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Hoof wall avulsion: Three case reports
HOOF WALL AVULSION: THREE CASE REPORTS Janice H. Young, DVM
SUMMARY Three case reports of hoof wounds are presented. Radical surgical avulsion with oral supplementation of d/1 methionine and biotin allowed good healing in all cases.
INTRODUCTION Traumatic foot injuries can range from minor heel grabbing to complete avulsion of large portions of hoof wall. Immediate concerns include damage to soft tissues structures of corium, joints, ligaments, tendon insertions, and bone. Bone fractures and bone sequestration, and coffin joint or navicular bursa infections should be suspected on any deep penetrating wound of the hoof.
CASE 1 A fungal keratitis had caused blindness in the right eye of a 16-year-old Arabian pleasure/broodmare. The owner found the mare in the pen standing in a pool of blood. An avulsed hoof wall was found hanging in a cyclone fence. (Figure l/A) The medial aspect of the right hoof wall had been removed 2 centimeters proximal to the coronary band. The medial collateral cartilage was found within the piece of avulsed hoof.1 Damage to the posterior digital artery and posterior digital nerve were grossly evident. Author's address: HC02, Box 444B, Cave Creek, AZ 85331. Acknowledgement: A special thanks to Burney Chapman, Myron McLane and Scott Simpson for holding my hand as I learn how to walk. 420
Radiographs showed no evidence of coffin bone or navicular bone fracture. The mare would only toe-touch the affectedfoot to the ground. The wound was cleaned of dirt and gravel and wrapped in nitrofurasone ointmenta for the first week. (Figure l/B) Tetanus prophylaxis and sulfa-trimethoprim oral antibiotic b therapy were initiate& Daily bandage changes were necessary to keep the wound free of exudate. A heart bar shoe was applied to the foot.a Only the wall over the t-n-sttwo toe nails was allowed to bear weight on the medial side. (Figure l/C) The frog support afforded by the heart bar shoe carded the weight normally borne by the wall. By leaving the medial wall non-weight-bearing, normal stresses of weight bearing were kept from disturbing the healing of the wound3 Healthy granulation tissue f'llled in the defect. The wound was then wrapped in Panalog ointment.* New coronary band tissue formed and produced infantile horn of a tan, soft nature. With time and wound contraction, the defect has been replaced by normal skin, coronary band and strong hoof wall. The mare is now back to pleasure riding in a plain shoe. (Figure I/D)
CAS E 2 A 5-year-old paint mare, used for show and jumping,2 had been plagued by a quarter crack from a past coronary band injury.6,9 A recent altercation with a piece of sheet metal =Fura-Septin, Anthony Products, Arcadia, CA 91006. bSulfamethoxazone and Trimethoprim Tablets, D.S. Vitarine Pharmaceuticals, Inc., Springfield Gardens, NY 11413 cPanalog Ointment, Solvay Veterinary, inc., Princeton, NJ 08540 EQUINE VETERINARY SCIENCE
Figure 1A.
Figure lC.
Figure 1B.
Figure 1D.
Figure 2A.
Figure 20.
Figure 2B. Volume 8, Number 6, 1988
Figure 2D. 421
Figure 3A.
Figure 3C.
Figure 3B.
Figure 3D.
