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Friday, March 29, 2013

Coffin Bone De-Rotation!!

Approximately 6 weeks ago, a middle aged mare presented for chronic founder and non-weight bearing lameness. At presentation, there was significant rotation of the coffin bone in the lame foot (greater than 15 degrees) and reduction in the sole depth at the toe region (Figure 1-3). Due to the severe degree of coffin bone rotation and lameness it was determined that transection of the deep digital flexor tendon was the best option for the mare. The procedure was performed at the barn with sedation and a regional block.

Figure 1

Figure 2

Figure 3
In addition to transection of the deep digital flexor tendon, corrective shoeing was achieved by an expert farrier who specializes in foundered horses  (Sir Adam Whitehead). Corrective shoeing is as important if not MORE important than the surgical procedure and without it the procedure could not be a success! The mare's lameness has slowly improved over the past 4 weeks and follow up radiographs revealed complete DE-ROTATION of the coffin bone (Figure 4).  The palmar angle (blue line) is now approximately zero degrees with respect to the horizon and there has been a moderate increase in the sole depth at the toe region (yellow arrow).

Figure 4

In my experience, horses coffin bone rotation that exceeds 15 degrees benefit greatly from this procedure. Typically, these horses require 4-6 months from time of surgery before they are barefoot and sound in the pasture. This mare's initial recovery was slowed due to a sub-solar abscess that involved her entire sole and communicated with the coronary band. 

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