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Incomplete fracture of the talus secondary to maladaptive stress remodeling in a horse

Scott A. Katzman1Department of Surgical and Radiological Sciences, William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

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Mathieu P. Spriet1Department of Surgical and Radiological Sciences, William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.

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Beau R. Beck2South Valley Large Animal Clinic, 1791 W 11400 S, South Jordan, UT 84095.

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Myra F. Barrett3Department of Environmental and Radiological Health Sciences, James L. Voss Veterinary Teaching Hospital, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523.

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Dean A. Hendrickson4Department of Clinical Sciences, James L. Voss Veterinary Teaching Hospital, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523.

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Abstract

CASE DESCRIPTION

A 6-year-old Quarter Horse gelding used for barrel racing was evaluated for acute onset of non–weight-bearing lameness of the left hind limb following strenuous exercise.

CLINICAL FINDINGS

Nuclear scintigraphic imaging revealed focal increased radiopharmaceutical uptake centrally within the left talus. Subsequent standard radiographic and ultrasonographic examinations of the tarsus failed to identify the cause of the increased radiopharmaceutical uptake; however, the lameness was definitively localized to the tarsocrural joint by intra-articular anesthesia. Subsequent MRI sequences of the left tarsus revealed an incomplete fracture of the talus that extended distally from the trochlear groove and evidence of maladaptive stress remodeling of the trochlear groove of the talus and distal intermediate ridge of the tibia.

TREATMENT AND OUTCOME

The horse was treated conservatively, with management consisting of stall confinement, physical rehabilitation, therapeutic laser therapy, and intra-articular autologous conditioned serum administration. The lameness resolved, and the horse was competing at its previous level within 15 months after lameness onset.

CLINICAL RELEVANCE

Although rare, incomplete fracture of the talus should be considered as a differential diagnosis for horses that develop acute hind limb lameness following strenuous exercise, especially when that exercise involves abrupt changes in direction while the horse is traveling at maximal speed. Acquisition of additional oblique projections during radiographic evaluation of the tarsus might be useful for identification of such fractures, but definitive diagnosis may require advanced diagnostic imaging modalities such as CT and MRI. Horses with incomplete fractures of the talus can be successfully treated with conservative management.

Abstract

CASE DESCRIPTION

A 6-year-old Quarter Horse gelding used for barrel racing was evaluated for acute onset of non–weight-bearing lameness of the left hind limb following strenuous exercise.

CLINICAL FINDINGS

Nuclear scintigraphic imaging revealed focal increased radiopharmaceutical uptake centrally within the left talus. Subsequent standard radiographic and ultrasonographic examinations of the tarsus failed to identify the cause of the increased radiopharmaceutical uptake; however, the lameness was definitively localized to the tarsocrural joint by intra-articular anesthesia. Subsequent MRI sequences of the left tarsus revealed an incomplete fracture of the talus that extended distally from the trochlear groove and evidence of maladaptive stress remodeling of the trochlear groove of the talus and distal intermediate ridge of the tibia.

TREATMENT AND OUTCOME

The horse was treated conservatively, with management consisting of stall confinement, physical rehabilitation, therapeutic laser therapy, and intra-articular autologous conditioned serum administration. The lameness resolved, and the horse was competing at its previous level within 15 months after lameness onset.

CLINICAL RELEVANCE

Although rare, incomplete fracture of the talus should be considered as a differential diagnosis for horses that develop acute hind limb lameness following strenuous exercise, especially when that exercise involves abrupt changes in direction while the horse is traveling at maximal speed. Acquisition of additional oblique projections during radiographic evaluation of the tarsus might be useful for identification of such fractures, but definitive diagnosis may require advanced diagnostic imaging modalities such as CT and MRI. Horses with incomplete fractures of the talus can be successfully treated with conservative management.

Contributor Notes

Address correspondence to Dr. Katzman (sakatzman@gmail.com).