Broken splint bone. Treatment and prognosis? X-rays included.

[RegentLion]

My gelding sustained a deep wound on the outside of his right hind cannon bone area 11 weeks ago. After 2 rounds of SMZs the wound seemed to stop healing at the size of a pencil eraser. He has never been lame.

Xrays revealed that, as suspected, the wound was a tract over the area of a broken splint bone.

My vet is seeking a second opinion through MSU but is recommending surgery, which is apparently close to 5k.

I cant see there being any other option other than surgery… but maybe there is… what’s recovery like? I don’t believe he’s going to be happy on stall rest and his wraps make him anxious. 🙄🤦🏼”â™€ï¸

I am basically beside myself and trying to hold it together. Have a 2w old baby and was really looking forward to my summer. It’s just a lot to process right now.

Attached are the 5 views she took.

[arabiansrock]

if he isn’t lame, why would you want to do surgery? My gelding had the same thing happen, lateral splint on lt hind. But my boy was dead lame. 3 legged. We did not wrapping, just some anti inflammatories at first, like for a week, then just pasture rest (he was in a solo pasture). 3 months later started tack walking, then trot then canter. After 5-6 months you would never know anything had happened.

[joiedevie99]

I can’t see the x-rays well, but it looks like the break is fairly far down towards the tip. I know of some surgeons who will remove those standing, which reduces both risk and expense. Drugs are your friend if your horse needs rest.

[RedHorses]

Yeah, if the wound isn’t healing the body may be treating the broken bit of bone like a foreign object. The good thing about surgery is that if there’s no tendon or ligament damage post surgery is simply healing the wound. No waiting 6-8 weeks for bone healing.

I do wonder about the 5K price on a fish out the broken piece surgery though… Seems high to me.

Mine broke his splint bone without displacement last spring, but it healed nicely.

[firefoot]

I would use surgery as a last resort. I had a horse get kicked in the hind cannon, initial radiographs weren’t clear with all the swelling, subsequent rads showed some chips and a fracture. The horse was acutely painful and NWB the entire time. After a week on SMZs, genacin, bute, and stall rest, he went to surgery. Surgery went great, surgeon was very optimistic about recovery, horse snapped a front cannon getting up from surgery and had to be put down. Horses go to surgery all the time I suppose and it’s always a risk but if your horse is sound and not bothered by the leg after 11 weeks, I would get a few opinions on whether surgery is the best route. How recent are these xrays?

[x-halt-salute]

The $5k price for splint fractures is usually for surgery under general. I second @joiedevie99 's recommendation of looking into standing surgery, especially if the horse is a well behaved, stoic type. I ended up not doing surgery when mine had a problematic splint fracture, but had investigated standing surgery for non-financial reasons and incidentally learned that it reduces the cost significantly.

[RegentLion]

@arabiansrock

if he isn’t lame, why would you want to do surgery? My gelding had the same thing happen, lateral splint on lt hind. But my boy was dead lame. 3 legged. We did not wrapping, just some anti inflammatories at first, like for a week, then just pasture rest (he was in a solo pasture). 3 months later started tack walking, then trot then canter. After 5-6 months you would never know anything had happened.

I think because of the fact that there’s an unhealing wound tract, suggesting infection.

i would like to avoid surgery if at all possible it it looks like it’s probably necessary at this point. He’s always been sound on it.

[RegentLion]

@RedHorses

Yeah, if the wound isn’t healing the body may be treating the broken bit of bone like a foreign object. The good thing about surgery is that if there’s no tendon or ligament damage post surgery is simply healing the wound. No waiting 6-8 weeks for bone healing.

I do wonder about the 5K price on a fish out the broken piece surgery though… Seems high to me.

Mine broke his splint bone without displacement last spring, but it healed nicely.

I think the presence of the wound/drainage track suggesting infection is why we can’t just leave it in. This is all new territory for me and maybe I’m missing something.

I would so much rather do this standing or avoid surgery at all. Given that he’s been sound on turnout for the whole time I was hoping for a non surgical prognosis.

[RegentLion]

@firefoot

I would use surgery as a last resort. I had a horse get kicked in the hind cannon, initial radiographs weren’t clear with all the swelling, subsequent rads showed some chips and a fracture. The horse was acutely painful and NWB the entire time. After a week on SMZs, genacin, bute, and stall rest, he went to surgery. Surgery went great, surgeon was very optimistic about recovery, horse snapped a front cannon getting up from surgery and had to be put down. Horses go to surgery all the time I suppose and it’s always a risk but if your horse is sound and not bothered by the leg after 11 weeks, I would get a few opinions on whether surgery is the best route. How recent are these xrays?

So sorry to hear about your horse. That’s the kind of thing I dread happening.

The xrays were today, which is just over the 11 week mark. He’s been sound the whole time on regular turnout. We assumed it was just a wound until the xrays were taken today.

I honestly don’t know how you stop this apparent infection process/heal this wound and avoid surgery.

[RegentLion]

@joiedevie99

I can’t see the x-rays well, but it looks like the break is fairly far down towards the tip. I know of some surgeons who will remove those standing, which reduces both risk and expense. Drugs are your friend if your horse needs rest.

I’d be happy to email you the X-rays if you like.

At this point I’m looking to see who will do it standing. I don’t know why you’d opt for a full general if standing is an option.

[RedHorses]

I wonder if there is something else in that wound and his body wants it out. Has the vet cleaned it out and probed for anything that shouldn’t be there? Have you at any point done hot compresses and/or an Animalintex type poultice to try and draw anything out?

