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  Discussion on Research Study: Thermography for Early Detection of Cast Complications
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DrO

Posted on Thursday, Jun 11, 2009 - 10:38 am:

The casting of horses has been used to treat muscoskeletal instabilities, deformities, and even to help wound heal. However the amount of pressure exerted on the leg and the general configuration leads to a high level of complications mainly in the form of skin ulceration from pressure. This complication is exacerbated by the inability to examine the skin so often these complications go unrecognized until significant damage is done. As a result many have taken to creating "clam shell" casts that can be removed and put back on however this is an imperfect solution as it reduces stability. This research group has come up with a way to identify complications earlier greatly increasing the usefulness of casting.
DrO

Equine Vet J. 2009 Jan;41(1):18-23.

Distal limb cast sores in horses: risk factors and early detection using thermography.

Levet T, Martens A, Devisscher L, Duchateau L, Bogaert L, Vlaminck L.
Department of Large Animal Surgery and Anaesthesiology, Ghent University, Salisburylaan 133, B-9820 Merelbeke, Belgium.

REASONS FOR PERFORMING STUDY: There is a lack of evidence-based data on the prevalence, outcome and risk factors of distal limb cast sores, and no objective tool has been described for the early detection of cast sores. OBJECTIVES: To investigate the prevalence, location, outcome and risk factors of cast sores after application of a distal limb cast and to determine whether static thermography of the cast is a valuable tool for the assessment of sores. METHODS: A prospective study was conducted on horses treated with a distal limb cast. At each cast removal, cast sores were graded as superficial sores (SS), deep dermal sores (DS) or full thickness skin ulcerations (FS). In several cases, a thermographic evaluation of the cast was performed immediately prior to removal and differences in temperature (AT) between the coolest point of the cast and 2 cast regions predisposed for sore development (dorsoproximal mc/mtIII and palmar/plantar fetlock) were calculated. RESULTS: Mean +/- s.d. total casting time of 70 horses was 31 +/- 18 days. Overall, 57 legs (81%) developed at least SS. Twenty-four legs (34%) ultimately developed DS and one horse had an FS. Multivariable analysis showed that the severity of sores was positively associated with increasing age (OR: 1.111, P = 0.028), a normal (vs. swollen) limb (OR: 3387, P = 0.023) and an increase in total casting time (OR per week: 1.363, P = 0.002). The thermographic evaluation (35 casts) revealed that the severity of sores was positively associated with increasing deltaT (OR: 2.100, P = 0.0005). The optimal cut-off values for the presence of SS and DS were set at, respectively, deltaT = 23 and 43 degrees C. CONCLUSION AND POTENTIAL RELEVANCE: Distal limb cast is a safe coaptation technique with increasing risk of developing sores with time. Thermography is a valuable and rapid clinical tool to monitor the development of cast sores.
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