare was presented for a 3/5 right hind lameness associated with osteoarthritis of the talocalcaneal joint (TCLJ). Positron emission tomography (PET) and computed tomography (CT) demonstrated marked increased uptake of 18F-sodium fluoride and bone remodeling at the medial facet of the TCLJ, respectively. Under general anesthesia 2 cortical screws (4.5 and 5.5 mm) were placed in neutral fashionan arthrotomy from dorsomedial to plantaromedial through the medial facet of the TCLJ followed by copious lavage of the tarsocrural joint. Eight weeks after surgery, observable effusion of the tarsocrural joint was present and lameness had worsened. Radiographic examination revealed a fragmented medial malleolus of the tibia, likely secondary to repetitive trauma of the screw heads during tarsal flexion. Repeated CT showed partial fusion of the TCLJ. Both screws were removed and the tarsocrural joint was thoroughly lavaged arthroscopically. At a 20-month recheck the lameness had not improved, and ultrasound examination revealed severe thickening of the TCLJ capsule. Recheck examination 48 mo after surgery showed complete fusion of the TCLJ and resolution of the lameness. Key clinical message: Diagnosis of osteoarthritis of the TCLJ is challenging. Management by arthrodesis using a dorsomedial approach can result in fragmentation of the medial malleolus, with secondary synovitis and capsulitis of the tarsocrural joint.
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Search related cases →Original publication: https://pubmed.ncbi.nlm.nih.gov/34341600/