case_images: PMC11150641_01
case_images: Treatment timeline.
case_images: fvets-11-1403174-g001.jpg
case_images: PMC11150641_01_fvets-11-1403174-g001.jpg
case_images: fig1
case_images: Palpation, manipulation, flexion test, and pain to pressure were performed, and all had a positive reaction (Figure 1, Day = 0). These localized the pain to the fetlock region (Figure 1, D = 0). The radiological examination was performed on assessment day (Figure 1, Day = 0), and those views that presented alterations were repeated during the rehabilitation program, as described in Table 1. Arthroscopy was performed to explore the LF MCj, to eliminate the possibility of a proximal P1 osteochondral chip fracture, to precisely assess the nature and extent of the radiological findings at MC3 and P1, and therapeutically address the pathological evidence (Figure 1, Day = 30). Tau Inversion Recovery (STIR), dorsal:T1W GRE and STIR, and transverse:T1W multiecho gradient recalled echo (GRE), T2W fast spin echo (FSE), and STIR. Two MRI exams were performed approximately 6 months apart (Figure 1, D = 135 and D = 315). In brief, under standing sedation with detomidine (Domosedan ), 10 mL of iohexol solution (Omnipaque  300, GE Healthcare, United Kingdom) was injected into the MCj, and a CT scan was performed (Figure 1, D = 495).
case_images: Pre-treatment diagnostic imaging and surgery: Radiographs and arthroscopy. Four radiographic projections (A) Lateromedial (LM), (B) Dorsopalmar (DP), (C) LM flexed, and (D) DMPLO (dorsomedialpalmarolateral Oblique) are presented. The slight radiological alterations are highlighted with a red (first phalanx) and green (MC3) arrow. Arthroscopic images of the LF metacarpophalangeal joint. (E) Red arrows present a semilunar partial thickness lesion on the dorsoproximal of P1 and blue arrows delimit a partial thickness liner lesion on the lateral aspect of the sagittal ridge of MC3. (F) Pink arrows present a circular partial thickness defect further proximal to the lateral aspect of the sagittal ridge of MC3. (G,H) show the main lesions on the dorso-distal aspect of the lateral condyle of MC3 (green arrows) before and after debridement of the lesion. Yellow arrows indicate an adjacent lesion on the dorsoproximal aspect of P1 (note that the joint is in slight flexion to allow visualization).
case_images: fvets-11-1403174-g002.jpg
case_images: PMC11150641_01_fvets-11-1403174-g002.jpg
case_images: fig2
case_images: LM and DP did not evidence abnormalities (Figures 2A,B). The LM flexed projection exhibited slight remodeling of the dorsoproximal aspect of the first phalanx without evidence of a loose intra-articular fragment (Figure 2C). The DMPLO projection revealed a faint radiolucent area over the lateral condyle (Figure 2D). (1) A linear partial thickness lesion extending distally through the axial aspect of MC3 lateral condyle (Figure 2E blue); a (2) semilunar-shaped partial thickness lesion dorsoproximal aspect of P1 (Figure 2E red); a (3) circular partial thickness lesion on the lateral side of the sagittal ridge (Figure 2F pink). With slight flexion of the joint, the main lesion was visible on the middle aspect of the lateral condyle, and this was a (4) full-thickness linear lesion of approximately 7 mm in length and covered with fibrillated fibrin (Figure 2G green). This lesion was debrided using a combination of bone curettes and a synovial resector down to the healthy subchondral bone plate at a depth of 2 mm (Figure 2H green). The latter was debrided in a similar fashion, but its depth did not extend further into the subchondral bone (Figure 2H yellow).