نشریه التیام
سال نهم شماره 2 (پاییز و زمستان 1401)

Cattle usually tolerate physical restraint so, many surgical or therapeutic techniques including limbs procedures can be performed by using a combination of mild sedation and local or reginal anesthesia. These techniques avoid the risk of general anesthetic and are relatively simple and inexpensive with low side effects. Local or reginal anesthesia involve the local anesthetic drug that provide the absence of sensation in a region of body. Use of appropriate of local anesthesia is an important tool to perform different therapeutic and surgical procedures in limbs of cattle. It is important that local anesthesia provides sufficient analgesia for pain management. Lidocaine is the most common local anesthetic drug used in cattle. Before injection, the skin should be cleaned to reduce the chance of introducing pathogens. There are several techniques of local and reginal anesthesia including nerve block, ring block, four-point and, intravenous regional anesthesia for distal limbs in cattle. In nerve block, an anesthetic drug injects near specific nerves while ring block performs by injection of an anesthetic drug circumferentially around the mid-metacarpus or metacarpus region. In low four-point block, local anesthetic drug is injected in four sites to anesthetize the lower limb from pastern distally. During intravenous regional anesthesia, an anesthetic drug is intravenously injected by a catheter followed by the placement of a tourniquet around the limb. Consideration to the volume of used local anesthetic drug is necessary for prevention of toxic effect of these drugs. In this article, the most common local anesthetic techniques of the distal limbs in cattle are described.

Tendon disorders are the important cause of lameness, decreased production and loss of economic in cattle. These disorders may be congenital or acquired. Acquired tendon injuries involve tendon laceration, avulsion and rupture. Direct trauma, breeding injuries, bulls fight, and, handling accidents are the most causes of tendon injuries in cattle. Deep and superficial digital flexor tendons and gastrocnemius tendon are commonly affected. Clinical signs of tendon injuries depend on the severity of injury. Pain, mild to severe lameness and recumbency are the clinical signs associated with tendon injuries in cattle. Treatment of tendon injuries consist of stall confinement, anti-inflammatory medications, limb supporting through application of cast or splint and tenorrhaphy. The prognosis of tendon injuries affects by the severity of injury. Common acquired tendon injuries in cattle are described in this article.

Lameness of the hindlimbs originating from the stifle joint is one of the causes of pain, production losses, and culling from herd in cattle. Stifle is a large joint divided into femeropatellar and lateral and medial femorotibial joints. The major soft tissue structures of the stifle joint are lateral and medial collateral ligaments, cranial and caudal cruciate ligaments, lateral, middle, and medial patellar ligaments, and menisci That contribute to stabilize the stifle joint and its function. Different disorders including fractures, arthritis, and injuries of the menisci, collateral, and cruciate ligaments, and upward fixation of the patella affect stifle joint in cattle. The most important sequela of the stifle injuries is degenerative joint disease. Various degree of joint effusion, pain and lameness are the common clinical signs of stifle injuries in cattle. Lameness of the stifle joint may be difficult to diagnose and treat. Therefore, careful examination of the hindlimb is indicated. Radiography and ultrasonography can be used for diagnosis of stifle joint injuries in cattle. Because of the economic considerations and other limitations, advanced diagnostic techniques such as arthroscopy, computed tomography, and magnetic resonance imaging are uncommonly performed in cattle. Conservative management and surgical techniques are used for treatment of stifle disorders in cattle. Economic value of the cattle, severity of injury, presence of degenerative joint disease, availability of surgical equipment, and expertise of the surgeon should be considered for selecting of treatment options. Prognosis of stifle disorders in cattle is variable and depends on the type of injury, its severity, involved structures and concurrent injuries as well as cattle condition. In this article the most important soft tissues injuries of the stifle joint, clinical signs, diagnosis, treatment and prognosis of these injuries are described.

