Page 805 - Adams and Stashak's Lameness in Horses, 7th Edition

Lameness Associated with the Axial Skeleton 771

very useful, especially when the procedure can be per- SPECIFIC TYPES OF PELVIC FRACTURES
formed in the standing horse. Ilial Wing Fractures
VetBooks.ir Ilial wing fractures are most commonly found in the

young Thoroughbred racehorse, age 1–2.5 years, with an
On‐Site Management
immature skeleton. Lameness is sudden in onset and can
Because of their traumatic origin, many of the pelvic vary in severity from 2 to 5 on a scale of 5, according to
fractures occur during a workout, in competition, in a the AAEP grading scale. The horse has the tendency to
race, or in the pasture. With the more serious injuries, plait with the hindlimbs or cross over the hindlimbs in a
such as ilial shaft and acetabular fractures, the horse trot. The severity of the lameness diminishes or decreases
may be down or impossible to move. In these cases it is in 24–48 hours. Profound muscle atrophy can occur
good practice to establish a preliminary diagnosis with a within the first 2 weeks after injury, which can give the
thorough clinical exam, which should at least include a horse a very asymmetric appearance when the injury is
rectal and/or vaginal exam. Crepitation and major swell- unilateral. When a complete fracture is present, the ipsi-
ing in the pelvic region at least can provide a severe sus- lateral tuber sacrale can be displaced. Manual pressure on
picion for pelvic fractures, but not confirmation. the tuber sacrale (see the section on clinical examination
Transportation to a clinical facility to perform more above) can be painful, as when sacroiliac injuries are pre-
diagnostics can be contraindicated or at least undesira- sent (see the section on the sacroiliac region below).
ble. In the field, ultrasonography can be a perfect tech- The major risk in these cases is when an initial incom-
nique to confirm the diagnosis of a pelvic fracture and plete fracture extends to a complete fracture. When this
make transportation unnecessary. 1,13,22,31 is the case bilaterally, the horse can become recumbent
with the chance for adjacent severe neurological damage
Treatment and Prognosis of Pelvis Fractures or a catastrophic injury during workout or race.
Therefore, correct diagnosis is important. 26,28,30
Treatment for pelvic fractures is conservative, including Ultrasonography is the first choice for a diagnosis in
with anti‐inflammatory medication (NSAIDs). 6,15,21,24,26,29 a practical field situation. 1,13,22,31 With a 3.5–5 MHz
Strict stall rest for at least 30 days is most important. Some transducer, nearly all commonly available ultrasound
clinicians advocate tying the horse in its stall for periods of equipment will facilitate imaging of the ilial wing.
up to 30–60 days to minimize the chance of a complete Moisturizing the skin and coating it with alcohol is all
fracture when getting up. In general, any horse will lie that is necessary to prepare the site for imaging. A better
down after some time, tied or untied. Therefore, tying the image can be obtained by clipping the coat before imag-
horse may increase the risk of other injuries associated ing. Following the contour of the ilial wing with the
with trying to lie down or getting up when tied. probe in a craniocaudal position and moving the probe
Furthermore, stress levels of horses that are tied up, or the from tuber sacrale out to the tuber coxae provides an
public opinion about the possible stress this procedure can outline figure of the ilial wing, and steplike changes can
evoke in the horse, decrease the acceptability of this be observed at the fracture site (Figure 6.10).
procedure. Scintigraphy is very useful for evaluating incomplete
Normal bone healing of pelvic fractures takes 2–3 stress fractures (Figure 6.11) as well as evaluating the
months, so motion must at least be restricted during this adjacent structures of the tuber sacrales and sacroiliac
period. Brief periods of hand walking (with the horse joints for involvement. In most cases, scintigraphy is the
under control) can assist in keeping muscle tension and most sensitive technique 5–10 days after initial
development more progressive than when complete stall injury. 10,12,20 Prognosis in most cases is good for a full
rest is recommended. The use of hot walkers or tread- recovery to an athletic career when no involvement of
mills must be avoided, because there is no permanent the sacroiliac joint(s) is present. When sacroiliac joint
control with these types of rehabilitation equipment. involvement is present and not diagnosed correctly, oste-
Use of this equipment risks the chance of a brief moment oarthritis of the sacroiliac joint(s) can be career limiting
of joy or fear, in which the horse can damage itself at a later stage. See the sacroiliac region section.
severely. Ultrasonographic examination can be a good
technique to monitor healing and determine when to
increase the workload. 1,31 Tuber Coxae Fractures
It is important to realize that complete healing of pel-
vic fractures (e.g., tuber coxae or tuber ischium frac- Tuber coxae fractures are nearly always associated
tures) and the adaptation of the adjacent structures to a with trauma, such as running into a door post or fence,
changed anatomical conformation can take several fighting, and kicking, and trailer accidents. In cases of
15
months to a year. Sometimes it is possible after this high‐energy impact to the tuber coxae (e.g., high‐speed
period to give a final prognosis for the return to an ath- collisions), adjacent structures in the sacroiliac region
letic career. It is a good practice to communicate this at may be involved and require attention later. See the sac-
an early stage with the owner and/or trainer so they are roiliac region section. Tuber coxae fractures are associ-
aware that the final outcome after such a long period of ated with moderate to severe lameness that decreases to
treatment and rehabilitation may be unfulfilling. mild lameness in 24–48 hours.
A recent paper however showed a better prognosis for These fractures are fairly easy to recognize because
Thoroughbreds with pelvic fractures than previously the contour of the tuber coxae is changed (Figures 6.12
reported, so it is wise to incorporate these findings in and 6.13). The fractured portion moves cranioventrally
your communication with clients. 21 due to traction of the internal abdominal oblique muscle.