Texas Equine Veterinary Association

www.teva-online.org • Page 14 vs. incomplete, displaced vs. non- displaced, orientation), anatomical location within the bone, and degree of soft tissue envelope damage. Common problems encountered in the contralateral limb include suspensory ligament fatigue, carpal varus, or foot deformities; mechanical laminitis is not common in foals. Disuse atrophy of the fractured limb can occur resulting in contracture or excessive laxity. Radius, ulna, tibia, and metacarpus/-tarsus fractures are generally more amenable to surgical repair than humeral or femoral fractures. Conservative management of femoral and humeral fractures in the form of stall confinement is a feasible alternative to surgical intervention if economics do not allow surgery. Fractures of the radius and tibia require internal fixation if any displacement is present; most foals undergoing surgical repair for these fractures have a fair-to-good prognosis for light-to-medium athletic use or for breeding purposes. Foals with ulna fractures containing any displacement should be repaired surgically; however, those with non-displaced fissure fractures often do not require immediate surgery. Foals with non-displaced ulna fractures should remain confined to a stall for eight to ten weeks and undergo radiographic monitoring every other day for the first two weeks, then once a week to assure displacement does not occur. Displaced, unstable metacarpus/-tarsus fractures generally warrant a guarded prognosis for future athletic use with or without surgery. Simple, stable fractures not requiring surgery have a good prognosis. The biggest complications encountered after any long bone surgery is implant failure or implant infection. Local wound therapy, systemic antimicrobials, and/or regional limb antimicrobial perfusions are performed when implants become infected. In general, these infections do not resolve until implants have been removed; fractures will continue to heal in the face of implant infection. Physeal fractures Physeal fractures are common because of the relatively weak physeal bone compared to the diaphyseal bone. Common physeal fractures encountered include olecranon, proximal tibia, distal radius, distal metacarpus/-tarsus, proximal aspect of proximal phalanx, supraglenoid tubercle, and the capital femoral physis. Diagnosis of physeal injury is based on clinical and radiographic findings (Figure 3). Clinical signs include varying degrees of lameness, pain on palpation of the injured area, swelling, limb instability, and/or angular limb deviation distal to the fracture. The primary differential for a stable physeal fracture is septic physitis. Fractures of compression physes are defined by the Salter-Harris classification scheme; olecranon fractures (tension physes) have their own classification scheme. Displaced, unstable physeal fractures typically require internal fixation. The one possible exclusion is the capital femoral physeal fracture; these can be managed conservatively with prolonged stall confinement if a broodmare is desired. In general, if adequate reduction and stabilization are achieved, the prognosis for soundness is good. The same complications encountered in long bone fractures can be applied for physeal fractures. Proximal sesamoid fractures Fractures of the proximal sesamoid bones are commonly seen in foals between two weeks and two months of age. These fractures most often involve one limb; however, multiple limbs may be involved and are sometimes they are biaxial. Clinically, these foals demonstrate a mild to severe lameness that is exacerbated by turning. Depending on the fracture configuration, there may be soft tissue swelling over the affected sesamoid. Fetlock joint effusion is often present, especially with basilar sesamoid fractures. Fetlock flexion and digital pressure applied over the fractured sesamoid will elicit a painful response. Diagnosis is confirmed radiographically. Conservative treatment consisting of small area confinement for six to eight weeks is recommended, followed by gradual return to a normal turnout schedule. A bandage can be applied as necessary to minimize soft tissue swelling or joint effusion. Although the sesamoid typically heals in an elongated manner, the prognosis for future athleticism is good. The prognosis for athleticism worsens when multiple sesamoids are involved. Pelvic fractures Pelvic fractures commonly occur prior to four months of age and can be a diagnostic challenge. Injuries to the pelvis region are generally a result of being kicked, running into a stationary object with the hind end, or excessive torsional load to the hind end while rearing and/or flipping over and landing on one side. Foals may carry the limb when trotting, but will frequently bear full weight while walking or standing. The tail is often set away from the affected side. Foals have a characteristic gait abnormality for different regions of the pelvis injured and a painful response can usually be detected with digital palpation of the affected side. Fractures caudal to the coxofemoral joint result in a reluctance to advance the limb and display a prolonged caudal phase of the stride, whereas tuber coxae fractures are characterized by a shortened caudal phase of the stride. The affected tuber coxae is often lower when compared to the contralateral side. Radiographs are required to confirm the fracture. Treatment for a pelvic fracture includes eight to 12 weeks of stall rest followed by a gradual return to controlled exercise. Fractures involving the acetabulum may require a longer duration of confinement before improvement in the degree of lameness is observed. Prognosis for foals with pelvic fractures not involving the acetabulum is favorable, but may be Figure 2. Tibia fracture in a 300 pound foal; pre- and post- surgery. Figure 3. Distal metacarpus physeal fracture.

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