Radiographic analysis of the angle in the lateromedial projection of the metacarpophalangeal joint and the distal interphalangeal joint in metacarpophalangeal flexural deformities in calves


Sato, A.; Ishii, O.; Tajima, M.

Veterinary Record Open 5(1): E000271

2018


The bone alignment of the metacarpophalangeal joint (MPJ) of the distal interphalangeal joint (DIPJ) in metacarpophalangeal flexural deformity (MPFD) in calves was evaluated by radiography. This study was designed by retrospective study of radiographs. Lateral to medial radiographs of distal forelimbs were taken from 19 MPFD affected calves (35 forelimbs) and 21 normal calves (42 forelimbs). Based on the radiographs, the lateral angles of MPJ were measured from the metacarpal bone axis and proximal phalanx axis, and lateral angles of DIPJ were measured from the middle phalanx axis and distal phalanx axis. Mean lateral angle of MPJ in the normal limbs was 175.9 (95% CI 174.5 to 177.4). Mean lateral angles of MPJ in MPFD were as follows: mild: 167.1 (158.9-175.2), moderate: 165.1 (158.5-171.7) and severe: 150.6 (146-155.1). MPJ angle in MPFD limbs was narrower than that in the normal limbs (mild, moderate and severe: P=0.017, P=0.003 and P<0.001, respectively). Mean lateral angle of DIPJ in the normal limbs was 211.9 (210.7-213.2). Mean lateral angles of DIPJ in moderate: 200.6 (195.2-206.1) and severe: 204.9 (203.3-206.5) MPFD were narrower than that in the normal limbs (both P<0.001). There was no significant difference between the normal limbs and mild: 210.3 (206.9-213.7) MPFD limbs (P=0.7). The clinical severity of MPFD corresponded well with the lateral angle of MPJ. The flexion of DIPJ in moderate and severe MPFD was similar to the flexion of MPJ in MPFD. This suggested that the lateral to medial radiographs accurately reflected the MPJ flexion and the DIPJ in MPFD in calves, providing useful information for the treatment of MPFD.

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updates
'Large
Animal
Clinical
Sciences,
Rakuno
Gakuen
University,
Ebetsu,
Japan
2
Minami-NOSAI,
Southern
Hokkaido
Agricultural
Mutual
Relief
Association,
Yalu
mo,
Japan
Correspondence
to
Professor
Motoshi
Tajima;
Food/farmed
animals
Veterid
Radiographic
analysis
of
the
angle
0
in
nary
_
r 1
in
the
lateromedial
projection
of
the
metacarpophalangeal
joint
and
the
distal
interphalangeal
joint
in
metacarpophalangeal
flexural
deformities
in
calves
Ayano
Sato,
1
Osamu
Ishii,
2
Motoshi
Tajima
1
ABSTRACT
The
bone
alignment
of
the
metacarpophalangeal
joint
(MPJ)
of
the
distal
interphalangeal
joint
(DIPJ)
in
metacarpophalangeal
flexural
deformity
(MPFD)
in
calves
was
evaluated
by
radiography.
This
study
was
designed
by
retrospective
study
of
radiographs.
Lateral
to
medial
radiographs
of
distal
forelimbs
were
taken
from
19
MPFD
affected
calves
(35
forelimbs)
and
21
normal
calves
(42
forelimbs).
Based
on
the
radiographs,
the
lateral
angles
of
MPJ
were
measured
from
the
metacarpal
bone
axis
and
proximal
phalanx
axis,
and
lateral
angles
of
DIPJ
were
measured
from
the
middle
phalanx
axis
and
distal
phalanx
axis.
Mean
lateral
angle
of
MPJ
in
the
normal
limbs
was
175.9
(95%
CI
174.5
to
177.4).
Mean
lateral
angles
of
MPJ
in
MPFD
were
as
follows:
mild:
167.1
(158.9-175.2),
moderate:
165.1
(158.5-171.7)
and
severe:
150.6
(146-
155.1).
MPJ
angle
in
MPFD
limbs
was
narrower
than
that
in
the
normal
limbs
(mild,
moderate
and
severe:
P=0.017,
P=0.003
and
P<0.001,
respectively).
