Complications following palmar digital neurectomy

Not emphasized enough is the need to be sure the foot is structurally sound prior to a palmar digital neurectomy. The horse is about to lose a significant amount of feeling in the foot. Feelings that help protect the foot from damage. At least a set of radiographs showing a structurally sound skeletal system and good would be an ultrasound of the soft tissue components of the foot.
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Navicular bone fracture and severe deep digital flexor tendinopathy after palmar digital neurectomy in two horses
Open Vet J. 2023 Dec;13(12):1752-1759. doi: 10.5455/OVJ.2023.v13.i12.24. Epub 2023 Dec 31.
Authors
Elizabeth A Larsen 1 , Megan R Williams 2 , Mike J Schoonover 2 , Kelsey A Jurek 3 , Jenna M Young 4 , Hugh R Duddy 5
Affiliations

1 Large Animal Clinical Sciences Department, University of Tennessee College of Veterinary Medicine, Knoxville, TN 37996, USA.
2 Veterinary Clinical Sciences Department, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK 74078, USA.
3 Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon 97331, USA.
4 Veterinary Population Medicine Department, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108, USA.
5 Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA.

PMID: 38292704
PMCID: PMC10824075
DOI: 10.5455/OVJ.2023.v13.i12.24

Abstract

Background: Navicular syndrome is a common cause of forelimb lameness in horses. Beyond changes to the navicular bone itself, horses with a clinical diagnosis of navicular syndrome often have pathology associated with other components of the navicular apparatus, including the navicular bursa, deep digital flexor (DDF) tendon, collateral sesamoidean ligaments, and impar ligament. Palmar digital neurectomy (PDN) is often used as a salvage procedure for horses diagnosed with navicular syndrome that become unresponsive to medical management. There are many potential complications associated with PDN, some of which are debilitating.

Case description: This report describes two cases of navicular bone fracture with severe DDF tendinopathy and distal interphalangeal joint subluxation/hyperextension that occurred 12 and 19 weeks after bilateral forelimb PDN.

Conclusion: These two cases highlight the importance of proper patient selection before PDN due to the high incidence of undiagnosed soft tissue pathology in conjunction with radiographic evidence of navicular syndrome. Advanced imaging of the digit is recommended to identify and characterize any soft tissue pathology associated with the navicular apparatus before pursuing PDN to avoid disease progression and catastrophic injury.

Keywords: Deep digital flexor tendon; Horse; Navicular bone fracture; Navicular syndrome; Palmar digital neurectomy.