Surgical Treatment of an Osseous Cyst-Like Lesion in the Middle Phalanx Communicating With the Distal Interphalangeal Joint of a Horse.
Authors: Balducci Jamie J, Barrett Myra F, Moorman Valerie J
Journal: Journal of equine veterinary science
Summary
Osseous cyst-like lesions affecting the middle phalanx are an uncommon but significant cause of persistent lameness in horses, particularly when they communicate directly with the distal interphalangeal joint, and conservative management frequently fails to resolve clinical signs. This case report documents a 4-year-old gelding with chronic lameness secondary to a subchondral cyst in the middle phalanx that had not responded to medical treatment, requiring surgical intervention to achieve resolution. The surgical approach involved thorough debridement of the cyst cavity followed by biological packing using tricalcium phosphate combined with bone marrow aspirate and platelet-rich plasma—a regenerative strategy designed to promote healing whilst maintaining structural integrity. The combination of mechanical cyst removal with osteoinductive and osteogenic materials achieved a successful outcome, suggesting this approach may merit consideration in cases where conventional medical management fails to improve lameness associated with these lesions. For practitioners managing horses with chronic distal limb lameness unresponsive to standard therapies, this case reinforces the importance of thorough imaging to identify potential intra-articular osseous pathology and the potential value of surgical intervention combined with biologically active scaffolding materials.
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Practical Takeaways
- •Subchondral cyst-like lesions of the middle phalanx are rare but should be considered in cases of chronic distal interphalangeal joint lameness unresponsive to medical management.
- •Advanced imaging is essential for diagnosis and surgical planning of these lesions.
- •Surgical debridement with biologic augmentation using bone marrow aspirate and platelet-rich plasma may be effective when conservative management fails.
Key Findings
- •A 4-year-old gelding with a subchondral osseous cyst-like lesion of the middle phalanx communicating with the distal interphalangeal joint failed medical management.
- •Surgical debridement combined with packing using tricalcium phosphate, bone marrow aspirate, and platelet-rich plasma resulted in successful resolution.
- •Osseous cyst-like lesions in the distal middle phalanx are uncommon in equids and may cause significant lameness unresponsive to conservative treatment.