Mean
lateral
angle
of
DIPJ
in
the
normal
limbs
was
211.9
(210.7-213.2).
Mean
lateral
angles
of
DIPJ
in
moderate:
200.6
(195.2-206.1)
and
severe:
204.9
(203.3-206.5)
MPFD
were
narrower
than
that
in
the
normal
limbs
(both
P<0.001).
There
was
no
significant
difference
between
the
normal
limbs
and
mild:
210.3
(206.9-213.7)
MPFD
limbs
(P=0.7).
The
clinical
severity
of
MPFD
corresponded
well
with
the
lateral
angle
of
MPJ.
The
flexion
of
DIPJ
in
moderate
and
severe
MPFD
was
similar
to
the
flexion
of
MPJ
in
MPFD.
This
suggested
that
the
lateral
to
medial
radiographs
accurately
reflected
the
MPJ
flexion
and
the
DIPJ
in
MPFD
in
calves,
providing
useful
information
for
the
treatment
of
MPFD.
INTRODUCTION
Congenital
metacarpophalangeal
flexural
deformities
(MPFD)
in
calves
present
most
commonly
in
the
forelimbs.
1
A
diagnosis
can
be
made
based
on
the
anatomical
construc-
tion
of
limbs
examined
by
inspection
and
palpation.
2
3
Most
cases
are
mild
and
recover
naturally,
whereas
moderate
and
severe
cases
can
be
treated
with
non-surgical
treatments
such
as
splints
or
foot
extensions."
However,
some
severe
cases
do
not
recover
and
require
surgery,
in
which
MPFD
is
treated
by
sequen-
tially
transecting
the
superficial
digital
flexor
tendon
(SDFT),
deep
digital
flexor
tendons
(DDFT)
and
suspensory
ligament
until
remis-
sion
of
the
deformity.
15
The
surgeon
decides
intraoperatively
which
tendons
or
ligament
to
transect,
and
thus
an
estimation
of
the
deformity
is
helpful
for
treatment.
In
horses,
distal
limb
flexural
deformities
present
as
carpus
flexural
deformities,
MPFD
or
distal
interphalangeal
flexural
deformities
(clubfeet,
DIPFD).
7-11
The
DDFT,
SDFT
and
suspensory
ligament
may
all
contribute
to
the
occurrence
of
MPFD
in
horses.
10
12
13
In
contrast,
DIPFD
involves
only
the
DDFT.
91213
For
identification
of
the
pathogenic
origin
in
such
cases,
radiography
is
useful
for
assessing
joint
disorders
and
their
prognoses.
7
8
11
14-16
Lateral
to
medial
and
45°-60°
dorsopalmar
views
of
the
foot
are
used
for
the
diagnosis
of
DIPFD
and
MPFD
in
foals.
In
the
bovine
cases,
criteria
for
the
choice
of
treatment
have
not
been
described.
The
objective
of
this
study
was
to
evaluate
the
changes
of
bone
alignment
on
the
metacar-
pophalangeal
joint
(MPJ)
and
the
distal
inter-
phalangeal
joint
(DIPJ)
in
MPFD
in
calves.
MATERIALS
AND
METHODS
Animals
This
study
was
conducted
according
to
the
guidelines
of
the
Experimental
Animal
Research
Committee
of
Rakuno
Gakuen
University.
Nineteen
calves
(14±10
days
old),
17
Holstein
and
two
Brown
Swiss,
with
MPFD
were
hospitalised
at
the
Animal
Medical
To
cite:
Sato
A,
Ishii
0,
Tajima
M.
Radiographic
analysis
of
the
angle
in
the
lateromedial
projection
of
the
metacarpophalangeal
joint
and
the
distal
interphalangeal
joint
in
metacarpophalangeal
flexural
deformities
in
calves.
Veterinary
Record
Open
2018;5:e000271.
doi:10.1136/
vetreco-2017-000271
Received
21
December
2017
Revised
7
February
2018
Accepted
8
March
2018
Sato
A,
Ishii
0,
Tajima
M.
Vet
Rec
Open
2018;5:e000271.
doi:10.1136/vetreco-2017-000271
1
Open
Access
g
Center
of
Rakuno
Gakuen
University.
