• 1.

    Olivier A, Nurton JP, Guthrie AJ. An epizoological study of wastage in Thoroughbred racehorses in Gauteng, South Africa. J S Afr Vet Assoc 1997;68:125129.

    • Search Google Scholar
    • Export Citation
  • 2.

    Riggs CM. Fractures—a preventable hazard of racing Thoroughbreds? Vet J 2002;163:1929.

  • 3.

    Stover SM, Johnson BJ, Daft BM, et al. An association between complete and incomplete stress fractures of the humerus in racehorses. Equine Vet J 1992;24:260263.

    • Search Google Scholar
    • Export Citation
  • 4.

    Stover S. Stress fractures. In: White N, Moore J, eds. Current techniques in equine surgery and lameness. 2nd ed. Philadelphia: WB Saunders Co, 1998;451459.

    • Search Google Scholar
    • Export Citation
  • 5.

    Martin RB, Stover SM, Gibson VA, et al. In vivo fatigue behavior of the equine third metacarpus: remodeling and microcrack damage analysis. J Orthop Res 1996;14:794801.

    • Search Google Scholar
    • Export Citation
  • 6.

    Verheyen KL, Wood JL. Descriptive epidemiology of fractures occurring in British Thoroughbred racehorses in training. Equine Vet J 2004;36:167173.

    • Search Google Scholar
    • Export Citation
  • 7.

    O'Sullivan CB, Lumsden JM. Stress fractures of the tibia and humerus in Thoroughbred racehorses: 99 cases (1992–2000). J Am Vet Med Assoc 2003;222:491498.

    • Search Google Scholar
    • Export Citation
  • 8.

    Ramzan PH, Newton JR, Shepherd MC, et al. The application of a scintigraphic grading system to equine tibial stress fractures: 42 cases. Equine Vet J 2003;35:382388.

    • Search Google Scholar
    • Export Citation
  • 9.

    Chisin R, Milgrom C, Giladi M, et al. Clinical significance of nonfocal scintigraphic findings in suspected tibial stress fractures. Clin Orthop Relat Res 1987;200205.

    • Search Google Scholar
    • Export Citation
  • 10.

    Murray RC, Dyson SJ, Weekes JS, et al. Scintigraphic evaluation of the distal tarsal region in horses with distal tarsal pain. Vet Radiol Ultrasound 2005;46:171178.

    • Search Google Scholar
    • Export Citation
  • 11.

    Weekes JS, Murray RC, Dyson SJ. Scintigraphic evaluation of metacarpophalangeal and metatarsophalangeal joints in clinically sound horses. Vet Radiol Ultrasound 2004;45:8590.

    • Search Google Scholar
    • Export Citation
  • 12.

    Weekes JS, Murray RC, Dyson SJ. Scintigraphic evaluation of the proximal metacarpal and metatarsal regions in clinically sound horses. Vet Radiol Ultrasound 2006;47:409416.

    • Search Google Scholar
    • Export Citation
  • 13.

    Dyson SJ, Weekes JS, Murray RC. Scintigraphic evaluation of the proximal metacarpal and metatarsal regions of horses with proximal suspensory desmitis. Vet Radiol Ultrasound 2007;48:7885.

    • Search Google Scholar
    • Export Citation
  • 14.

    American Association of Equine Practitioners. Guide to veterinary services for horse shows. 7th ed. Lexington, Ky: AAEP, 1999.

  • 15.

    Mackey V, Trout D, Meagher D, et al. Stress fractures of the humerus, radius, and tibia in horses. Vet Radiol 1987;28:2631.

  • 16.

    Dyson SJ. Subjective and quantitative scintigraphic assessment of the equine foot and its relationship with foot pain. Equine Vet J 2002;34:164170.

    • Search Google Scholar
    • Export Citation
  • 17.

    Dyson S, Murray R, Branch M, et al. The sacroiliac joints: evaluation using nuclear scintigraphy. Part 2: lame horses. Equine Vet J 2003;35:233239.

    • Search Google Scholar
    • Export Citation
  • 18.

    Dyson S, Murray R, Branch M, et al. The sacroiliac joints: evaluation using nuclear scintigraphy. Part 1: the normal horse. Equine Vet J 2003;35:226232.

    • Search Google Scholar
    • Export Citation
  • 19.

    Murray RC, Dyson SJ, Weekes JS, et al. Nuclear scintigraphic evaluation of the distal tarsal region in normal horses. Vet Radiol Ultrasound 2004;45:345351.

    • Search Google Scholar
    • Export Citation
  • 20.

