Hélène Lardé

Noninfectious Joint Disease in Cattle

Osteochondrosis causes variable degrees of joint effusion and lameness. Arthroscopic debridement of the lesions provides the best long-term outcome. Articular fracture or joint instability following collateral ligament rupture causes severe joint effusion and lameness. Internal fixation combined with external coaptation is the treatment of choice. Degenerative joint disease in young animals has a guarded prognosis. Arthroscopy combined with medical therapy may slow down the disease process. Degenerative joint disease involving the distal interphalangeal joint has a good prognosis following joint resection.

Surgical Management of Omphalophlebitis and Long Term Outcome in Calves: 39 Cases (2008–2013)

OBJECTIVE To describe and evaluate the surgical management of omphalophlebitis and to report the short and long term outcomes in calves. STUDY DESIGN Retrospective case series. ANIMALS Calves (n = 39). METHODS Medical records (2008-2013) of calves diagnosed with omphalophlebitis and that underwent surgical correction were reviewed. Short term (hospital discharge) and long term (≥6 months after surgery) survival rates were obtained. Descriptive statistics were used to describe the population and a Fishers exact test was used to evaluate the relationship between clinical signs, surgical management, and outcome. RESULTS Thirty-nine calves (median age 30 days) were included in the study. Eleven calves had septic arthritis associated with omphalophlebitis and 18 had evidence of liver abscesses on ultrasound. Complete surgical en bloc resection was achieved in 18 calves and umbilical vein marsupialization was performed on the other 21 calves. Thirty-five calves were discharged from the hospital and long term followup was obtained for 30 of them. Twenty-nine animals were performing according to the owners expectation at least 6 months after surgery (14 for marsupialization and 15 for en bloc resection). A better prognosis was detected when en bloc resection was performed (100% survival); however, when marsupialization was performed, the prognosis was good (74%; P = .05). Septic arthritis had a significant negative effect on overall survival (P < .001). CONCLUSION The overall survival is good with both surgical options, and even calves with liver involvement and septic arthritis associated can be successfully treated with a combination of long term antibiotics and umbilical vein marsupialization.

Arthroscopy in Cattle: Technique and Normal Anatomy

Arthroscopy has all the advantages of minimally invasive surgery in cattle. Specialized equipment and knowledge of normal joint anatomy of cattle are mandatory for successful arthroscopy. The surgical technique is different in cattle compared with the horse. Thick skin and joint capsules complicate movement of the arthroscope within the joints. In cattle, septic arthritis and osteochondrosis are the most frequent disorders suitable for arthroscopic treatment.

Surgical Correction of Traumatic Lateral Patellar Luxation

OBJECTIVE To report successful surgical repair of a grade IV lateral patellar luxation in a 437-kg heifer. STUDY DESIGN Case report. ANIMAL Seventeen-month-old Holstein heifer (437 kg). METHODS Diagnosis of traumatic lateral patellar luxation was made based on physical examination, and confirmed on radiographs. Arthroscopic examination of the stifle assessed joint changes. Lateral patellar luxation was surgically repaired using lateral release of the patella and medial imbrication of the joint capsule. RESULTS The heifer presented nonweight-bearing lameness of the left hind limb (5/5 lameness score). Unilateral grade IV lateral patellar luxation was diagnosed based on physical examination and radiography. Arthroscopic examination of the stifle showed synovitis and cartilage eburnation of the medial articular surface of the patella and of the lateral trochlear ridge of the femur. Lateral release of the patella and medial imbrication of the joint capsule was performed. The heifer remained lame (4.5/5 lameness score) and developed severe disuse muscle atrophy after surgery. By day 112, the heifer was walking easily and was completely weight bearing on the left hindlimb but did have a gait alteration (2/5 lameness score). On day 229, the heifer calved for the first time and lameness was no longer evident. CONCLUSION This report documents successful surgical treatment of traumatic lateral patellar luxation in a large heifer but additional case evaluation is required to provide an accurate prognosis for this condition and treatment in large cattle.

