pastern fracture

[sandsarita]

So unfortunately my very nice now 4 year old hurt herself in turnout. She came in extremely lame, could only find a slightly sprung shoe and two small cuts. Trainer removed shoe, she continued to get worse, vet came out and x rayed and u/s eval (had no heat, no swelling, good pulses) and she has a nondisplaced fracture of the front pastern near the joint. Vet (who is equine only and very good) is sending x rays and calling and talking to our other vet, who is a major referral hospital (and is actually my primary vet as they are the closest equine vets to my place). Currently he thinks no surgery, just 6-8 weeks of stall rest and hopefully will be fine with an increased risk of arthritis in the joint. Likely will put her in the soft ride boots as well, is on mats and deeply bedded. Trying not to move her at all, so prefer to not haul her to vet facility and keep her at trainer’s even though I have ability to keep her at my house (is being put on board only).

Does anybody have any experience with something like this? It is new for both me and my trainer. Any questions you would ask?

Things I am thinking of currently are:

• is it in the growth plate?
• when to re x-ray to ensure proper healing
• pain control: should she be on anti-inflammatories for a while, she has been given bute but I hate it long term
• ulcer control while on stall rest
• we were fixing to start her on pentosan for prevention, should we go ahead and do it now?
• Osphos - would this be useful in this situation, or wait and reevaluate healing first (she has minor navicular changes on x-ray, had sent the PPE films to referral vet we are contacting tomorrow and he was completely unworried with them)

Thanks in advance, needless to say getting this phone call while I was at a show with my gelding on my own was not a good way to start the new year. I am still a bit frazzled as I was trying to sell current horse while getting her going. Obviously he is off the market for now.

[csaper58]

P1 fracture or P2?

Is the leg stabilized in any way? A heavy standing wrap or such?

[kmwines01]

No osphos. You want that bone to be able to heal and remodel. Yes to pain meds. May need sedatives as well. Repeat rads will depend on healing. We managed one with an ulnar fracture that we radiographed ever few weeks to evaluate.

[knic13]

I don’t know that I would want to go with soft rides in this type of situation. They are tall and quite heavy.

[Ticker]

Sorry to read about the fracture, but good news it’s not displaced.

We x-rayed my foal with a cannon bone fracture every week or two to monitor progress. Stabilizing the area is very important to prevent further cracking. The x-rays will show you how much new bone is being laid down over the crack.

My foal had a significant ‘bone callus’ at the fracture site as a result of the healing process. (big lump) The bone callus will eventually be re-absorbed but it takes time. Not sure if any residual bone callus will remain on an older horse.

Most equine vets don’t have a lot of fracture experience as it’s the kind of injury that most owners euthanize. The exception is a vet clinic that works with cows. Calf fractures are common, so contact your local teaching university veterinarian clinic, if you have one, or a local cow vet for an xray consult. They most likely are your best experts for treatment advice to get you going.

Best wishes to you.

[findeight]

Was in a big show barn for years. Recall one that had a non displaced cannon bone fracture, more along the lines of a hairline, had been NQR for some time, took a clinic trip and advanced diagnostics to reveal it. Another same type pastern fracture, likely suffered in the paddock, as OP described in a younger horse. They were not my horses so no details.

But they were kept in heavily bedded stalls, Bute for inflammation and discomfort, long acting sedation. IIRC both were wrapped but with quilts and wraps, nothing else-no boots or anything. They also modified their diets to be sure they provided complete nutrition but avoid packing on weight or too much energy. They x rayed the one with the pastern a few weeks after the injury and probably every month after that but they took it home after about 90 days, no idea but they kept all theirs as pasture puffs and never saw it shown again, assume it was retired.

The one with the cannon fracture was out work over a year but did return to jumping at a lower height and continued for some years. Still doing flatwork last I heard, must be early 20s by now.

Sorry can’t be of more help but until recently few kept average pleasure horses around after suffering such injuries.

Oh, the bone callus going away on older horses? Not completely IME. Again, small sample size. A few well bred, well regarded performance wise stallions and one mare in breeding programs. I have known a few with non displaced fractures that never threw a callus, like that one with the cannon described above.

For OP, there’s really nothing you are going to be able to do other then wait and see, no magic bullet fix, no miracle supplement, just proper nutrition modified to reflect lack of activity, protect the area, keep her quiet, Bute. And wait. Treating for ulcers won’t hurt a thing and might be a good idea.

[IPEsq]

I think if you just pull shoes and keep the stall well bedded, it would be fine without boots. Sounds like it is not a P3 fracture.

Keep the nutrition up even if you need to cut calories. Be sure she has balanced vit/min ration. I’ve put my horse on Platinum Performance Osteon for a couple of different issues. It’s basically a silicon. Figure it won’t hurt, might help. I’d wait on all the other things (Osphos, Pentosan, etc), except ulcer preventative, unless directed by the vet.

Osphos will help alleviate the bone pain immediately but does affect bone metabolism, so I don’t know at what stage it should be given if at all for a fracture. I think there is a risk that the bone that’s built due to Osphos will be more brittle. Which is maybe a risk to take where you have bone loss but maybe not for this kind of fracture.

[sandsarita]

Thank you guys for some thoughts. Have talked to trainer this am, have not talked to referral vet yet

First it sounds like p2 and more of a chip fracture that has not displaced.

Am looking at doing Equioxx long term while healing, is currently on bute and ulcer guard.

Holding off on soft rides. They were initially considering them because she was putting so much weight on left front and very little on right so it was more to protect the left front foot. Today she is pretty equal so we are holding off at this time

She is currently being quiet. We are cutting calories but keeping on good nutrition. Discussed medication if she becomes wild in stall - there is some new “natural” supplement for calming the clinic has been using with good success. Want to stay away from reserpine unless absolutely needed as trainer has experience of them waking up from it pretty wild.

