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Case Report
Can distal border fragments of the navicular bone be a
primary cause of lameness?
M. Biggi, T. Blunden and S. Dyson*
Centre for Equine Studies, Animal Health Trust, UK.
Keywords: horse; distal sesamoidean impar ligament; podotrochlear apparatus; osseous cyst-like lesion; radiography;
MRI
Summary
A horse with unilateral forelimb lameness and pain
localised to the palmar aspect of the foot was evaluated
using radiography and low field magnetic resonance (MR)
imaging. A distal border fragment of the navicular bone,
an osseous cyst-like lesion (OCLL) in the distal third of
the navicular bone and focal distal sesamoidean impar
desmitis were identified as the most likely causes of
pain and lameness. No other lesions likely to contribute to
pain and lameness were identified on MR images or gross
post mortem examination. The OCLL was characterised
histologically by enlarged bone lacunae containing
proliferative fibrovascular tissue. Focal lesions of the distal
aspect of the navicular bone are rarely found in isolation
but can be causes of pain and lameness in horses.
Introduction
There are a variety of abnormalities of the navicular bone,
with or without lesions of the podotrochlear apparatus
(the collateral sesamoidean ligaments [CSL] or the distal
sesamoidean impar ligament [DSIL]) or the deep digital
flexor tendon, which may result in pain and forelimb
lameness (Dyson and Murray 2011; Dyson et al. 2011).
Fragments on the distal border of the navicular bone were
observed with higher frequency in horses with navicular
disease (Wright 1993; Schramme et al. 2005) compared
with horses free from lameness (Kaser-Hotz and Ueltschi
1992). However, fragments were identified in 7% of 523
horses (Kaser-Hotz and Ueltschi 1992) and 8.6% of 676
horses (Verwilghen et al. 2009) in which no lameness was
observed. Therefore, the contribution of a fragment to pain
and lameness is not completely understood. It has been
suggested that movement between a fragment and the
navicular bone may be a cause of pain and lameness
(Schramme et al. 2005).
*Corresponding author email: sue.dyson@aht.org.uk
a)
M. Biggi et al.
a)
b)
Fig 4: Palmar surface of the left navicular bone; lateral is to the left.
The osseous fragment is embedded in the distal sesamoidean
impar ligament (white arrows). There is a well defined depression in
the contour of the distal aspect of the navicular bone proximal to
the fragment. There is mild fibrocartilage loss around the sagittal
ridge midway from proximal to distal.
Fig 2: Lateral parasagittal T2* weighted gradient echo (a) and short
tau inversion recovery (b) images of the left foot. a) There is a well
defined osseous cyst-like lesion (OCLL) in the distal third of the
navicular bone with mild increased signal intensity surrounded by
an hypointense rim (white arrow). The lesion corresponds to the ill
defined radiolucenct area seen in Figure 1a. The fragment is visible
as an hypointense area embedded in the distal sesamoidean
impar ligament (black arrows). b) There is an oval area of
homogeneous high signal intensity which corresponds to the OCLL
observed in a).
Discussion
To our knowledge this is the first report in which a distal
border fragment, associated with focal pathology in the
adjacent navicular bone and DSIL, were considered to be
the most likely causes of pain and lameness. Although
there were low grade signal intensity changes in the lateral
lobe of the DDFT in MR images, no structural abnormality
was identified grossly or histologically. The contribution of
a fragment to pain and lameness has been subject to
debate because fragments have been observed, albeit
with low prevalence, in sound horses, or in conjunction with
2012 EVJ Ltd
a)
b)
M. Biggi et al.
Acknowledgements
We thank Ray Wright for preparation of the histological
sections.
Manufacturers addresses
1Carestream
2Hallmarq,
References
Biggi, M. and Dyson, S. (2010) Correlation between radiological and
magnetic resonance imaging lesions in the distal border of the
navicular bone with particular reference to distal border fragments
and osseous cyst-like lesions. Equine Vet. J. 42, 707-712.
Biggi, M. and Dyson, S. (2011a) High-field magnetic resonance imaging
investigation of distal border fragments of the navicular bone in
horses with foot pain. Equine Vet. J. 43, 302-308.
Biggi, M. and Dyson, S. (2011b) Distal border fragments and shape of
the navicular bone: radiological evaluation in lame horses and
horses free from lameness. Equine Vet. J. Epub ahead of print; doi:
10.1111/j.2042-3306.2011.00429.x.