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Modified abaxial approach for resection of the distal sesamoid bone and distal interphalangeal joint while preserving the digital flexor tendons of three Angus bulls with septic arthritis

Sarel R. van Amstel BVSc, MMedVet1, David E. Anderson DVM, MS2, and Ricardo Videla DVM, MS3
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  • 1 Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996.
  • | 2 Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996.
  • | 3 Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996.

Abstract

CASE DESCRIPTION 3 Angus bulls, aged 2 to 3 years, with severe lameness of 2 to 4 weeks' duration and swelling proximal to the coronary band of the affected limb were evaluated after failing to respond to antimicrobial treatment.

CLINICAL FINDINGS Septic arthritis of a distal interphalangeal joint (DIPJ) was diagnosed in all 3 bulls on the basis of results of a physical examination, radiographic and ultrasonographic evaluations of the affected foot, and cytologic evaluation of synovial fluid from the affected DIPJ.

TREATMENT AND OUTCOME A novel modified abaxial approach was used to resect the infected distal sesamoid bone (navicular bone) and DIPJ of all 3 bulls. A window was created in the abaxial hoof wall that was lateral to and of sufficient size to extract the navicular bone. Following removal of the navicular bone, the DIPJ was debrided and resected and an orthopedic block was applied to the contralateral claw to minimize weight bearing on the infected digit. Two bulls also had a fiberglass cast applied to the affected limb to help immobilize the DIPJ. All 3 bulls recovered without complications, and 2 bulls were no longer lame, whereas the remaining bull was only mildly lame, at 4 to 5 weeks after surgery.

CLINICAL RELEVANCE The modified abaxial approach described for surgical resection of the DIPJ allowed extraction of the infected navicular bone without damage to the digital flexor tendons, something that cannot be achieved with other abaxial approaches. This approach is best used for patients without septic tenosynovitis.

Contributor Notes

Address correspondence to Dr. van Amstel (svamst@utk.edu).