As the anatomical condition of the limbs is extremely important for production performance, animal welfare, as well as economic consequences, it is very important to study the types of limbs malformations in infants and provide corrective measures. A congenital malformation of the animal's limbs is more common in calves, lambs, and foals, involving flexor and extensor tendons in the fetlock and pastern joints. Deformities of the wrist and palmar-carpal joint in the forelimbs are the most common congenital deformities in calves. A non-surgical treatment is performed in cases whose limbs can be opened with the hand, and the ventral part of the fingers is in contact with the ground. The use of surgical treatment is mainly reserved for severe cases of deformity and calves with insufficient correction after splints and casts have failed. Generally, calves with flexion deformity have a good prognosis. Angular deformity of the limb refers to the deviation of the limb outward (valgus) or inward (varus). An Dorso-Palmar (Plantar) position is necessary to examine and measure the deformity's anatomical position. Angular deformities associated with abnormal bone growth plates can be corrected by removing the bone matrix or delaying on growth plate using of fixation through the growth plate. Furthermore, there are two other surgical methods for correcting angular deformity: osteotomy using the closing wedge and the step-wise method. Angular deformities related to imbalances in growth plates have a good prognosis. Secondary angular deformity caused by orthopedic injuries in the opposite limb has a poor prognosis.

Septic arthritis is an important cause of lameness in cattle and calves and delay in treatment, can lead to early culling, a decrease in production, and economic losses in herd. Although responsible for septic arthritis but can also be caused by other microorganisms. This condition occurs when joint space affects by invasion of various microorganisms. Failure of transfer of passive immunity, penetrating wounds, septicemia, and therapeutic or diagnostic interventions are the causes of septic arthritis. Lameness, joint effusion, pain, and fever are the most important of clinical signs of septic arthritis. One or more joints may be affected. Complete physical examination, synovial fluid and blood analysis, and imaging studies techniques are used as diagnostic tools for septic arthritis. Early diagnosis and appropriate treatment of septic arthritis are necessary to improve prognosis. Treatment strategy of septic arthritis includes antimicrobial therapy, anti-inflammatories, and joint lavage. Pathophysiology, diagnosis and treatment of septic arthritis are described in this article.

Lameness of limbs is one of the most important problems of today's cattle farms, which causes irreparable economic losses, so that about 60% of cows in each herd are lame at least once a year (finger injuries in Iran are 31.8%). Injuries of the digits is one of the major causes of lameness in cattle. Bones of the digits in cattle include the first, second and, third phalanx. Two vestigial digits are existed in cattle. The medial digit and the lateral digit are the main weight bearing structures on the forelimb and hindlimb, respectively. One of the practical treatments for injuries of the digits is its amputation. Among the most important causes of digit amputation, can mention osteomyelitis of finger and navicular bones, septic arthritis of interdigital joints, fractures and hoof traumas that have not responded to other conservative treatment. Most of digit amputation procedures perform under local anesthetic techniques with the cattle standing position. Selection of digit amputation techniques depends on several factors, such as the lesion type and the extent of involved anatomical structures. The most common surgical method is to amputate the digit through the distal aspect of the proximal phalanx without the need for a skin flap, which usually has a good prognosis and is effective in improving the economic life of the animal. Todays, limb amputation and the use of prosthesis are indicated in cattle or calf with untreatable musculoskeletal trauma or infection. General anesthesia is recommended for limb amputation. Although the short-term prognosis for limb amputation is good, the long-term prognosis depends on the weight of the animal and caring condition.

Today, bone fracture is one of the common problems that can occur in animals and can cause many damages. Fracture is common in ruminants including cattle, these animals are generally considered as good candidates to perform surgical operations in order to correct fracture and recovery. Generally, fractures which occur in ruminants and generally in large ruminants are of great importance for treatment because according to experiences, despite the cost incurred, the treatment of these complications is a good result .Often fractures occur in hind limb and fore limb parts of the animals and fewer cases are reported from the other parts. Selection of appropriate treatment method and control of these complications is affected by several factors, but in general, economic factors in patients can be considered as one of the most effective factors in this selection. About fracture management, some factors such as physical examination, prevention of subsequent secondary infection and etc, are discussed. In general, from 1950 onwards, the use of internal fixation in the treatment of fractures increased. The costs that are used to provide internal fixation instruments, preparation of radiographs, the salary of surgeons, postoperative cares and etc, may be considered for the owner, therefore, it should be considered before the beginning of surgery. Although there are many studies about the modification of fractures with external fixation, but there is a little data about the use of this system in large animals. In this article, the principles of treatment of internal and external fixation fractures are mentioned.