Page 307 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

282 CHAPTER 1

VetBooks.ir 1.531

Fig. 1.531 Radiograph of the coxofemoral
joint and acetabulum taken under general
anaesthesia. Note the comminuted fracture
of the acetabulum with a number of displaced
bone fragments. (Photo courtesy Henk van
der Veen)

sedated horse (Fig. 1.533); however the full extent Management
of ischial and pubic involvement cannot be reliably Surgical fixation of pelvic fractures in the adult
determined using this technique, and it is unlikely to horse is very difficult, and commonly the only treat-
identify iliac wing fractures. ment option is stall confinement for 3–6 months
Nuclear scintigraphy is very useful for identifi- (Fig. 1.539). Removal of bony fragments that have
cation of pelvic fractures, with one study reporting formed a sequestrum may be indicated (Fig. 1.540).
increased radiopharmaceutical uptake in the region
of the fracture in 64% of horses. This study also Prognosis
found a positive correlation between the age of the The outcome in terms of functional anatomy
fracture and the degree of radiopharmaceutical depends on the site and initial displacement of the
uptake, meaning that this modality may fail to iden- fracture and the extent of further distraction of the
tify more recent fractures. (Figs. 1.532, 1.535). fragments by the subsequent muscle contracture.
Ultrasonographic examination is easy, quick One study found that horses with displaced frac-
and relatively inexpensive compared with other tures had fewer race starts than those with non-
imaging modalities. This modality is useful for displaced fractures, but that there was no significant
fractures of the tuber coxae (Fig. 1.534), as well as difference in race earnings. This study also found
the ilial wing (Fig. 1.536) and shaft, acetabulum that horses that do not present acutely with severe
(Fig. 1.537), sacrum and tuber ischii. Minimally pain necessitating euthanasia on humane grounds
displaced or incomplete fractures, as well as poor have a good prognosis for return to racing. Other
callus formation, may not be identified with studies have found that 60–93% of horses with
ultrasonography. pelvic fractures resumed racing at a median of 210
The use of CT has been reported in two fil- days post injury; however, median duration until
lies with pelvic fractures. In both of these cases, a subsequent retirement has been reported to be
definitive diagnosis could not be reached on ultra- just 10 months, suggesting that such injuries may
sonography or radiography alone, and CT provided affect longevity of high- performing equine athletes.
additional information regarding the nature of the Horses with partial fractures of the tuber coxae
fracture. The use of this modality is only feasible in have been demonstrated to return to function sig-
small horses or foals (Fig. 1.538). nificantly sooner than those with complete fractures