Thirty-five
MPFD
forelimbs
(left=18,
right=17)
were
examined
in
this
study
including
16
calves'
bilateral
forelimbs
and
three
calves'
unilateral
forelimbs.
Twenty-one
Holstein
calves
(10±7
days),
which
were
hospitalised
for
treatment
of
diarrhoea,
pneumonia,
omphalitis
or
other
conditions
with
normal
walking,
were
examined
as
normal
control
forelimbs
(42
forelimbs:
left=21,
right=21).
All
MPFD
were
classified
based
on
the
inspection
and
palpation
of
affected
calves
according
to
a
previous
report.
4
In
mild
cases,
calves
are
able
to
walk
on
their
feet
but
the
heels
do
not
contact
the
ground.
In
moderate
cases,
the
dorsal
aspect
of
the
hoof
breaks
over
a
vertical
plane
perpendicular
to
the
ground.
In
severe
cases,
the
calves
walked
on
the
dorsal aspect
of
the
pastern,
fetlock
or
carpus.
The
MPFD
cases
observed
in
the
present
study
were
classified
into
7
mild,
7
moderate
and
21
severe
limbs.
Radiographic
technique
The
calf
was
placed
on
a
mattress
in
the
lateral
recum-
bent
position
with
the
affected
limb
uppermost.
The
affected
limb
was
positioned
perpendicular
to
the
trunk
and
the
carpal
joint
was
extended.
The
limbs
were
adjusted
so
that
the
outside
claw
overlapped
the
inside
claw.
The
adjustment
was
performed
by
the
rotation
of
elbow
joint
which
was
out
of
the
primary
radio
beam.
Lateral
to
medial
radiographs
from
proximal
of
the
metacarpal
bone
to
the
toe
were
made
with
the
limb
parallel
to
the
radiographic
film
cassette.
The
x-ray
was
focused
on
the
centre
of
MPJ
under
conditions
of
70
kV
and
0.4
mAs.
Radiographic
evaluation
Radiographs
were
digitised
and
analysed
using
software
(ImageJ,
V.1.48,
NIH,
USA).
The
lateral
angles
of
MPJ
and
DIPJ
were
measured
using
axis
lines
of
the
meta-
carpal
bone
and
each
phalanx.
The
metacarpal
bone
axis
line
was
drawn
between
the
midpoint
of
the
minimum
diameter
of
the
diaphysis
and
the
midpoint
of
the
distal
growth
plate
(Fig
1).
The
proximal
phalanx
axis
(P1
axis)
line
was
drawn
between
the
midpoint
of
the
meta-
carpophalangeal
and
proximal
interphalangeal
articular
surface
(Fig
2).
The
middle
phalanx
axis
(P2
axis)
line
was
drawn
between
the
midpoint
of
the
proximal
inter-
phalangeal
articular
surface
and
the
midpoint
of
the
minimum
diameter
portion
of
the
middle
phalanx.
The
distal
phalanx
axis
(P3
axis)
line
was
drawn
between
the
midpoint
of
the
distal
interphalangeal
articular
surface
and
the
tip
of
the
distal
phalanx.
The
metacarpal
bone
axis
and
the
P1
axis
were
translated
and
extended
to
intersect
with
each
other,
and
the
lateral
angle
of
MPJ
was
measured
as
the
angle
formed
on
the
palmar
side
(Fig
3).
Similarly,
the
P2
axis
and
the
P3
axis
were
trans-
lated
and
extended
to
intersect
with
each
other,
and
the
lateral
angle
of
DIPJ
was
measured
between
the
palmar
sides.
All
axis
lines
and
angle
measurements
were
made
by
the
first
author.
a
FIGURE
1:
Landmarks
for
metacarpal
bone
axis
in
the
lateral
to
medial
direction.
The
metacarpal
bone
axis
(line
a)
was
defined
as
a
line
connecting
the
midpoint
of
the
minimum
diameter
portion
of
the
diaphysis
of
the
metacarpal
bone
(line
b)
and
the
midpoint
of
the
distal
growth
plate
(line
c).