caused a hoof wall laceration that was dorsal to the quarter crack on the lateral left front foot. (Figure 2/A) Though still attached when the mare was admitted, the horn peeled back easily without hemorrhage and without a local nerve block. (Figure 2/B) A heart bar shoe was constructed. 12The weight-bearing of the lateral wall was only at the first 3 nail holes. A clip was added to prevent spread of the toe wall. (Figure 2/C) Relief from lameness was immediate. Tetanus prophylaxis was administered and bandages were used to keep the wound clean. The mare competed in a jumping event 2 weeks after the application of the heart bar shoe. It is interesting that, although with total avulsion of the hoof wall in this case, a "memory" seam was evident on the new horn in the area of the past quarter crack. (Figure 2/D)
20 minutes in diluted povidone iodine solutionf and wrapped in nilrofurazone ointment. Debridement of the whole medial hoof wall and medial collateral cartilage resulted in very little hemorrhage. This was done under a local low medial palmar nerve block) ° The fractured piece of the coffin bone was removed to prevent the formation of a bone sequestrum. The circumflex artery did bleed after removal of the bone fragment. Hemorrhage was only noticed when the foot was nonweight Mating. When weight was on the foot, no hemorrhage occurred. The whole medial sole and medial frog had been undermined at the time of injury. (Figure 3/B) Heart bar shoes were constructed and applied to both feet. The left foot had a slightly increaseddigital pulse pressure from abnormal weightbearing. On the fight foot, only the medial toe wall was allowed to bear weight on the medial side of the foot. Relief from lameness was moderate as part of the medial frog had been injured and undermined. The wound was packed with nitrofurazone and bandages were changed regularly. When a healthy bed of granulation tissue had filled the defect, the wound was wrapped in Panalog. (Figure 3/C) With time, a new sole and frog formed underneath and were protected by the old sole and frog. An infantile coronary band started to form close to the sole, but as the normal wound contraction progressed the coronary band became more proximally located. New soft horn began to be secreted. (Figure 3/D) On the
CASE 3
A Thoroughbred gelding caught the right medial foot on the bottom guy-wire of a cyclone fence. The wound was discolored, packed with dirt and sawdust, and had a foul smell upon initial examination. (Figure 3/1) The foot was nonweight beating and in much pain. On probing, the wound was found to go down to the bone and the sole of the hoof. Radiographs revealed a displaced wing fracture of the coffin bone.TM The navicular bone was intact, but there was a concem over possible coffinjoint or navicular bursa involvement. Tetanus, phenylbutazone,d and ampicillin ° were administered immediately. The foot was cleaned and soaked for 422
dphen-Buta-Vet tablets, Anthony Products, Arcadia, CA 91006. Amp-Equine, Beecham Laboratories, Bristol, TN 37620 Betadine solution, The Purdue Frederick Co., Norwalk, CT 06856
~
EQUINE VETERINARY SCIENCE
REFERENCES
first reset, a new frog and sole were evident and definite wall formation was underway. The horse was sound on the second reset, with healing of the frog injury.
1. Adams OR: Lameness in Horses, 3rd ed. Lea and Febiger, Philadelphia, PA, p 376, 1962• 2. Baumler, CJ: personal correspondence. 3. Brown, CJ: personal communication. 4. Butler D: The Principles of Horseshoing ll, 2nd ed., Doug Butler Publishing, Mavjville, MO, p 371, 1985. 5. ChapmanB: personal communication. 6. Emery L, Miller J, Van Hoosen N: Horseshoeing Theory and Hoof Care, Lea and Febiger, Philadelphia, PA, p 216-217, 1977. 7. Gabel AA and Bukowiecky CF: Fractures of the Phalanges. The Veterinary Clinics of North America Equine Edition, 5(2):255-257, 1983. 8. Getty R: Sisson and Grossman's Anatomy of the Domestic Animal, Vol. 1., 5th ed., W.B. Saunders Co., Philadelphia, PA, pp 730-735, 1975. 9. Pascoe RR: Diseases of the wall and coronet: Hoof conditions of the horse. Proceedings of the University of Queensland, pp 54-55, 1986. 10. Pasquini C, Reddy VK, Ratzlaff MH: Atlas of Equine Anatomy, 2nd ed. Sudz Publishing, Eureka, CA, p 277, 11. Reid C"F:Fractures of the Third Phalanx. The Veterinary Clinics of North AmericaEquine Edition, 2(1):59-164, 1980. 12. Vlasis C: personal communication.