Opioid‐induced adverse effects in a Holstein calf

This is a report of an opioid-induced adverse effect in a 2-month old 70 kg female Holstein calf that was referred to our veterinary teaching hospital (VTH) with persistent left hind limb lameness. Two weeks before presentation, an arthrotomy was performed due to septic arthritis of the left stifle. An arthroscopy was then repeated at our institution but lameness and severe pain continued for 72 hours after surgery even after intravenous (IV) administration of meloxicam (0.5 mg kg 1 every 48 hours) (Anderson & Edmondson 2013). Further analgesia was required. Under aseptic conditions, an epidural injection of preservative-free morphine (0.1 mg kg ; Morphine, 10 mg mL ; Sandoz, QC, Canada) with sterile saline 0.9% (total of 10 mL) was performed between the first and second intercoccygeal intervertebral space using a 20 gauge 3.8 cm Tuohy needle. In addition, a 100 lg hour 1 fentanyl patch (1.43 lg kg hour ; Fentanyl patch; Sandoz) was applied at the cranial aspect of the left tibia immediately after the epidural injection. The skin was prepared by clipping the hair, gentle wash with warm water, and then air-drying. A light bandage was applied to cover the patch. Approximately 2 hours later, the calf became agitated with an altered state of consciousness. Mydriasis, nystagmus, increased locomotor activity, vocalization, myoclonus of the tail, hyperesponsiveness to external stimuli and hyperthermia (40.7°C) were observed. Thoracic auscultation revealed tachycardia (>200 beats minute ) and tachypnea (>100 breaths minute ) without change in mucous membrane color. A possible opioid-induced dysphoria due to overdosing was suspected. The fentanyl patch was removed immediately and diazepam (0.07 mg kg ) was administered IV. Approximately 5 minutes later, acepromazine (0.015 mg kg ) IV was also administered since clinical signs had not ceased. Ice packing and a fan were used for cooling of the calf. Lactated Ringer’s solution (4 mL kg hour ) was administered IV. Five minutes later naloxone (5 lg kg ) was diluted into 5 mL of sterile saline and given IV over 3 minutes. The calf returned to normal behavior in approximately 2 minutes later. Sedation was observed followed by sternal recumbency. Temperature, heart and respiratory rate returned to their normal limits within the following hours without renarcotization. Drug concentrations and volumes were reviewed and deemed to be correct. The analgesic and adverse effects of opioids have not been well studied in cattle (Machado Filho et al. 1998). Opioids are not commonly used for pain management in farm animals because of their withdrawal times, economic constraint, and need for record keeping of controlled substances. However, epidural administration of morphine and the application of transdermal fentanyl patches have been used in clinical practice. These techniques provide long-sustained analgesia but changes in behavior, increased locomotor activity, dysphoria, and hyperthermia have been observed in other species after opioid administration. We are unaware of a case report in calves. Substantial variations in plasma drug concentrations, onset of action and analgesic effectiveness have been documented after fentanyl patch placement in different species. Changes in skin temperature, preparation and permeability, and location of the patch may affect absorption and efficacy of fentanyl. However, to our knowledge, there are no published data on the pharmacokinetics and pharmacodynamics of fentanyl in cattle. In foals, plasma concentrations of fentanyl were detected as early as 20 minutes after patch placement (Ebersp€ acher et al. 2008). Rapid absorption of fentanyl could explain the observed behavioral changes after drug administration in this case. Central nervous system (CNS) excitation after opioid administration has been linked to the distribution of opioid receptors in the brain, release of excitatory neurotransmitters or decreased activity of inhibitory neurotransmitters. Furthermore, opioids may also affect the thermoregulatory center in the hypothalamus inducing hyperthermia (Kukanich & Papich 2009). Letters to the Editor

Dorsal Arthroscopic Approach and Intra-Articular Anatomy of the Bovine Antebrachiocarpal and Middle Carpal Joints.

OBJECTIVE To determine arthroscopic approaches to the dorsal synovial compartments of the antebrachiocarpal and middle carpal joints in adult cattle, and to describe the arthroscopic intra-articular anatomy from each approach. STUDY DESIGN Ex vivo study. ANIMALS Six fresh adult bovine cadavers. METHODS Two carpi were injected with latex and dissected to determine the ideal location for arthroscopic portals. Arthroscopy of the antebrachiocarpal and middle carpal joints of 10 carpi was then performed. The dorsolateral approach was made between the extensor carpi radialis and common digital extensor tendons. The dorsomedial approach was made medial to the extensor carpi radialis tendon, midway between the distal radius and proximal row of carpal bones (antebrachiocarpal joint) and midway between the two rows of carpal bones (middle carpal joint), with the joint in flexion. RESULTS Arthroscopy of the antebrachiocarpal joint allowed visualization of the distal radius, proximal aspect of the radial, intermediate and ulnar carpal bones, and a palmar ligament located between the radius and the intermediate carpal bone. The approach to the middle carpal joint allowed visualization of the distal aspect of the radial, intermediate, and ulnar carpal bones, the proximal aspect of the fourth and fused second and third carpal bones and an interosseous ligament. The most lateral articular structures (lateral glenoid cavity of the distal radius, ulnar carpal and fourth carpal bones) were difficult to assess. CONCLUSION Dorsal approaches to the antebrachiocarpal and middle carpal joints allowed visualization of most intra-articular dorsal structures in adult cattle.

Milk flow obstruction caused by varicose vein of the teat in dairy cattle.

Objective To describe varicose vein as a cause of obstruction of the teat cistern in dairy cattle and to report therapeutic options and outcome. Study Design Retrospective case series. Animals Dairy cows (n = 22). Methods Medical records (1998–2011) of dairy cows admitted for milking difficulties caused by a teat varicose vein were reviewed. Three treatment approaches were used: sclerotherapy, ligation of the vein associated with sclerotherapy, and phlebectomy. Long-term outcome was obtained ≥6 months after treatment and defined as a milking improvement. Descriptive statistics were used to determine the population at risk and a chi square test was used to evaluate the relationship between treatments and outcomes. Results Twenty-four teats (22 cows) had a varicose vein. Forequarters were more frequently affected than rear quarters (P < .01). Three sclerotherapies, 12 ligations associated with sclerotherapy and 6 phlebectomies were performed. Five veins were not treated. Overall prognosis with treatment was good (84%) at ≥ 6 months and was not significantly different between treatment types (P = .38). Recurrence of the obstruction by the varicose vein occurred in 3 of 19 teats. Conclusions and clinical relevance Several surgical options are available for treatment of teat varicose veins. The overall prognosis of return to normal milking is good.OBJECTIVE To describe varicose vein as a cause of obstruction of the teat cistern in dairy cattle and to report therapeutic options and outcome. STUDY DESIGN Retrospective case series. ANIMALS Dairy cows (n = 22). METHODS Medical records (1998-2011) of dairy cows admitted for milking difficulties caused by a teat varicose vein were reviewed. Three treatment approaches were used: sclerotherapy, ligation of the vein associated with sclerotherapy, and phlebectomy. Long-term outcome was obtained ≥ 6 months after treatment and defined as a milking improvement. Descriptive statistics were used to determine the population at risk and a chi square test was used to evaluate the relationship between treatments and outcomes. RESULTS Twenty-four teats (22 cows) had a varicose vein. Forequarters were more frequently affected than rear quarters (P < .01). Three sclerotherapies, 12 ligations associated with sclerotherapy and 6 phlebectomies were performed. Five veins were not treated. Overall prognosis with treatment was good (84%) at ≥ 6 months and was not significantly different between treatment types (P = .38). Recurrence of the obstruction by the varicose vein occurred in 3 of 19 teats. CONCLUSIONS AND CLINICAL RELEVANCE Several surgical options are available for treatment of teat varicose veins. The overall prognosis of return to normal milking is good.

Repair of transverse process fractures of multiple lumbar vertebrae in an adult dairy cow.

OBJECTIVE To report lumbar vertebrae transverse process fracture repair using a narrow 3.5 mm limited contact dynamic compression plate (LC-DCP) in an adult dairy cow. STUDY DESIGN Case report. ANIMALS A 3-year-old Holstein cow. METHODS Under general anesthesia, fractured left transverse processes of lumbar vertebrae 2-4 were repaired using internal fixation. A narrow 3.5 mm LC-DCP was contoured and secured to the spinous process and the transverse process of each fractured vertebra. RESULTS Fractured transverse processes of the lumbar vertebrae were successfully repaired and the cow discharged 10 days after surgery. At 10 months after surgery, the cow was declared reserved champion at a regional show. CONCLUSION A paramedian approach and muscle splitting can be used to repair multiple lumbar transverse process fractures using internal fixation with an excellent cosmetic outcome.

Clinical findings and diagnostic test results for calves with septic arthritis: 64 cases (2009–2014)

OBJECTIVE To describe clinical findings and diagnostic test results and identify potential prognostic indicators for calves with septic arthritis. DESIGN Retrospective case series. ANIMALS 64 calves with septic arthritis. PROCEDURES The medical record database for a veterinary teaching hospital was searched to identify calves ≤ 6 months old that were treated for septic arthritis between 2009 and 2014. Data evaluated included signalment, history, physical examination and diagnostic test results, treatment, and outcome. Descriptive data were generated, and calves were assigned to 2 groups (neonatal [≤ 28 days old] or postneonatal [29 to 180 days old]) on the basis of age at hospital admission for comparison purposes. RESULTS 64 calves had 92 infected joints; 17 calves had polyarthritis. Carpal joints were most frequently affected followed by the stifle and tarsal joints. Forty-nine bacterial isolates were identified from synovial specimens for 38 calves, and the most commonly identified isolates were catalase-negative Streptococcus spp (n = 14) and Mycoplasma bovis (9). Calves in the neonatal group had a shorter interval between onset of clinical signs and hospitalization and were more likely to have an infected carpal joint than calves in the postneonatal group. Outcome was positive for 35 calves. Synovial fluid total nucleated cell count was positively associated with a positive outcome. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that empirical antimicrobial treatment for calves with septic arthritis should target gram-positive catalase-negative cocci and M bovis and that synovial fluid total nucleated cell count might be a useful prognostic indicator.

Arthroscopic approach and intra‐articular anatomy of the dorsal and plantar synovial compartments of the bovine tarsocrural joint

OBJECTIVE To determine arthroscopic approaches to the dorsal and plantar synovial compartments of the tarsocrural joint in adult cattle, and to describe the arthroscopic intra-articular anatomy from each approach. STUDY DESIGN Ex vivo study. ANIMALS Fresh adult bovine cadavers (n = 7). METHODS Two tarsocrural joint were injected with latex to determine arthroscopic portal locations and arthroscopy of the tarsocrural joint of 12 tarsi was performed. The dorsolateral approach was made through the large pouch located between the long digital extensor and peroneus longus tendons. The dorsomedial approach was made just medial to the common synovial sheath of the tibialis cranialis, peroneus tertius, and long digital extensor tendons. The plantarolateral and plantaromedial approaches were made lateral and medial to the tarsal tendon sheath, respectively. RESULTS Each approach allowed visualization of the distal tibia articulating with the proximal trochlea of the talus. Consistently observed structures included the distal intermediate ridge of the tibia, and the medial and lateral trochlear ridges and trochlear groove of the talus. Lateral and medial malleoli were best assessed from dorsal approaches. From the lateral approaches evaluation of the abaxial surface of the lateral trochlear ridge allowed visualization of the fibulocalcaneal joint. From the plantar approaches additional observed structures included the coracoid process of the calcaneus, plantar trochlea of the talus, and plantar talotibial and talofibular ligaments. CONCLUSION In cattle, the dorsolateral and plantarolateral approaches allowed for the best evaluation of the dorsal and plantar aspects of the tarsocrural joint, respectively.