The
lateromedial
direction
angles
of
MPJ
and
DIPJ
were
measured
at
the
outside
claw
and
the
inside
claw,
and
the
average
values
were
calculated.
The
radio-
graphic
features
of
both
sides
of
the
claw
at
MPJ
did
not
completely
overlap.
To
evaluate
the
angle
variation
by
positional
rotation
of
the
limb
in
radiological
exam-
inations,
we
calculated
a
per
cent
deviation
of
the
outside
claw
and
the
inside
claw
in
the
lateral
angles
of
MPJ
and
DIPJ,
respectively.
The
per
cent
deviation
was
calculated
as
the
difference
of
the
angles
in
the
area
of
the
DIPJ
of
both
digits
divided
by
the
average
angle
in
this
area
of
all
calves
involved,
multiplied
by
100
(Fig
4).
Per
cent
devia-
tion
of
the
lateral
angle
of
DIPJ
including
all
normal
and
MPFD
cases
varied
in
range
compared
with
per
cent
devi-
ation
of
the
lateral
angle
of
MPJ
including
all
cases.
Any
per
cent
deviation
of
5
per
cent
or
more
in
the
lateral
angle
of
DIPJ
was
excluded
as
an
outlier,
and
42
normal
limbs
and
35
MPFD
limbs
were
used
for
this
estimation
in
the
present
study.
Statistical
analysis
All
statistical
analyses
were
performed
using
a
software
program
(SPSS
Statistics
V.24,
IBM).
Data
from
each
group
were
combined,
and
means±sd
with
95%
CIs
were
determined.
A
t
test
was
performed
to
determine
differ-
ences
between
left
forelimbs
and
right
forelimbs
for
normal
and
MPFD,
respectively.
After
analysis
of
variance
2
Sato
A,
Ishii
0,
Tajima
M.
Vet
Rec
Open
2018;5:e000271.
doi:10.1136/vetreco-2017-000271
Open
Access
b
E
FIGURE
2:
Landmarks
for
each
phalangeal
axis
in
the
lateral
to
medial
direction.
The
proximal
phalanx
axis
(P1
axis,
line
a)
was
defined
as
a
line
connecting
the
midpoint
of
the
metacarpophalangeal
articular
surface
(A)
and
the
midpoint
of
the
proximal
interphalangeal
articular
surface
(B).
The
middle
phalanx
axis
(P2
axis,
line
b)
was
defined
as
a
line
connecting
the
midpoint
of
the
proximal
interphalangeal
articular
surface
(C)
and
the
midpoint
of
the
minimum
diameter
portion
of
middle
phalanx
(line
c).
The
distal
phalanx
axis
(P3
axis,
line
d)
was
defined
as
a
line
connecting
the
midpoint
of
the
distal
interphalangeal
articular
surface
(D)
and
the
tip
of
the
distal
phalanx
(E).
as
post
hoc
analysis,
Dunnett's
test
was
performed
to
determine
the
differences
between
controls
and
each
severity
of
MPFD
(mild,
moderate
and
severe)
in
lateral
angle
of
MPJ
and
DIPJ.
Significance
was
set
at
P<0.05.
RESULTS
The
per
cent
deviation
of
the
lateral
angle
of
MPJ
in
77
forelimbs
ranged
from
0
to
2.5
per
cent
(minimum
to
maximum).
The
per
cent
deviation
of
DIPJ
in
77
forelimbs
ranged
from
0
to
4.5
per
cent.
Three
forelimbs
from
three
MPFD
calves
were
excluded
from
the
study
with
per
cent
deviation
over
5
per
cent.
All
normal
forelimbs
were
used
for
the
study.
The
lateral
angles
of
MPJ
and
DIPJ
in
21
normal
left
limbs
were
176.9±4.9°
(mean±sd)
and
211.5±4.5°,
and
in
21
normal
right
limbs
were
174.9±4.3°
and
212.4±4.1°,
respectively.
There
was
no
significant
difference
between
left
and
right
limbs
(MPJ:
P=0.2
and
DIPJ:
P=0.5,
respec-
tively).
The
lateral
angles of
MPJ
and
DIPJ
in
18
MPFD
left
limbs
were
158.7±11.6°
and
204.1±6.3°,
and
in
17
MPFD
right
limbs
were
154.7±13.6°
and
206.3±4.7°.
