Disorders of the bovine upper limb (Proceedings)
Fractures of the metatarsal/metacarpal regions commonly occur in food animal practice particularly in young calves. Factors such as whether the fracture is open or closed and whether vascular damage has occurred determine the prognosis. Generally, the classic mid-shaft metatarsal/metacarpal fracture heals well under a cast to immobilize the joint above and below the fracture. I generally don't encase the foot, but some do. I like to keep them in a cast for 4-6 weeks, however, in young growing calves, they may outgrow the cast so we'll bring them back in about 2.5 weeks to re-check, and if necessary, change the cast.
Fractures of the shaft of the ileum usually result in mild to moderate swinging limb lameness. The gait is altered rather than having a definitive pain response. These present with the "knocked down hip" in which there is asymmetry noted in the pelvic girdle. Cattle with severe muscle atrophy may create an optical illusion as to whether the tuber coxae is lower than the other side. Typically, rectal palpation reveals a palpable fracture line or a definitive indentation or lack of continuity in the shaft of the ilium. These tend to heal with strict stall confinement. The only consideration is what the fracture does to the width and depth of the pelvis. There may be some ramifications for future natural delivery of a calf.Salter- Harris fractures of the distal physis of the metacarpus or metatarsus occur. These animals are not as lame as you would expect. Casting the limb up to the carpus or tarsus generally allows enough stabilization for healing.
Some fractures above the carpus and tarsus can be corrected with combinations of external or internal fixation. External fixation with pin casts or double cortex pins and a connecting rod are usually tolerated quite well. In addition, casting and incorporating a Schroder-Thomas splint in cases of distal tibial or radial/ulnar fractures can provide satisfactory results as well.
Commonly in show animals or other cattle with overly straight hind limbs present with "puffy" hock joints. This swelling is not warm to the touch or painful and the animals are not lame. The degree of swelling is generally symmetrical. Animals with overly straight hocks, especially bulls, over time get joint effusion just from "wear and tear". These cases are aided by drugs such as Adequan®, however, this is only a short term fix.
Femoral nerve paralysis
Femoral nerve paralysis is most commonly seen as a result of dystocia, and more specifically when the calves get "hip locked" for any length of time. These calves can't extend the stifle, and if it is bilateral, usually can't stand. These calves have a guarded prognosis. The calves, in addition to ensuring they have adequate passive transfer of antibodies, require physical therapy. If the owners are willing to do this, we usually give them about 4 weeks to show signs of improvement. The main differentials are bilateral hip luxation and lateral luxation of the patella.
Stifle injuries are most commonly a result of mounting mishaps, fighting, poor footing and falling, degenerative joint disease or ataxia from metabolic disease (ie: low calcium). Clinical signs of stifle injury or disease usually result in the following:
Avoids flexing the stifle
Hock and stifle tend to remain in a fixed position
The animal puts most of its weight on the toe
The unaffected legs are camped under the body to take weight off the affected leg
Periarticular and intra-articular joint swelling
Warm to the touch in cases of infection (gonitis)
Lameness in the foot may closely resemble stifle signs so make sure to start at the foot even though it may appear obvious that the stifle is involved. To tap the lateral femorotibial joint compartment for fluid analysis or lidocaine insertion the needle is inserted behind the lateral patellar ligament and directed caudally. The femoropatellar space can be reached by inserting the needle between the medial and middle patellar ligaments directing dorsally and caudally. Obviously, appreciating a cranial drawer sign in a large ruminant is difficult, however, sometimes joint instability may be observed by palpation at a walk. In cases of some duration, quadriceps and gluteal muscle atrophy may be noted. Crepitation in the hip can appear as if its coming from the stifle, therefore, evaluate the coxofemoral joint internally and externally.