Possible Hip Fracture in Young Horse

[Dressurfrau]

My five year old 18.2 horse slipped and fell while playing in the field. He trotted off find but later was lame on his left hind. He has gotten progressively better over the last few weeks but we were trying to diagnose a moving lameness/swelling in his legs. The vet came again yesterday and took xrays of his hocks since there was some swelling in the front of the affected leg. Hocks and other xrays were fine.
The vet believes it may be a hip fracture and has instructed me to put him in a smaller paddock to ensure he doesn’t trot around much. The vet office doesn’t have the ability to xray his hips and my vet said the therapy would be the same even if I had it done.

He’s eating fine and acting normally, thank the good Lord.

Does anyone have experience with hip fractures and the prognosis?

[beowulf]

First, jingles for your boy. Sorry to hear he has slipped.

Do you know if the clinic is saying they can’t x-ray his hip because they think the results won’t be readable for diagnostics? In your shoes I’d really want to know what you’re dealing with.

“Hip fracture” is such a broad term and the prognosis and healing time are so varied depending on where. Tuber coxae fracture, also sometimes called a “pelvic wing fracture”? You are probably fine going this route. Acetabulum fracture? You are really going to want to get some rads/films of this area because the time and therapies are different.

My horse had a total wipeout years ago and fractured his ribs and his pelvis in three places. He had a wingtip fracture, acetabulum rim fracture, and IIRC, ischium (sp?) fracture. The wingtip fracture had the best prognosis for return to sport and the least heal time; I think it was something like 6-8 weeks. The other fractures were much more severe and guarded. I’m lucky my horse returned to a riding career at all. I started a thread about it if you’re curious. I think it was in 2016.

I remember the day it happened he already had developed a huge hematoma over his hips and the vet did not think his portable x-ray machine was strong enough for a good reading. My horse was in no condition to get on the trailer to haul to a clinic since there was no way he could have pulled himself over the ramp. Once the hematoma subsided I coaxed my vet into taking ultrasounds/x-rays of the area. Initially he was reluctant to do so since he did not think his machine was powerful enough, but we got clear enough rads and films to understand we were dealing with multiple fractures within the pelvis. See if your vet can be convinced: sometimes, they don’t want to waste the client’s money with poor rads/films.

In the meantime keep him in a medical paddock like the vet said. Something the width and length of two stalls max. My horse lived in that paddock for 6 months before we gradually opened it up via pen panels. Movement can make it significantly worse.

Good luck and keep us updated.

[NancyM]

Yes, I’ve had TWO of my own who have had pelvic fractures, and have known a few others too. Both of mine survived, and were sound. Others that were not mine, not sound after healing. You really can’t (at least I could not find a vet who could) xray much in the pelvis. There are breaks that CAN occur in the pelvis which do not heal well, and will not be sound in the long run. But, apparently, some can… maybe even “most”??? Exactly where it is is not “knowable” as far as I know, it’s a “wait and see” situation, as long as the horse can be made comfortable enough to give things time to heal. The horse who won the Grand National a couple years ago (I forget his name now), had broken his pelvis TWICE previously to running in the Grand National. So… there is hope for your horse for future soundness.
There isn’t much you can do for them, other than rest. Pain management if they need it. Keep them calm, and restrict movement if you can. Take it “day by day”, and see what happens, in time. Good luck with it!
I got a phone call here a few years ago, from a local horse owner, who had a very lame horse. We are semi-remote here, vets are few and far between. She had called the vet, who “did not have time to attend”, and he had said that it was probably a hoof abscess, over the phone. I was called in for an opinion on this. The horse had a broken pelvis, not a hoof abscess. You could push on the point of the butt, and hear the bones move- the horse did not react to this. I suggested that she give the horse the banamine she had (oral), and call the vet again for some prognosis on possible survival. The vet finally came, and put the horse down. I don’t know if the horse had a chance to recover or not, but the vet felt not. But that vet has a history of putting horses down in a number of different circumstances, rather than attempt to address problems. He’s not a vet I respect or use.

[Dressurfrau]

Thanks everyone for the info and the encouragement. He trots pretty sound but guards his leg in the canter.

He’s afraid of vets so the visit before this last one didn’t go well and he actually was rearing. Can a horse with a fractured hip rear?

[BroncoMo]

I would be hesitant to allow him to be loose with a possible hip/pelvis fracture. I’ve dealt with 2. The first one had multiple breaks, confirmed via palpation and ultrasound (I think the hip fracture was visible via X-ray). Completely non weight bearing lame. She fell on the way to her stall at the university and ran head first in to a gate, knocking herself out. We had to put her on a plastic skid of sorts and drag her to the stall. When she stood up, a piece of bone punctured her femoral artery and she bled to death.

The second one had a break at what we think is high in the illium. The X-ray was hard to get and not great quality. We were advised to tie her for 3-4 months and not allow her to lie down for fear of causing more displacement and another scenario like above. We did so though she had a couple instances where she fell asleep and fell down on her good side, with no issue; she was healing and looked like she might still get riding sound. Then about 3 months in, she fell hard on her bad side and I believe rebroke it and displaced it. She hasn’t been the same since. She lives in a small quiet dry lot with a crooked walk but not in pain. She lives a good life despite what I think she sees is an inconvenience, not a handicap.