FIGURE
3:
The
lateral
angle
of
the
metacarpophalangeal
joint
(MPJ)
(angle
A)
was
determined
by
crossing
the
metacarpal
bone
axis
(line
a)
and
the
P1
axis
(line
b)
and
measuring
the
angle
formed
on
the
palmar
aspect.
The
lateral
angle
of
the
distal
interphalangeal
joint
(DIPJ)
(angle
B)
was
made
by
crossing
the
P2
axis
(line
c)
and
P3
axis
(line
d)
and
measuring
the
angle
formed
on
the
palmar
aspect.
Also,
in
MPFD-affected
calves,
there
was
no
significant
difference
between
left
and
right
limbs
(P=0.4
and
P=0.3,
respectively).
The
lateral
angles
of
MPJ
in
normal
limbs
and
MPFD
limbs
are
summarised
in
Table
1.
The
lateral
angle
of
MPJ
in
MPFD
was
significantly
narrower
(mild:
P=0.017,
moderate:
P=0.003
and
severe:
P<0.001,
respectively)
I.
A'
1
FIGURE
4:
The
per
cent
deviation
was
the
average
deviation
of
A
and
A'
values
divided
by
the
average
of
A
and
A'
and
multiplied
by
100.
Per
cent
deviation
=IA-
{(A+A')/2}1/
{(A+A')/2}x100%.
A,
angle
of
one
lateral
distal
interphalangeal
joint;
A',
angle
of
the
other
lateral
distal
interphalangeal
joint.
1
Sato
A,
Ishii
0,
Tajima
M.
Vet
Rec
Open
2018;5:e000271.
doi:10.1136/vetreco-2017-000271
3
Open
Access
g
TABLE
1:
Lateral
angles
of
MPJ
in
42
normal
limbs
and
35
MPFD
limbs
Normal
limbs
Mild
MPFD
limbs
Moderate
MPFD
limbs
Severe
MPFD
limbs
(n=42)
(n=7)
(n=7)
(n=21)
Mean
lateral
angle
of
MPJ±sd
(°)
175.9±4.6
167.1±10.9*
165.1±8.9t
150.6±10.4t
95%
CI
for
mean
lateral
angle
of
MPJ
174.5
to
177.4
158.9
to
175.2
158.5
to
171.7
146.1
to
155.1
Significant
difference
("p<0.05,
**p<0.01)
compared
with
normal
limbs
(Dunnett's
test).
MPFD,
metacarpophalangeal
flexural
deformity;
MPJ,
metacarpophalangeal
joint.
than
that
in
the
normal
limbs.
Severe
MPFD
showed
the
smallest
angle
among
the
affected
limbs.
The
lateral
angles
of
DIPJ
in
normal
limbs
and
MPFD
limbs
are
summarised
in
Table
2.
The
lateral
angle
of
DIPJ
in
moderate
and
severe
MPFD
was
significantly
narrower
(both
P<0.001)
than
that
in
the
normal
limbs.
There
was
no
significant
difference
between
the
normal
limbs
and
mild
MPFD
limbs
(P=0.7).
The
DIPJ
angle
corresponded
well
with
the
severity
of
MPFD.
There
were
no
fractures
or
morphological
abnormali-
ties
of
bones
in
all
calves.
Both
joint
angles
were
narrower
according
to
the
severity
of
clinical
features.
This
indi-
cated
that
the
joint
disorders
reflected
surrounding
soft
tissue
abnormities.
DISCUSSION
In
the
present
study,
the
lateral
angle
of
MPJ
in
MPFD
limbs
was
narrower,
according
to
severity,
and
the
lateral
angles
of
DIPJ
in
moderate
and
severe
MPFD
were
signif-
icantly
narrower
on
the
palmar
side
compared
with
normal
limbs.
In
MPFD
and
DIPFD
of
horses,
the
characteristic
morphology
of
affected
limbs
in
severe
cases
has
been
used
for
diagnosis.
9-11
Treatment
guidelines
for
MPFD
in
horses
are
based
on
the
angle
of
the
fetlock,
and
treat-
ment
guidelines
for
DIPFD
in
foals
are
based
on
the
angle
of
the
dorsal
hoof
wall
relative
to
the
ground.