DISCUSSION Debridement and bandage changes are essential to proper wound management and tissue healing? All 3 of the cases reported here received oral supplementation of d/1 methionine and biotin.g The heart bar shoe was indicated because it supported the boney column and relieved the normal weight bearing stresses from the injured and healing area. Application of a heart bar shoe in cases such as these, provides easy access for wound management and relief from weight bearing lameness, and provides an alternative to casting techniques, which have been the standard treatment in the past) gDX510EagleMillingCo Inc TucsonAZ 85703
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3559 U S 62Star Route Millersburg Ohio 44654 . . (216) 8932933
Equine Endocrine Analysis HORMONAL ASSAY SERVICE FOR VETERINARIANSAND FARM MANAGEMENT RESULTS REPORTED BY PHONE A T NO EXTRA CHARGE RESULTS FOR MOST ASSAYS AVAILABLE ON DAY SAMPLE IS RECEIVED
LH & FSH--Cortisol--T3 & T4--Progesterone PMSG---EstroneSulfate Testosterone TotalEstrogens 6174 Jacks Creek Road Lexington, KY 40515 (606) 273-3036 or 273-0178
R.H. Douglas, PhD, President
[ itality Systems
w N
c
28550N.W.OLSONRD.°GASTON,OREGON97119 TOLL
FOR ORDERING: FREE 1-800.247.7596
IN OREGON Volume 8, Number 6, 1988
1-503-222-1435
'U L T R A
MAKESURE 'OUKNOVVWHAT 'OUARE PA FOR, OURS IS AI_VVAY S . .
M
S
PURE M
®
METHYLSULFONYLMETHANE MSM ® ...... 99.6%MIN. ASSAY WATER...... 0.4% MAX.
OF CONTENTS
ADDITIVES .
.
.
.
.
.
.
.
0.0%
423
SUMMARY Three case reports of hoof wounds are presented. Radical surgical avulsion with oral supplementation of d/1 methionine and biotin allowed good healing in all cases.
INTRODUCTION Traumatic foot injuries can range from minor heel grabbing to complete avulsion of large portions of hoof wall. Immediate concerns include damage to soft tissues structures of corium, joints, ligaments, tendon insertions, and bone. Bone fractures and bone sequestration, and coffin joint or navicular bursa infections should be suspected on any deep penetrating wound of the hoof.
CASE 1 A fungal keratitis had caused blindness in the right eye of a 16-year-old Arabian pleasure/broodmare. The owner found the mare in the pen standing in a pool of blood. An avulsed hoof wall was found hanging in a cyclone fence. (Figure l/A) The medial aspect of the right hoof wall had been removed 2 centimeters proximal to the coronary band. The medial collateral cartilage was found within the piece of avulsed hoof.1 Damage to the posterior digital artery and posterior digital nerve were grossly evident. Author's address: HC02, Box 444B, Cave Creek, AZ 85331. Acknowledgement: A special thanks to Burney Chapman, Myron McLane and Scott Simpson for holding my hand as I learn how to walk. 420
Radiographs showed no evidence of coffin bone or navicular bone fracture. The mare would only toe-touch the affectedfoot to the ground. The wound was cleaned of dirt and gravel and wrapped in nitrofurasone ointmenta for the first week. (Figure l/B) Tetanus prophylaxis and sulfa-trimethoprim oral antibiotic b therapy were initiate& Daily bandage changes were necessary to keep the wound free of exudate. A heart bar shoe was applied to the foot.a Only the wall over the t-n-sttwo toe nails was allowed to bear weight on the medial side. (Figure l/C) The frog support afforded by the heart bar shoe carded the weight normally borne by the wall. By leaving the medial wall non-weight-bearing, normal stresses of weight bearing were kept from disturbing the healing of the wound3 Healthy granulation tissue f'llled in the defect. The wound was then wrapped in Panalog ointment.* New coronary band tissue formed and produced infantile horn of a tan, soft nature. With time and wound contraction, the defect has been replaced by normal skin, coronary band and strong hoof wall. The mare is now back to pleasure riding in a plain shoe. (Figure I/D)
CAS E 2 A 5-year-old paint mare, used for show and jumping,2 had been plagued by a quarter crack from a past coronary band injury.6,9 A recent altercation with a piece of sheet metal =Fura-Septin, Anthony Products, Arcadia, CA 91006. bSulfamethoxazone and Trimethoprim Tablets, D.S. Vitarine Pharmaceuticals, Inc., Springfield Gardens, NY 11413 cPanalog Ointment, Solvay Veterinary, inc., Princeton, NJ 08540 EQUINE VETERINARY SCIENCE
Figure 1A.
