1. Hock Fracture in a 2 Month Old Heifer Mandy Gutliph 2/19/2014 Advisors: Dr. Hayley Lang Dr. Ruth Van Hatten

2. Signalment: 2 month old Holstein Heifer Valuable History: Weaned December 31 st New pig wire pen Non-weight bearing lameness left hind limb on January 1 st Swollen hock No improvement with 2 days of flunixin meglumine and 5 days of penicillin

3. Physical Exam Bright, Alert, Responsive TPR WNL Large, Clean Calf Small amount of perineal staining Umbilicus WNL Non weight bearing left hind limb Left tarsus swollen, especially caudally Rest of physical unremarkable

4. Problem List Swollen Left Tarsus Non Weight Bearing Lameness Differential Diagnosis Degenerative Joint Disease- osteochondrosis, osteoarthritis Developmental Abnormality- Anomalous- serous tarsitis Metabolic- Neoplastic/Nutritional- Idiopathic/Inflammatory- septic arthritis, lyme disease Trauma/Toxic- fracture Vascular- hematoma

5. Plan Radiograph the Left Tarsus -Typical Equine Views 1. Lateralmedial (Lateral) 2. Dorsoplantar (DP) 3. Dorsolateral-plantaromedial oblique (DLPMO) 4. Dorsomedial-plantarolateral oblique (DMPLO) Also we did 5. Flexed Dorsal Plantar Image 1

6. Dorsal View Medial Side to Right of Screen Distal Trochlea of Talus Fused Central and 4 th Tarsal Bones Fused Metatarsal 3 and 4 BOVINE EQUINE

7. 2 Medial View Cranial to Left of Screen BOVINE EQUINE Tuber Calcanei Sustentaculum Tali Fused Tarsal 2 and 3 Sesamoid Bone

8. Lateral View Cranial to Right of Screen Body of Calcaneus BOVINEEQUINE Talocalcaneal Joint

9. Lateral Views Cranial to the Left of Screen RIGHT TARSUS LEFT TARSUS

10. Dorsal Plantar Lateral

11. Flexed Dorsal Plantar Cranial Lateral

12. Diagnosis Radiographs show: –Comminuted fracture of Calcaneus Tuber Calcanei Body Sustentaculum tali –Fracture Line in Talus (?) –Luxation of Talocalcaneal Joint – Soft Tissue Swelling

13. Updated Plan Computed Tomography- including normal tarsus General Anesthesia

14. Computed Tomography Radiographs: 1890s CT: 1970s Veterinary CT: 1989 in Paris Gantry –X ray tube with cathode, anode and detectors Sliding Table Console

15. Sagittal Slices Cranial to Left of Screen Moving Lateral to Medial within limb from Left to Right Image

16. Transverse Image Through Talus Incomplete Fracture DORSAL LATERAL

18. Surgery

19. Post Operatively

20. Prognosis Bristol Retrospective Study of Traumatic Hock Fractures –7/13 horses returned to work –6 euthanized –Depends on fracture site Auyer and Stick on Equine Surgery –Non-displaced talus fractures- increased prognosis –Closed calcaneus fractures- increased prognosis Likely to develop Osteoarthritis Good Prognosis for full fracture healing and full function as dairy cow

21. Recheck Exam

22. Cost Initial Exam Radiographs$160 CT$420 Anesthesia$500 Surgery$750 Total$2,300 First Recheck Exam Including radiographs, anesthesia, cast change $500

23. References Auer, Jo ̈ rg A, and John A. Stick. Equine Surgery. St. Louis, Mo: Saunders Elsevier, 2006. Jakovlevic S, Gibbs C, Yeats J.J. Traumatic fractures of the equine hock: A report of 13 cases. Equine Veterinary Journal. 1982; 14:2042-3306. Blackwell Publishing Ltd Meagher D, and Mackey V. "Lag Screw Fixation of a Sagittal Fracture of the Talus in the Horse." Journal of Equine Veterinary Science. 10.2 (1990): 108-112. Merck Manual: Disorders of the Bones and Joints in Cattle: http://www.merckmanuals.com/vet/musculoskeletal_system/lameness_in_cattle/disorders_of_the_bones_and_ joints_in_cattle.html Raes, E. V., Bergman, E. H., van,. V. H., Vanderperren, K., Van,. V. E., & Saunders, J. H. (January 01, 2011). Comparison of cross-sectional anatomy and computed tomography of the tarsus in horses. American Journal of Veterinary Research, 72, 9, 1209-21. Schwarz, T., & Saunders, J. (2011). Veterinary computed tomography. Chichester, West Sussex, UK: Wiley-Blackwell. Image 1: http://www.3d-it.vet.ed.ac.uk/xrayhandbook/webpages/other/Hindlimb/Tarsus.html

24. Thanks! My Patient Dr. Hayley Lang Dr. Ruth Van Hatten Rotation Mates Imaging Department Class of 2014