It wouldn’t necessarily show up on the X-ray.

[ElementFarm]

When my gelding had a sequestrum it presented as a sound horse with tiny swelling/cut that just wouldn’t heal, despite rest, wraps, abx. He had standing surgery to debride it, rehab was short and easy, no problems with it ever again. I wonder if there’s an aspect of the broken splint bone that’s causing a similar reaction.

from the internet:
Bone sequestrum is a piece of a dead bone that has separated from the healthy, sound bone during necrosis. If the part of the bone that is separated cannot be revascularized, the granulation tissue often sequesters it; this is the body’s attempt to extrude the dead bone

[IPEsq]

After 11 weeks I’d think you’d start to see some healing on X-ray for a clean break. There may be something in there preventing healing. The images are small but I don’t really see any clear bone fragments around the break. I think I’d have the wound probed first to see if anything obvious can be debrided. It’s not like we’re talking thick tissue in this area.

[RegentLion]

@RedHorses

I wonder if there is something else in that wound and his body wants it out. Has the vet cleaned it out and probed for anything that shouldn’t be there? Have you at any point done hot compresses and/or an Animalintex type poultice to try and draw anything out?

It wouldn’t necessarily show up on the X-ray.

Actually had one vet suggest another longer round Of antibiotics and animalintex poultices for 2 weeks in an effort to resolve the infection and hopefully avoid surgery.

But if the infection resolves, is avoiding surgery still a good choice?

[RegentLion]

@IPEsq

After 11 weeks I’d think you’d start to see some healing on X-ray for a clean break. There may be something in there preventing healing. The images are small but I don’t really see any clear bone fragments around the break. I think I’d have the wound probed first to see if anything obvious can be debrided. It’s not like we’re talking thick tissue in this area.

Where would you expect to see the healing? Like the ends of the bone knitting together?

I would happily email you the films if you want to see them better.

At at this point the wound would, I think, need to be really opened to probe.

[x-halt-salute]

@RegentLion

At this point I’m looking to see who will do it standing. I don’t know why you’d opt for a full general if standing is an option.

When I looked into it, it sounded like standing is not preferred because there are a number of things that are easier to do in a fully anesthetized, recumbant horse, like freeing the bone fragment(s) from the interosseous ligament, inspecting for small fragments, and reshaping the fractured end of the remaining bone. It’s not as easy as making an incision and plucking out a loose bone like a game of Operation, so general is still the standard protocol.

I was given the impression that standing is only an option (at least for my vets) if the break is fairly uncomplicated and if the horse is one that the surgeon expects will quietly tolerate manipulation of the leg and unusual sensations under sedation. Mine was a borderline candidate for the latter reason; your guy’s candidacy for standing surgery may rest on the former if they need to take a more exploratory approach to figure out what is preventing healing.

Given that you’re 11 weeks in without any healing of the fracture or the more superficial tissues, I’d probably be leaning toward surgery in your shoes, regardless of antibiotic response. Unless the vet is confident that the distal splint segment is rock solid immobile (i.e. won’t ever irritate nearby structures) and that the slow wound healing is a simple matter of infection, not foreign body, another round of antibiotics might just be kicking the can down the road. But personal feelings about avoiding invasive procedures vs. spending more time in troubleshooting mode, and of course money all come into play in evaluating whether antibiotics or surgery is a better next step.

I hope you get answers quickly about which options (e.g. standing) are on the table and figure out the best way forward for your guy!

[IPEsq]

@RegentLion

Where would you expect to see the healing? Like the ends of the bone knitting together?

I would happily email you the films if you want to see them better.

At at this point the wound would, I think, need to be really opened to probe.

Almost 3 months in, there should be some new calcification happening or something since it doesn’t appear to be shattered or grossly displaced. But these bones sometimes don’t heal the best, which is why with a middle body or distal fracture, the bottom piece just gets taken out. If anything is infected or necrotic, it definitely gets taken out.

How’s the horse’s bloodwork?

[RedHorses]

The fractured piece can end up “loose” without concern if it is positioned so as not to affect the surrounding soft tissue. The body can produce stabilizing scar tissue and the piece of bone can be left alone. Should that change some time down the years, surgery is still an option.

So if you can get that wound healed, and there is no lameness, he might not need surgery.

[LadyBug]

Sorry to hear about your horse. I can relate to the new baby and looking forward to the summer. When my mare had a similar break it was not long after I had brought her home after having my baby.

My vet x-rayed the leg on the first visit because of the location of the wound. We did antibiotics, wraps to keep the wound clean, and stall rest. I opted out of surgery since my horse is a little older and vet didn’t think it was necessary, so we did follow-up x-rays to make sure everything was still in place. She came back completely sound. However, if I had opted for surgery my vet was going to do it at the clinic and gave me a ballpark estimate of $1,200-1,500. Food for thought.

[Spud_amp_Saf]

My horse had a fully displaced fracture of the bottom 2/3 of her hind right splint bone about 2 years ago. She underwent surgery for removal, as the displaced section was likely to irritate the ligaments in the area if left in. She is still perfectly sound at age 20.

I am in Ontario, Canada and the procedure was one under general, and cost only about a quarter of your quote including tax and a course of Baytril. I had the procedure done at Milton Equine. Since I see you are in Michigan, maybe it is possible for you to come to Ontario to have the surgery done, especially given the exchange rate?