Page 204 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Musculoskeletal system: 1.4 The forelimb 179

VetBooks.ir 1.343 1.344

Fig. 1.344 Cranioproximal/caudodistal radiograph
of the proximal humerus showing an incomplete non-
displaced fracture of the deltoid tuberosity following a
kick injury to the region.

Non-surgical management or removal/internal fixa-
tion of fractures of the greater tubercle have been
Fig. 1.343 Mediolateral radiograph of a 5-year-old Cob described.
with acute right forelimb lameness following a fall showing
a displaced comminuted fracture involving the humeral Prognosis
tubercles, extending into the scapulohumeral joint. Prognosis for complete humeral fractures in the adult
horse is hopeless. Incomplete fractures or stress frac-
Diagnosis tures can respond well to conservative management,
Clinical signs may be sufficient for a diagnosis of a although return to work should be undertaken care-
complete humeral fracture. Radiography is important fully to avoid acute propagation of the fracture. Deltoid
in characterising the fracture but may be difficult to tuberosity fractures and fractures of the greater tuber-
achieve (Figs. 1.343, 1.344) In some cases, specific cle have a good prognosis for return to function.
oblique views (e.g. cranioproximal/craniodistal) are
required to highlight the injury. Ultrasonography SCAPULA FRACTURES
may be useful in some cases. Stress fractures can be
visualised using nuclear scintigraphy by increased Definition/overview
radiopharmaceutical uptake at the predilection sites. Fractures of the scapula include fractures of the
Radiography may show periosteal new bone forma- supraglenoid tubercle, neck, body or spine, and
tion with chronic incomplete stress fractures. stress fractures.

Management Aetiology/pathophysiology
Horses with complete humeral fractures are eutha- Most fractures of the scapula are due to a traumatic
nased. Incomplete stress fractures may be managed episode (e.g. high-speed impact with a fence or kick).
conservatively with rest and alterations to training Stress fractures occur due to non-adaptive remodel-
regimes. Fractures involving the deltoid tuberosity ling because of intense training regimes and occur
can be managed by local debridement of fragments if at the distal end of the scapula spine. Fractures of
loose but respond well to conservative management. the supraglenoid tubercle occur more often in young