The
surgical
options
including
desmotomy
and/or
tenotomy
are
determined
based
on
the
angle
of
the
deformity.
8
912
Lateral
to
medial
view
radiographs
of
the
foot
in
DIPFD
are
useful
to
estimate
the
disorders
of
DIPJ
alignment
and
angle
of
the
dorsal
hoof
wall.
9
11
14
16
The
present
study
is
the
first
radiographic
analysis
of
MPFD
in
calves.
Accordingly,
the
metacarpal
bone
and
phalanx
axes
were
established
by
reference
to
radiographs
of
flexural
defor-
mities
in
foals.
9
11
14
16
For
accurate
radiographs
of
DIPFD
in
horses,
lateral
to
medial
and
dorsopalmar
views
with
weightbearing
by
the
affected
limbs
in
a
standing
position
are
neces-
sary.
8
9
11
14
16
The
anatomical
change
involves
the
degree
of
flexion
and
the
soft
tissues
related
to
the
distortion
of
the
hoof
capsule.
14
16
The
weightbearing
properties
of
the
foot
reveal
the
position
of
the
distal
phalanx
within
the
hoof
capsule,
solar
depth
and
length
of
the
heels,
and
the
osseous
integrity
of
the
perimeter
of
the
distal
phalanx.
8
14
16
It
is
difficult
to
exactly
overlap
both
digits
of
the
same
foot
in
standing
position.
Thus,
in
the
present
study,
radiography
was
performed
in
a
lateral
recumbent
position.
The
affected
limb
was
positioned
perpendicular
to
the
trunk
and
the
carpal
joint
was
extended
as
far
as
naturally
possible
without
traction.
Because
radiographs
were
obtained
without
weightbearing,
the
present
study
was
designed
under
restricted
conditions.
A
comparison
with
radiographs
taken
while
weightbearing
in
a
standing
position
is
needed.
However,
based
on
the
comparison
with
normal
limbs,
the
lateral
angle
of
MPJ
in
MPFD
limbs
narrowed
depending
on
the
severity.
As
shown
in
the
Results
section,
the
morphological
changes
corre-
sponded
well
with
the
severity
of
the
joint
disorder.
The
soft
tissue
damage
to
tendons
and
ligaments
could
be
esti-
mated
from
the
analysis
of
the
bone
alignment
of
MPJ.
The
lateral
angles
of
MPJ
and
DIPJ
were
measured
from
radiographic
features
of
both
sides
of
the
claw.
Radiographs
of
obviously
rotated
limbs
were
excluded,
and
the
deviation
between
both
digits
of
the
same
foot
for
all
lateral
angles
of
MPJ
was
very
small
(per
cent
devi-
ation:
0-2.5
per
cent,
minimum-maximum).
In
contrast,
a
large
deviation
between
both
sides
of
the
claw
for
all
lateral
angles
of
DIPJ
was
recognised
(per
cent
deviation:
0-4.5
per
cent).
Although
radiographs
were
taken
many
times
in
some
cases,
the
digits
of
the
same
foot
did
not
always
exactly
overlap.
This
was
thought
to
be
due
to
the
TABLE
2:
Lateral
angles
of
DIPJ
in
42
normal
limbs
and
35
MPFD
limbs
Normal
limbs
(n=42)
Mild
MPFD
limbs
(n=7)
Moderate
MPFD
limbs
(n=7)
Severe
MPFD
limbs
(n=21)
Mean
lateral
angle
of
DIPJ±sd
(°)
211.9±4.3
210.3±4.6
200.6±7.4*
204.9±3.8*
95%
CI
for
mean
lateral
angle
of
DIPJ
210.7
to
213.2
206.9
to
213.7
195.2
to
206.1
203.3
to
206.5
*Significant
difference
(P<0.01)
compared
with
normal
limbs
(Dunnett's
test).
DIPJ,
distal
interphalangeal
joint;
MPFD,
metacarpophalangeal
flexural
deformity.
4
Sato
A,
Ishii
0,
Tajima
M.
