Page 289 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

264 CHAPTER 1

VetBooks.ir 1.501 1.502

Figs. 1.501, 1.502 (1.501) Lateral radiograph of the withers area in a Thoroughbred that had suffered a
heavy fall onto the area. Multiple displaced fractured DSPs are visible. The pull of the nuchal ligament tends to
pull the dorsal sections downward, making the fragments override one another. (1.502) Composite radiograph of
the same horse 3 months later. The withers were externally healed, but modified tack was needed.

1.503

Fig. 1.503 Lateral radiograph
of a single dorsal spinous process
fracture of T11. (Photo courtesy
Graham Munroe)

Differential diagnosis Management
Horses with lumbar fractures without neurological In the absence of neurological symptoms, at least
signs can resemble animals with pelvic fractures. 6 weeks box rest with additional anti-inflammatory
If the presenting signs are vague vertebral column medication should be supplied for as long as needed,
discomfort and poor performance, then the other depending on symptoms (usually around 2 weeks).
causes of such signs must be considered (see later). An additional one-off dose of corticosteroid is indi-
Discharge at the withers secondary to an infected cated to minimise early swelling. Horses are fed
fracture(s) should be differentiated from an infected and watered from a height as they are often unwill-
supraspinous bursa. ing or unable to put their head to the ground. An
increased risk of pleuropneumonia is present due
Diagnosis to consequent pooling of bronchial secretions, and
The diagnostic approach is the same as that outlined therefore temperature should be taken daily and
above for soft-tissue lesions, unless there are obvious bloods obtained if any doubt arises about the horse’s
clinical signs such as ataxia, marked swelling or dis- respiratory tract health. With neurological deficits,
charge. If vertebral displacement is present, a devia- systemic corticosteroid medication should be con-
tion of the DSP(s) may be palpable. The DSPs can tinued for at least three to four treatments. Internal
be assessed ultrasonographically and radiographi- fixation of fractures of the vertebral bodies in the
cally in the standing horse (Figs. 1.501–1.503). thoracolumbar area has not been described and is
Scintigraphy is very sensitive at detecting the high currently not considered feasible. Euthanasia is
osseous metabolic rates associated with fractures and indicated if hindlimb ataxia or paresis is significant
would therefore be the imaging modality of choice to and progressive despite treatment, or if pain cannot
confirm diagnosis of a suspect fracture (Fig. 1.488). be controlled.