Figure lC.
Figure 1B.
Figure 1D.
Figure 2A.
Figure 20.
Figure 2B. Volume 8, Number 6, 1988
Figure 2D. 421
Figure 3A.
Figure 3C.
Figure 3B.
Figure 3D.
caused a hoof wall laceration that was dorsal to the quarter crack on the lateral left front foot. (Figure 2/A) Though still attached when the mare was admitted, the horn peeled back easily without hemorrhage and without a local nerve block. (Figure 2/B) A heart bar shoe was constructed. 12The weight-bearing of the lateral wall was only at the first 3 nail holes. A clip was added to prevent spread of the toe wall. (Figure 2/C) Relief from lameness was immediate. Tetanus prophylaxis was administered and bandages were used to keep the wound clean. The mare competed in a jumping event 2 weeks after the application of the heart bar shoe. It is interesting that, although with total avulsion of the hoof wall in this case, a "memory" seam was evident on the new horn in the area of the past quarter crack. (Figure 2/D)
20 minutes in diluted povidone iodine solutionf and wrapped in nilrofurazone ointment. Debridement of the whole medial hoof wall and medial collateral cartilage resulted in very little hemorrhage. This was done under a local low medial palmar nerve block) ° The fractured piece of the coffin bone was removed to prevent the formation of a bone sequestrum. The circumflex artery did bleed after removal of the bone fragment. Hemorrhage was only noticed when the foot was nonweight Mating. When weight was on the foot, no hemorrhage occurred. The whole medial sole and medial frog had been undermined at the time of injury. (Figure 3/B) Heart bar shoes were constructed and applied to both feet. The left foot had a slightly increaseddigital pulse pressure from abnormal weightbearing. On the fight foot, only the medial toe wall was allowed to bear weight on the medial side of the foot. Relief from lameness was moderate as part of the medial frog had been injured and undermined. The wound was packed with nitrofurazone and bandages were changed regularly. When a healthy bed of granulation tissue had filled the defect, the wound was wrapped in Panalog. (Figure 3/C) With time, a new sole and frog formed underneath and were protected by the old sole and frog. An infantile coronary band started to form close to the sole, but as the normal wound contraction progressed the coronary band became more proximally located. New soft horn began to be secreted. (Figure 3/D) On the
CASE 3
A Thoroughbred gelding caught the right medial foot on the bottom guy-wire of a cyclone fence. The wound was discolored, packed with dirt and sawdust, and had a foul smell upon initial examination. (Figure 3/1) The foot was nonweight beating and in much pain. On probing, the wound was found to go down to the bone and the sole of the hoof. Radiographs revealed a displaced wing fracture of the coffin bone.TM The navicular bone was intact, but there was a concem over possible coffinjoint or navicular bursa involvement. Tetanus, phenylbutazone,d and ampicillin ° were administered immediately. The foot was cleaned and soaked for 422
dphen-Buta-Vet tablets, Anthony Products, Arcadia, CA 91006. Amp-Equine, Beecham Laboratories, Bristol, TN 37620 Betadine solution, The Purdue Frederick Co., Norwalk, CT 06856
~
EQUINE VETERINARY SCIENCE
REFERENCES
first reset, a new frog and sole were evident and definite wall formation was underway. The horse was sound on the second reset, with healing of the frog injury.