It might be worth trying to get an X-ray if the lameness can be pinpointed to an area that can be seen. If they have to lay him down to X-ray, that is not worth the risk and I was advised to not do so with mine since spreading their legs to get access to the area is likely to displace the break.

Just a few thoughts on a catastrophic one and one less catastrophic.

[joiedevie99]

I would want a real answer on this one, especially before turning the horse out. If you can’t find a vet who will x-ray (I’ve had them done in the clinic and you can see a good deal, but not all, of the pelvis), can you do a rectal ultrasound?

[Dressurfrau]

I’m going to ask that question re: the ultrasound.

Can a horse with a hip fracture rear? Wouldn’t it be too painful?

[NancyM]

IMO, FWIW, the damage, if there is any, is done. Presume it is at least a crack, if that’s what it looks like. Getting pictures of it isn’t going to make it any better… only time and healing does that. So… treat it like it’s damaged, cracked, or broken. Stall rest, if he’s OK with that. Keep him quiet, and happy, and comfortable enough, but not comfortable enough to hurt himself further by making bad decisions… whatever that takes (a buddy to hang out with? a goat? or?). Spending money on it now with a vet is only for interest’s sake. It takes 6 weeks to heal a bone crack, minimum. Can he rear with a crack or break? Maybe he can, and has- depends on where the damage is. But it’s not a good idea to put him in a position where he may feel that rearing would be something that he’s going to want to do. Avoid that. Keep him quiet and confined. Give him time to heal. See what you’ve got after any healing is complete. Or, if it makes you feel better and you are rich, take xrays and ultrasounds of it first.

[No1]

What does your vet mean by a ‘hip fracture?’ A fracture off the tuber coxae? Those are relatively easily diagnosed by ultrasound in the field. They usually heal decently.

There are other types of fractures in the pelvis that have varying prognosis and treatments. All are usually diagnosed by ultrasound, sometimes bone scan. I’ve seen simple ones turn out very well and others turn out very badly.

[ASB_Stars]

As little movement as possible is key. A box stall is ideal, but a small pen might work. I have dealt with two over the years, and both healed up sound.

A Vet friend of mine told me that the real issue is that if they fracture, and have any splintering, they can slash the artery and bleed out. Pretty scary stuff!

[NaturallyHappy]

I’ve been told this, as well. The only one I knew healed well. As far as rearing goes, I imagine the amount of adrenalin might be the deciding factor, OP. I don’t know.

[punchy]

@Dressurfrau

Thanks everyone for the info and the encouragement. He trots pretty sound but guards his leg in the canter.

He’s afraid of vets so the visit before this last one didn’t go well and he actually was rearing. Can a horse with a fractured hip rear?

Sure, they can rear. They can also run around and give themselves a catastrophic breakdown.

I had a racehorse who we suspected had a fractured pelvis. We gave him 4 months stall rest and he came back right as rain.

[beowulf]

The location of the fracture matters for prognosis, though. Only way to know prognosis and return to sport, is to know the nature of the fracture.

A tuber coxae fracture is usually no issue and the regime you’ve described is reasonable to assure recovery. You can give them as little as 8 weeks off, and go right back to work.

But an acetabular, ilum, or ischium fracture are much worse, requires much longer layup, and has much higher incidence of reinjury and/or displacement – which can cause hemorrhage and/or hematomas that do complicate healing time and affect lots of soft issue bodies in the pelvic region. Those require six month to two years, and lots and lots of rehab that tuber-coxae fractures do not require.

And don’t forget, any time you involve stall rest, the body needs rehab for the stall rest too. So you aren’t just fixing the damage caused by trauma/fracture – you’re fighting the atrophy/loss of muscle from extended stall rest too.

“Hip Fracture” is just too vague a term to be guessing.

[Dressurfrau]

Thanks so much for the insight. It’s greatly appreciated!

[Dressurfrau]

So, I’m going to bring him for a bone scan. Anyone have experience with this? My vet suggested NC State. Appreciate any info on that vet hospital as well. Thx!

[No1]

I’ve never gone to NC State, it’s a top 10 vet college in the US, though. And they will have the ability to do any follow up imaging needed.

[IPEsq]

I’m not sure I’d spend the $3k on a bone scan as a first step versus trying to take some X-rays. A bone scan will show if there’s a likely injury to the pelvis, but you’d still want to try to image it with xray or ultrasound. Bone scans can be good if you don’t have much idea where in the body the problems are, but you often need to do more imaging afterwards, they are expensive, it’s a long day for the horse with a lot of sedation and usually 2 overnights at the hospital.

[NaturallyHappy]

I’d try this first, too. Bone scans aren’t the end all, be all we think in our heads. As IPEsq said, it typically requires additional imaging.

[beowulf]

This. Can they refer you to another practice to get x-rays/ultrasounds? I wouldn’t do a bone scan in your shoes either unless you think insurance would cover it.

[wildlifer]

I’ve taken my horses to ncsu several times & been very happy with them. I did have a bone scan done there with follow up rads; the ortho service is great. I would ask whoever you work with at NCSU what they recommend (include your vet if that is appropriate) - they may just have you go straight to xray or may want to evaluate your horse more first.

They also have the high end x ray equipment that makes REALLY nice pictures, I’ve always been amazed at how much more I can see on their stuff. Of course I pay more for it, but there are times when that is warranted.