Still waiting on more answers but that is a start

[findeight]

If it’s any consolation, you should know more sooner then later. Unlike soft tissue injuries that are harder to pin down and can take a very looong time to heal only to have a greater chance of re injury then fully healed bone in a non displaced fracture.

[WNT]

My TB fractured his short pastern on XC several years ago. He was barely off, we actually thought it was a stone bruise before getting the vet out on the Monday after. He jogged slightly off on flexion, and the vet thought possible coffin bone fracture. There was a tiny bit of swelling at the coronary band. The X-ray of the hoof caught the very bottom of the pastern fracture.

It looked like someone had drawn a line halfway down the center of the short pastern bone with a sharpie. It did go into the joint, but there was no displacement or damage to the long pastern bone. He was stall rested for six weeks, and hand walked three times a day. On the follow up X-ray, the fracture had completely healed without a hint of arthritis in the joint. He rehabbed beautifully, having been fit for Prelim eventing when he got hurt. He was hurt in July, and we took everything easy over the winter and were competing again in April.

[sandsarita]

Well the good news is that the referral vet is in agreement, just stall rest for about 6 weeks, rex-ray. They are hopeful that things will be good as long as she keeps calm on it. Luckily she has been easy going and is in a busy training barn so has lots to look at.

WNT - thanks for the good story on this. The vets seem to think the long term prognosis is good but anytime you hear pastern fx you kinda freak out. She is just so freakin talented and so kind and gentle it just makes me sick.

[ktm_here]

My experience was slightly different. My older guy was 17 when he must have slipped on ice and had a non-displaced P2 fracture. He did get operated on with pins/screws followed by almost 9 months of stall rest/rehab. He has done well since and is back in full work albeit on previcox and routine injections. Per the surgeon, he can’t jump any higher than 2’9".

[sandsarita]

Well unfortunately the part that was nondisplaced displaced and went into fetlock joint. She is having arthroscopy to remove the piece tomorrow. She was looking much more sound, but we held the equioxx for a couple of days before vet eval and she was very off again. Dropped off today, hoping for good news tomorrow am. Vet is at the major referring hospital, and one I use quite a bit. He is very hopeful that she will be fine, about 2 month recovery and then rehab as long as nothing else is found. He is most worried about long term arthritis in the joint. Is thinking of continuing pentosan and then doing IRAP as well. Will see.

[JB]

@IPEsq

Keep the nutrition up even if you need to cut calories. Be sure she has balanced vit/min ration.

Glad someone brought this up early!

Nutrition is critical! An injured horse needs the nutrition of roughly a moderately hard working horse. Ration balancers will be your friend during this time. She needs ample protein, and enough and balanced calcium and phosphorous, but that doesn’t mean other things like copper and zinc aren’t important.

Plus, she’s still growing. Feed her like the young horse she is AND as if she was working pretty hard. Good quality hay (adding a little alfalfa will be find and good if she can take the calories), and use a ration balancer. I’d say 2lb for her, even 3 if she’s really big (like the 17h range)

[sandsarita]

Another update in case someone else has a horse with a similar injury. Surgery had to be a cut down to get the bone chop out. Found cartridge damage in fetlock which was out. Also partial tear of superior branch of superficial digital flexor tendon. Was brought home, 2 weeks stall rest then start class 4 laser 3 times a week and 10 min of hand walking a day.

Eval today showed lots of love mprovement. Joint space likes good with none of the arthritic changes they were worried about. Walking looked sound, which she has for about 3-4 weeks. Trotting good, just a bit stiff in joint but very minimal. Was only off after jumping in air and landing on front feet for a short time. When she did the same and landed behind first no issues.

Injected the joint with ha and steroids. Now to start ponying. Straight lines, walk 10 min, trot 5, walk 10. Each week if doing well add 5 min. So I borrowed a rope horse that is used to ponying all kinds of things and start Monday. Now she was a bit sore when I got her home but am tying to not let that worry me as she had a 3.5 hr trailer ride, lots of time on concrete and standing in trailer and first time trotting since Jan 1. Have to laugh though as she completely dwarfs the roping horse

[csaper58]

Glad today’s eval was good!

Have you and the vet discussed giving a little bit of Acepromazine (tranq) the first few times you pony her? It can be given by mouth, or in a little bit of mash.

[WNT]

Slow and easy wins this race. As a youngster, she’s got plenty ahead of her to take your time now. You’ll probably be rehabbing the tendon tear longer than the fracture. When we hit about our four week mark, I started wrapping it part of the time with a Back on Track wrap. I used one of his hind ones so it went all the way down to his coronet band.

I also agree with a light sedative if she’s feeling frisky, it’s so easy for a buck and a bad landing to undo the healing that’s been done.

[sandsarita]

I will ask vet. Right now we hd a flooding event and it will be a bit before I can get in the pasture. I was joking with my trainer during vet exam that if I didn’t know better I would have thought she was drugged. Except for those couple of moments while trotting. Poor thing was hand walked in barn aisle for 20 min today. Thankfully it is matted

[skykingismybaby1]

Try google to find the story of “Always B Miki” Miki belongs to a friend of mine and is a Standardbred race horse (now standing at stud). As a three year old he broke and displaced his left hind pastern, later that year he broke non displaced right hind pastern. He raced as a five year old and broke four world records. He is the fastest Standardbred ever.

Good luck and best wishes.

[TheJenners]

Had a similar fracture on a rear leg for a mini donkey, and he was casted for…four months? Does anyone remember? I think I blocked it from my memory. Sound as a bell now :yes: