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Surgical management of capped elbow in a horse.

Introduction

Shoe boil or capped elbows are two common names for bursitis of elbow (Stashak, 2002). As a result of trauma, transudative fluid accumulate in subcutaneous tissue which becomes encapsu-lated by fibrous tissue ultimately a synovial like membrane develops, producing fluid that is similar to joint fluid although it differs in viscosity and mucin clot (Mcllwraith, 2002). Chronic bursitis is characterized by accumulation of bursal fluid and thickening of bursal wall by fibrous tissue, fibrous bands and septa may develop in bursal cavity and subcutaneous tissues around bursa continue to thicken (Honnas et al., 1995). The growth hardens with lesser amount of fluid if not removed and remained as such for longer duration (Fossum, 1997). The condition is common in horses and dogs (O'Connor, 2005 and Venugopalan, 1986). Surgical intervention either by placing drains or en bloc resection appears to have greatest success (Veenendaal et al., 1981). Present case report describes surgical management of capped elbow condition on left elbow of a stallion.

History and Diagnosis

A seven year old stallion was presented with history of golf ball sized growth over left elbow and observable lameness since last two months. Clinical examination revealed chronic, prominent and often freely movable swelling over the point of elbow (Fig. 1). On basis of history and clinical examination, the case was diagnosed as 'capped elbow' that might be comprised of fibrous tissue.

[FIGURE 1 OMITTED]

Surgical Management

The horse was fasted for 24 hours. The horse was prepared aseptically for surgery and was anaesthetized using Xylazine Hcl @ 1.1 mg/kg b. wt. and Ketamine Hcl @ 2.2 mg/kg b.wt. intravenously. Maintenance surgical anaesthesia was followed by bolus doses of Ketamine hydrochloride. Animal was placed on lateral recumbency with affected limb up. Elliptical incision was made on capped elbow post-erolaterally (Fig. 2) and golf ball sized fibrous tissue mass was excised by blunt dissection (Fig 3 and 4). Subcutaneous fascia was sutured with chronic catgut size 2 in a interrupted horizontal mattress apposition pattern. An additional layer of subcuticular sutures was applied using chromic catgut size 1 in a continuous pattern. Skin was sutured with silk size 2 in horizontal mattress pattern (Fig. 5). Bandaging was done properly at elbow region to protect the suture line and provide some compression. Antitetanus toxoid 5 ml (10 Lf units) was administered IM. Post-operatively antibiotic, AC-Veta (4.5 g IV, for 7 days); Analgesic Flunixin Meglumine (1.1 mg/ kg b.wt. IM, for 3 days) and Multivitamin, Tribiveta (15 ml IV, for 3 days) were administered. The skin sutures were removed on 11th post-operative day. Animal made uneventful recovery.

[FIGURE 2 OMITTED]

[FIGURE 4 OMITTED]

Discussion

Elbow hygroma is a characteristic movable swelling over the point of olecranon tuberosity, usually developing from trauma (McIlwraith, 2002). Chronic bursitis occur when trauma is mild but repeated in nature (O'Connor, 2005). Chronic bursitis due to repeated trauma was observed in present study. Chronic bursitis is characterized by thickening of bursal wall, extrusion of fibrous bands or septa within bursal cavity and generalized sub-cutaneous thickening (Fathy and Radad, 2006). Similar findings were found in present study.

Surgical intervention either by placing drains or en bloc resection appears to have greatest success (Veenendaal et al., 1981). Surgical treatment is considered to be an effective method for treatment of olecranon bursitis particularly for chronic proliferative and fibrous form (Fathy and Radad, 2006). Rapid and economic healing is also achieved by surgical intervention than conservative treatment (Arican et al., 2005 and Hayat et al., 2009) and it has also been advocated when all other methods of treatment have failed and bursa is large and composed of primarily fibrous tissue (Honnas et al., 1995). Surgical correction was considered in present case because of chronic nature of lesion and animal recovered completely.

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References

Arican, M.; Kocabiyik, A. and Izei, C. (2005). Treatment of bilateral olecranon bursitis in a horse. Indian Vet. J. 82: 325. Fathy, A. and Radad, K. (2006). Surgical treatment and histopathology of different forms of Olecranon and presternal bursitis in cattle and buffalo. J. Vet. Sci. 7: 287-91.

Fossum, T.W. (1997). Small Animal Surgery, 2nd ed., Mosby Publication. Missouri, p. 137-38.

Hayat, A.; Han, M.C.; Sagliyan, A. and Biricik, H.S. (2009). Different treatment of olecranon bursitis in six horses. J. Anim. Vet. Adv. 8: 1032-34.

Honnas, C.M.; Schumacher, J. and McClure, S.R. (1995). Treatment of olecranon bursitis in horses: 10 cases (19861993). J. Amer. Vet. Med. Assoc. 206:1022-26.

McIlwraith, C. (2002). Diseases of joints, tendons, ligaments and related structures. In: Adams' Lameness in Horses. Stashak T, ed. Lippincott Williams and Wilkins, Philadelphia, p. 640-44.

O'Connor, J.J. (2005). Dollar's Veterinary Surgery. 4th ed., Tindall and Cox, Great Britain, p. 819-22.

Stashak, T. (2002). The Elbow. In: Adams' Lameness in Horses. Stashak T, ed. Lippincott Williams and Wilkins, Philadelphia, p. 888-90.

Veenendaal, V.J.; Speirs, V. and Harrison, I. (1981). Treatment of hygromata in horses. Australian Vet. J. 57: 513-14.

Venugopalan, A. (1986). Essentials of Veterinary Surgery, 5th ed., Oxford and IBH publishing company. New Delhi, p. 151-54.

(a)--Brand of Intas Animal Health, Ahmedabad

J. Khurma (1), Ravendra Singh (2) and T.K. Gahlot (3)

Department of Veterinary Surgery and Radiology College of Veterinary and Animal Science Rajasthan University of Veterinary and Animal Sciences (RAJUVAS) Bikaner--334001 (Rajasthan)

(1.) Post Graduate Scholar and Corresponding author. E-mail: khgaurav01@gmail.com

(2.) Post Graduate Scholar

(3.) Professor and Head
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Title Annotation:Short Communication
Author:Khurma, J.; Singh, Ravendra; Gahlot, T.K.
Publication:Intas Polivet
Geographic Code:9INDI
Date:Jan 1, 2016
Words:908
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