History
A 21-year-old Saddlebred gelding was evaluated for colic of 5 hours' duration. On physical examination, the horse's heart rate was 52 beats/min (reference range, 25 to 44 beats/min), its respiratory rate was 24 breaths/min (reference range, 8 to 16 breaths/min), and gastrointestinal borborygmi were decreased in all abdominal quadrants. A large, gas-distended viscus and an impaction in the large colon were detected during rectal examination. A healing wound was detected on the horse's right carpus, with swelling of the right carpal joints, and the horse was lame (grade 2/51) on the right forelimb. The owner reported that the horse had been kicked in the right carpus 2 weeks earlier and was being treated with phenylbutazone and penicillin; however, radiography had not been performed at the time of injury.
The horse was treated medically for colic, which resolved with IV and oral administration of fluids. Phenylbutazone was discontinued for the first 2 days of hospitalization, so further signs of colic could be detected, and the horse became increasingly lame on the right forelimb. Heat and swelling also became more evident over the right carpal region. Radiographs of the right carpal joint and distal aspect of the radius were obtained (Figure 1).
Dorsopalmar (A) and dorsomedial-palmarolateral oblique (B) radiographic views of the right carpal joint and distal aspect of the radius of a 21-year-old Saddlebred gelding evaluated for colic and right forelimb lameness.
Citation: Journal of the American Veterinary Medical Association 230, 2; 10.2460/javma.230.2.193
Determine whether additional imaging studies are required, or make your diagnosis from Figure 1—then turn the page
Radiographic Findings and Interpretation
A radiolucent line can be seen coursing from the distolateral to proximomedial aspect of the radius, indicative of a nondisplaced spiral fracture (Figure 2). The fracture line does not appear to extend into the carpal joints. There is minimal periosteal reaction and callus formation around the fracture line.
Same radiographic views as in Figure 1. Notice the radiolucent spiraling line coursing proximally and medially from the distal aspect of the radius (black arrows).
Citation: Journal of the American Veterinary Medical Association 230, 2; 10.2460/javma.230.2.193
Comments
On the basis of the history and radiographic findings, a diagnosis of a nondisplaced spiral radial fracture was made. The horse was treated with trimethoprim-sulfadiazine (30 mg/kg [13.6 mg/lb], PO, q 12 h) because of the open wound over the dorsal aspect of the right carpus and ranitidine (7 mg/kg [3.2 mg/lb], PO, q 8 h) to help decrease gastric ulcer formation. Because the fracture was stable and the owner had financial constraints, the horse was sent to a rehabilitation facility for 8 weeks of stall rest and cross-tying.
In adult horses, radial fractures are generally associated with external trauma and often may have a wound overlying the joint area.2 In contrast, most radial fractures in young racing Thoroughbreds are attributed to biomechanical damage.2 The horse of this report had sustained an injury to the right carpus resulting in swelling, heat, and a wound over the carpal region. In most cases, radial fractures tend to be oblique or spiral fractures of the diaphysis and can often become open fractures because of minimal soft tissue in that area.2,3 When fractures become displaced, open reduction and internal fixation are generally recommended; however, the prognosis is not favorable.2 Complications reported following internal fixation of radial fractures include breakdown of the implant, osteomyelitis, and laminitis.3 Displaced fractures can be identified during physical examination by detection of crepitus in the carpal region and non–weight-bearing lameness.2 Diagnosis of a nondisplaced radial fracture can be difficult in horses because they may be lame without instability at the fracture site. A horse with a nondisplaced or minimally displaced fracture of the radius can be treated with conservative management.
Treatment options for radial fractures include conservative management, external coaptation, and trans-fixation casting or internal fixation.2 The treatment decision is based on several factors including whether the fracture is open or closed, the location and degree of displacement, the fracture configuration, the size and temperament of the horse, and the expense involved.2 In general, conservative management is chosen for most horses with nondisplaced radial fractures and includes long-term (at least 8 weeks) stall rest with cross-tying, if necessary to prevent failure of the fracture caused by movement. Bandages are not recommended because they do not provide adequate fixation of the fracture and can be detrimental. In addition, full-limb casts are not recommended because they can cause redistribution of tension to the caudal aspect of the bone.4 Radiography should be performed every 2 to 3 weeks to monitor fracture healing and for detection of possible sequestra. In the horse of this report, radiography performed 4 weeks after surgery revealed bony callus formation and fracture healing. According to the owner, 6 months after discharge, the horse was being turned out into a small paddock and was no longer lame.
- 1.↑
Seeherman HJ. Lameness evaluation. In:Auer JA, Stick JA, ed.Equine surgery. Philadelphia: WB Saunders Co, 1999;611–619.
- 2.↑
Matthews S, Dart AJ, Dowling BA, et al. Conservative management of minimally displaced radial fractures in three horses. Aust Vet J 2002;80:44–47.
- 3.↑
Rodgerson DH, Wilson DA, Kramer J. Fracture repair of the distal portion of the radius by use of a condylar screw implant in an adult horse. J Am Vet Med Assoc 2001;218:1966–1969.
- 4.↑
Bolt DM, Burba DJ. Use of a dynamic compression plate and cable cerclage system for repair of a fracture of the radius in the horse. J Am Vet Med Assoc 2003;223:89–92.