1. Adams OR: Lameness in Horses, 3rd ed. Lea and Febiger, Philadelphia, PA, p 376, 1962• 2. Baumler, CJ: personal correspondence. 3. Brown, CJ: personal communication. 4. Butler D: The Principles of Horseshoing ll, 2nd ed., Doug Butler Publishing, Mavjville, MO, p 371, 1985. 5. ChapmanB: personal communication. 6. Emery L, Miller J, Van Hoosen N: Horseshoeing Theory and Hoof Care, Lea and Febiger, Philadelphia, PA, p 216-217, 1977. 7. Gabel AA and Bukowiecky CF: Fractures of the Phalanges. The Veterinary Clinics of North America Equine Edition, 5(2):255-257, 1983. 8. Getty R: Sisson and Grossman's Anatomy of the Domestic Animal, Vol. 1., 5th ed., W.B. Saunders Co., Philadelphia, PA, pp 730-735, 1975. 9. Pascoe RR: Diseases of the wall and coronet: Hoof conditions of the horse. Proceedings of the University of Queensland, pp 54-55, 1986. 10. Pasquini C, Reddy VK, Ratzlaff MH: Atlas of Equine Anatomy, 2nd ed. Sudz Publishing, Eureka, CA, p 277, 11. Reid C"F:Fractures of the Third Phalanx. The Veterinary Clinics of North AmericaEquine Edition, 2(1):59-164, 1980. 12. Vlasis C: personal communication.
DISCUSSION Debridement and bandage changes are essential to proper wound management and tissue healing? All 3 of the cases reported here received oral supplementation of d/1 methionine and biotin.g The heart bar shoe was indicated because it supported the boney column and relieved the normal weight bearing stresses from the injured and healing area. Application of a heart bar shoe in cases such as these, provides easy access for wound management and relief from weight bearing lameness, and provides an alternative to casting techniques, which have been the standard treatment in the past) gDX510EagleMillingCo Inc TucsonAZ 85703
-~ '-
FORAGE • FEEDSTUFF • WATER • SOIL • MANURE ('-
r Bt i!t
~
1M
/
A !~ | A I V ( ~ | ~ M I ~11"~ I.,. I ~ I ~ •
1
III
~
m=B
.
.
An importanttoolin montormgrelationsh,ps betweentraceandmajorminerals
ll I Holmes
/
| |
g/h
L=UU'C=tV'
If,:
In
[
.Reports complete in 2days .Free self-addressed sample bags • Rush service .Other analyses or combinations available
"
1
Call or write for free information brochure:
~
.
.
3559 U S 62Star Route Millersburg Ohio 44654 . . (216) 8932933
Equine Endocrine Analysis HORMONAL ASSAY SERVICE FOR VETERINARIANSAND FARM MANAGEMENT RESULTS REPORTED BY PHONE A T NO EXTRA CHARGE RESULTS FOR MOST ASSAYS AVAILABLE ON DAY SAMPLE IS RECEIVED
LH & FSH--Cortisol--T3 & T4--Progesterone PMSG---EstroneSulfate Testosterone TotalEstrogens 6174 Jacks Creek Road Lexington, KY 40515 (606) 273-3036 or 273-0178
R.H. Douglas, PhD, President
[ itality Systems
w N
c
28550N.W.OLSONRD.°GASTON,OREGON97119 TOLL
FOR ORDERING: FREE 1-800.247.7596
IN OREGON Volume 8, Number 6, 1988
1-503-222-1435
'U L T R A
MAKESURE 'OUKNOVVWHAT 'OUARE PA FOR, OURS IS AI_VVAY S . .
M
S
PURE M
®
METHYLSULFONYLMETHANE MSM ® ...... 99.6%MIN. ASSAY WATER...... 0.4% MAX.
OF CONTENTS
ADDITIVES .
.
.
.
.
.
.
.
0.0%
423