    Tucker RL, Schneider RK, Sondhof AH, et al. Bone scintigraphy in the diagnosis of sacroiliac injury in twelve horses. Equine Vet J 1998;30:390395.

    • Search Google Scholar
    • Export Citation
  • 21.

    Ishibashi Y, Okamura Y, Otsuka H, et al. Comparison of scintigraphy and magnetic resonance imaging for stress injuries of bone. Clin J Sport Med 2002;12:7984.

    • Search Google Scholar
    • Export Citation
  • 22.

    Kiuru MJ, Pihlajamaki HK, Hietanen HJ, et al. MR imaging, bone scintigraphy, and radiography in bone stress injuries of the pelvis and the lower extremity. Acta Radiol 2002;43:207212.

    • Search Google Scholar
    • Export Citation
  • 23.

    Fredericson M, Bergman AG, Hoffman KL, et al. Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 1995;23:472481.

    • Search Google Scholar
    • Export Citation
  • 24.

    Arendt EA, Griffiths HJ. The use of MR imaging in the assessment and clinical management of stress reactions of bone in high-performance athletes. Clin Sports Med 1997;16:291306.

    • Search Google Scholar
    • Export Citation
  • 25.

    Wall J, Feller JF. Imaging of stress fractures in runners. Clin Sports Med 2006;25:781802.

  • 26.

    Sofka CM. Imaging of stress fractures. Clin Sports Med 2006;25:5362, viii.

  • 27.

    Diehl JJ, Best TM, Kaeding CC. Classification and return-to-play considerations for stress fractures. Clin Sports Med 2006;25:1728, vii.

  • 28.

    Pepper M, Akuthota V, McCarty EC. The pathophysiology of stress fractures. Clin Sports Med 2006;25:116, vii.

  • 29.

    Gregg PJ, Clayton CB, Fenwick JD, et al. Static and sequential dynamic scintigraphy of the tibia following fracture. Injury 1986;17:95103.

    • Search Google Scholar
    • Export Citation
  • 30.

    Oni OO, Graebe A, Pearse M, et al. Prediction of the healing potential of closed adult tibial shaft fractures by bone scintigraphy. Clin Orthop Relat Res 1989;239245.

    • Search Google Scholar
    • Export Citation

Advertisement

Quantitative analysis of scintigraphic findings in tibial stress fractures in Thoroughbred racehorses

Alejandro Valdés-Martínez DVM1, Gabriela Seiler Dr Med Vet2, Wilfried Mai DVM, PhD3, David M. Bolt Dr Med Vet, MS4, Margaret Mudge VMD5, Sarah A. Dukti DVM6, and Jeremy D. Hubert DVM, MS7
View More View Less
  • 1 Department of Clinical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104-6044.
  • | 2 Department of Clinical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104-6044.
  • | 3 Department of Clinical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104-6044.
  • | 4 Equine Referral Hospital, Royal Veterinary College, University of London, Hatfield, Hertfordshire, AL97TA, England.
  • | 5 Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.
  • | 6 Marion DuPont Scott Equine Medical Center, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech and University of Maryland, Leesburg, VA 24601-0442.
  • | 7 Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803.

Abstract

Objective—To develop a quantitative method of interpreting tibial scintigrams of Thoroughbred racehorses with tibial stress fractures that may facilitate diagnosis of fractures and to provide prognostic information regarding future performance of affected horses.

Animals—35 Thoroughbred racehorses.

Procedures—Static bone-phase scintigrams of tibial stress fractures were quantitatively analyzed by use of ratios of the mean radionuclide counts per pixel in a region of interest (ROI) drawn around the area of increased uptake of radiopharmaceutical to mean counts per pixel in a second ROI drawn around an apparently normal area of the tibial diaphysis. In horses with unilateral fractures, ratios for the contralateral tibia were determined by use of 2 ROIs drawn at the same positions as the ROIs in the fractured tibia. Ratios were compared between fractured versus apparently normal tibias, between horses that returned to racing versus those that did not, and among horses with various grades of lameness. The association between ratios for fractured tibias and intervals between diagnosis and return to racing was also assessed.

Results—Mean ratio of ROIs in apparently normal tibias was 1.35 (95% confidence interval [CI], 1.21 to 1.50); that in tibias with stress fractures was 3.55 (95% CI, 2.50 to 4.60). These ratios were significantly different. None of the associations between ratios for fractured tibias and grades of lameness or performance outcomes were significant.

Conclusions and Clinical Relevance—Tibial stress fracture scintigrams can be quantitatively analyzed. A prospective study with a controlled rehabilitation period is necessary to evaluate the possible applications of this method.

Contributor Notes

Address correspondence to Dr. Valdés-Martínez.