1. Interactive Case Tutorial
Case 04 Large Animal Bone

2. Instructions Review the history and signalment for the client
Evaluate the radiographs provided
Explore the interactive images and compare the answers given with your own interpretations. When you’ve clicked on the image, click the same spot again to make the label disappear.
Answer the questions regarding a diagnosis and recommendations
Review the radiologist’s findings

3. Case Presentation Signalment: 10 year old Appendix mare
History: on and off right pelvic limb lameness since purchased several months ago for the purposes of hunter/jumper use; grade 3/5 right pelvic limb lameness; positive to hoof testers; moderate positive to distal limb flexion
Study: distal right pelvic limb
Technique note: a skyline view of the navicular bone is difficult to obtain in a pelvic limb

4. Distal right pelvic limb
Small osteophyte
Normal navicular
Faint lucent line on distal phalanx
R HIND

5. Distal right pelvic limb
Irregular lucent line at lateral plantar process
Sclerosis
Solar margin resorption
Line extends into distal interphalangeal joint
Normal navicular bone

6. Distal right pelvic limb
Enthesopathy at origin collateral ligament
Normal navicular
Normal medial plantar process
Line extends into distal interphalangeal joint
Irregular lucent line at lateral plantar process
Sclerosis
Solar margin resorption

7. Conclusions Provide a diagnosis based on your findings. Feedback
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Chronic, likely type II (intra-articular), fracture involving the lateral plantar process of the distal phalanx of the right pelvic limb
Healing is suspected as at the dorsal surface the lucent line is not as visible
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8. Recommendations Provide your recommendation for this client. Feedback
Egg bar shoe with 4 clips to use the hoof wall to provide equal support of the foot and fractured distal phalanx
The shoe should be reset every 6-8 weeks for at least the next 4 months
Complete stall rest for at least the next 3 months
Recheck lameness evaluation and radiographic evaluation in 3 months
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9. Findings
An irregular lucent line traverses the lateral plantar process extending into the distal interphalangeal joint
The bone surrounding the lucent line is sclerotic and the margins are poorly defined
Resorption is present at the solar margin of the lateral quarter/heel of the distal phalanx

10. Follow-up
At 3 month recheck, lameness had mildly improved. On radiographs, the fracture line had healed approximately 60%.
Continued stall rest for an additional 6-8 weeks was recommended, followed by 5-10 minutes of hand walking twice daily with an increase of time by 5 minutes every two weeks after that
Note that fractures of the distal phalanx may heal by fibrosis; thus, a lucent line may always be present to a variable degree

11. The End