Proximale Resektion des lateralen Griffelbeins in Kombination mit einer partiellen Entfernung metatarsaler Knochenexostosen als alternative Therapiemethode bei einem Pferd mit hochgradiger chronisch aktiver Desmopathie des Fesselträgerursprungs
Proximal resection of the fourth metatarsal bone in combination with partial removal of metatarsal bone exostoses as alternative treatment for severe chronic proximal suspensory ligament desmopathy in a horse
Kiemle J, Nitzl D, Hellstern D, Dixon J
DOI: 10.21836/PEM20210502
Jahr: 2021
Volume: 37
Ausgabe: 5
Seiten: 464–473
Proximal suspensory ligament desmopathy (PSLD) is a common cause of lameness in pleasure and performance horses and occurs in both forelimbs and hindlimbsThis case report describes the successful surgical treatment of a 9-year-old Warmblood gelding used for showjumping that presented with a 2/5 right hindlimb lameness, which had persisted for more than 2 years and was caused by chronic-active proximal suspensory ligament desmopathy and second and fourth metatarsal exostosis. Previous treatment methods including extracorporeal shockwave therapy, local corticosteroid injections and subsequent plantar fasciotomy and neurectomy of the deep branch of the lateral plantar nerve were unsuccessful. As the full extent, as well as the severity and location of the lesions could not be reliably determined using ultrasonography and radiography, computed tomography was helpful to delineate the extent of the pathology at the origin of the suspensory ligament. The horse was successfully treated by proximal resection of the fourth metatarsal bone in combination with partial removal of plantar metatarsal bone exostoses impinging on the suspensory ligament. The horse was sound 3 months following surgical treatment. It remained free of lameness at subsequent follow-up examinations at 6, 9, 12 and 18 months post-surgery, and was competing successfully 9 months after surgery. The favorable clinical outcome and rapid post-surgical recovery support the authors´ hypothesis that pressure reduction via proximal ostectomy of the fourth metatarsal bone and partial removal of metatarsal bone exostoses reduced osseous impingement on the suspensory ligament and created increased space for the pathologically altered soft tissue structures to heal.