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Ultrasound diagnosis of pelvic injuries
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Summary
Pelvic injuries are common in horses. Lumbosacral and sacroiliac degenerative injuries are frequently identified in race and sport horses. Fatigue fractures are mainly found in race horses. Traumatic fractures of the ilium, ischium, pubis, acetabulum are found in all breeds and disciplines at every age. Ultrasonography is the easiest, the quickest and the less invasive technique to diagnose these injuries and document their evolution.
Key-words: ultrasonography, pelvis, horse, fracture, sacroiliac joint, lumbosacral joint
Introduction
Ultrasonography is an essential imaging procedure for investigating the pelvis in standing horses. A complete procedure is made combining an external approach using low frequency convex probe and a transrectal ultrasonographic examination (TRUSE) using a rectal probe. This technique is indicated in every horse suspected of low back pain, in athletes suspected of fatigue fractures and in horses how sustained a trauma of the pelvis.
Athletic problems
An objective assessment of back pain and a clear identification of the cause(s) of the pain are not easy in horses. Osteoarticular thoracolumbar lesions has been well documented in horses (Jeffcott 1975, 1980, Denoix 1999a and b). Papers have been published on the clinical and nuclear scintigraphic evaluation of the sacroiliac joint (Dyson 2003). Arthropathies and intervertebral discs injuries have been described at the umbosacral junction (Denoix 2004).
Lumbosacroiliac (LSI) pain can induce different athletic and clinical manifestations. Generally speaking, affected horses present performance limitations (such as asymmetrical lateral bending, lack of engagement, lack of propulsion, defenses for sport horses or asymmetrical gait at high speed for trotters without hind limb lameness.
Our routine diagnostic approach of low back pain in horses includes a complete radiographic examination of the lumbar spine down to the fourth lumbar vertebra (L4) (Denoix 1999a, Denoix and Dyson 2011) and a TRUSE of the caudal part of the lumbar spine (from L4 to L6), lumbosacral junction and sacroiliac joint (Denoix and Audigié 2004, Tallaj 2017a and b). In a lot of sport and race horses, nuclear scintigraphy is also used to help localizing bone injuries in these areas.
Abnormal radiographic findings in the lumbar vertebral column include: kissing of the spinous processes especially between L4-L5 or L5-L6; osteoarthrosis of the articular process joints; ventrolateral spondylosis on the vertebral bodies.
Abnormal ultrasonographic findings seen at the LS junction include : congenital abnormalities such as lumbosacral ankylosis (sacralisation of L6) or intervertebral ankylosis between L5 and L6 (Haussler 1997) ; disc degenerative lesions especially of the lumbosacral disc. These lesions include: fissures or cavitation of the disc; dystrophic mineralization and/or ventral herniation; intervertebral malalignment (spondylolisthesis) of the lumbosacral joint or the joint between L5 and L6; intertransverse lumbosacral osteoarthrosis: periarticular osteophytes, remodeling on the joint margins and even synovitis can be seen.
Abnormal findings seen at the ventral aspect of the sacroiliac joint as assessed with ultrasonography include (Tallaj 2017b): bone remodeling of the sacrum and/or ilium; periarticular osteophytes of the auricular surfaces; ventral sacroiliac ligament desmopathy or enthesopathy. Several grades of lesions have been recognized on ultrasonographic images. Grade 3 and 4 are more correlated to clinical manifestations and increased capture on scintigrams.
Fatigue injuries
Exercise induced fatigue injuries are mainly found on the Ilium wing in racing thoroughbreds (and standarbred trotters); their ultrasound diagnosis is achieved through an external approach of the pelvis. Extension of the fracture plane to the sacroiliac joint can be assessed through TRUSE. Fatigue fracture of the cranial branch of the pubis has been diagnosed using TRUSE in racing thoroughbreds, standardbred trotters and endurance horses.
Traumatic injuries
They can involve every part of the pelvis. The most common in foals and yearling involve the acetabulm. Diagnosis of acetabular fracture are best done on the standing horse to avoid any displacement of the bone fragments during recumbence. An external approach must be combined with an internal approach (not always possible, especially in foals). Fracture of the tuber ischiaticum usually, but not always, induce a physical flattening of the point of the croup. Ultrasound diagnosis is easy using a caudal approach and a convex probe. Fractures of the bottom of the pelvis, involving the pubis and/or ischium require a TRUSE. Combination of an external approach and TRUSE are recommended for extablishing a complete diagnosis and documentation of fractures of the ilium neck, sacrum and base of the tail.
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[1] Jeffcott LB. (1975) The diagnosis of diseases of the horse back. Equine Vet J, 7(2)69-78.
[2] Jeffcott LB. (1980) Disorders of the thoracolumbar spine of the horse - a survey of 443 cases. Equine Vet J, 12(4)197-210.
[3] Denoix J.-M. (1999a) Ultrasonographic evaluation of back lesions. Vet Clin North Am : Equine pract. 15(1)131-159.
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