Vet
Rec
Open
2018;5:e000271.
doi:10.1136/vetreco-2017-000271
Open
Access
focus
of
the
radiographs
and
to
the
route
of
the
common
digital
extensor
tendons.
17
The
variance
between
lateral
angles
of
DIPJ
from
both
sides
of
the
claws
was
consid-
ered
to
result
from
the
harmonisation
of
extensor
and
flexor
musculotendinous
tissues.
The
mean
lateral
angle
of
DIPJ
in
moderate
MPFD,
which
was
smaller
than
the
mean
lateral
angle
of
DIPJ
in
severe
MPFD,
might
be
influenced
by
variance
between
the
digits
of
the
same
foot.
However,
the
lateral
angle
of
DIPJ
in
moderate
and
severe
MPFD
limbs
was
significantly
narrower
than
that
in
normal
limbs.
The
appearance
of
DIPJ
in
moderate
and
severe
MPFD
by
inspection
and
radiographs
was
similar
to
DIPFD
caused
by
contracted
DDFT
in
horses.
We
suspected
that
moderate
and
severe
MPFD
in
calves
is
influenced
by
a
contracted
DDFT.
Successful
treatment
of
MPFD
depends
on
the
severity
and
on
an
appropriate
choice
of
therapy.
6
Mild
to
moderate
MPFD
usually
responds
to
physical
therapy
and
treatments
using
a
toe
shoe,
splint
or
cast.
1
Most
MPFD
calves
recover
by
non-surgical
management.
However,
the
results
in
severe
MPFD
limbs,
especially
chronic
cases,
are
often
disappointing
and
these
animals
are
usually
euthanased
because
of
their
restricted
movement
even
after
complete
tenotomy
of
the
flexor
tendons.
1
4
6
Severe
MPFD
is
an
intractable
disease,
and
it
is
important
that
an
appropriate
diagnosis
is
made
and
surgery
is
performed
early.
This
study
suggested
that
a
criterion
for
appropriate
surgical
treatment
of
severe
MPFD
may
be
obtained
based
on
radiographs
of
the
lateral
angle
of
DIPJ.
In
conclusion,
the
present
study
showed
that
radio-
graphs
provide
more
detailed
information
about
the
MPFD
in
calves,
supplementing
inspection
and
palpa-
tion.
The
lateral
angles
of
MPJ
in
MPFD
were
more
flexed
to
the
palmar
side
according
to
the
severity
of
MPFD
compared
with
normal
limbs,
and
the
lateral
angles
of
DIPJ
in
moderate
and
severe
MPFD
were
more
flexed
to
the
palmar
side
compared
with
normal
limbs.
We
suggest
that
the
DIPJ
flexion
is
related
to
MPJ
flexion,
and
that
lateral
to
medial
radiographs
are
diagnostically
useful
for
estimating
the
prognosis
of
MPFD
in
calves
with
DIPJ
flexion,
particularly
when
planning
surgery.
Acknowledgements
We
thank
all
the
staff
members
of
the
Animal
Medical
Center
of
Rakuno
Gakuen
University
for
their
support.
Contributors
AS
and
01
took
radiographs.
AS
performed
image
analysis
and
wrote
this
paper.
MT
is
the
corresponding
author.
Funding
The
authors
have
not
declared
a
specific
grant
for
this
research
from
any
funding
agency
in
the
public,
commercial
or
not-for-profit
sectors.
Competing
interests
I
do
not
disclose
my
identity.
Provenance
and
peer
review
Not
commissioned;
externally
peer
reviewed.
Data
sharing
statement
There
are
no
additional
unpublished
data.
Open
Access
This
is
an
Open
Access
article
distributed
in
accordance
with
the
Creative
Commons
Attribution
Non
Commercial
(CC
BY-NC
4.0)
license,
which
permits
others
to
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adapt,
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upon
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work
non-commercially,
and
license
their
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works
on
different
terms,
provided
the
original
work
is
properly
cited
and
the
use
is
non-commercial.
See:
http://creativecommons.org/
licenses/by-nc/4.0/
C
British
Veterinary
Association
(unless
otherwise
stated
in
the
text
of
the
article)
2018.AII
rights
reserved.
No
commercial
use
is
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granted.
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5