Scapular body fracture

On the topic of horses constantly looking for ways to kill themselves, I introduce my red horse, the “quietest horse in the barn,” bolting away from the barn manager (whom he loves) at turn in (read: dinner, and horse is an “easy keeper”) time, making a bee-line for the fence to the paddock next door, and trying to jump out. Said paddock fence is steel pipe fencing with hot wire cord strung at 2 levels inside the paddock plus a line above. Horse has his winter blankets on, catches right front upper leg/knee on the fence, doesn’t quite rotate at this time and lands in other paddock on his head/neck/left shoulder then rotates over, also slicing left stifle in the process (probably on hot wire or one of the hot wire attachments), gets up right away and then lets horrified barn manager catch him as he is now dead lame.

Things he did NOT do to himself - break his neck (although he had what appeared to be a subcutaneous bleed a few hours later that swelled up a lot but responded right away to ice), break his stifle, break his humerus, break his elbow, break or separate anything at the shoulder joint, break his withers, break the neck of the scapula, or break the supraspinous fossa or spine of scapula. What he DID do was manage to have an oblique fracture of the infraspinous fossa, which is underneath a lot of muscle and in this horse’s case some fat rolls. Unclear if he might have some broken ribs somewhere, as he has a bit of swelling that’s persisting farther back on his right side also.

Aside from being dead lame and not totally weight bearing on the right front, he doesn’t mind having things pushed on or moved around, and if it weren’t for some crunching noises, we probably wouldn’t have even investigated the scapula that thoroughly. We can only see it on ultrasound, as he’s too dense to image this on Xray.

It’s been 4 weeks, and he’s showing some improvement, including no longer having me freak out so much about the possibility of support limb laminitis. We have another month or so until his next ultrasound. He’s on Robaxin and Equioxx and is getting cold laser and PEMF.

Of course, we had just come out the other side from an SI injury, and figured out how to manage his asthma, and he was going the best he’s ever gone with me. Won at a local hunter show. Started taking dressage lessons again and doing great. Was at a nice lean (for him), muscled weight. Super fit and lovely. All things considered, I’m thankful he’s alive.

My vets researched this, and there are only 2 somewhat similar cases in the journals. Neither of which are very helpful. The radiologist thinks it will heal fine. The consensus is not to try to put a plate in. Consultation with canine orthopedic surgeons (where this type of injury is less rare) suggest it will heal fine. He already had saddle fit issues on this shoulder in particular, so that could be a new journey in the future, assuming he can be ridden again. The estimate is for 6 months stall rest. Maybe back to work in 11-12 months. Thankfully, he is the quietest horse in the barn, and so far handling confinement like a champ. We’ll see once he can move more comfortably if he stays so quiet.

Posting here in case anyone else has seen something like this. And, if not, maybe it could help someone in the future to follow along given how rare this seems to be.

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I know of an older sweet, quiet horse that was turned out in a pen with a round bale and two other older, quiet horses.
Best guess one may have kicked at him and he was dead lame, examination did show a broken shoulder, prognosis was wait and see.
Vet called around and found out such breaks were rare, as your vet did.
Horse was kept stalled for long time, then rehabbed and came back 100%, no worse for his accident.

Hope yours heals just as well, but it does take long time.

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Oh, I should clarify also that the scapula he broke was the right side–so the side that caught the fence, but not the side he landed on. And (I guess good news?) he didn’t break it in the usual locations from impact on the fence. Would have made more sense in this location if a kick, but he was out all by himself.

Oh no, what an awful thing to have happened. Glad that he didn’t break his neck but…yeesh… Can’t the horses give you a break on your vet bills?

I took care of a horse that broke his scapula while I was a teen – he broke his left scapula and had very guarded prognosis. We rigged a sling for him and put him in an anti-cast surcingle. The sling ran across a large beam that ran diagonal in his stall. Depending on how severe your boy’s break is, this might be unnecessary, but I remember with this horse it was a lifesaver because he made the fracture worse initially from the stress of trying to get up/down after rolling. The sling prevented him from going totally down.

It was a long time of stall rest. If I remember right he was confined in a stall for almost a year. The main thing with him was keeping his stall heavily bedded and keeping him quiet - as you can imagine, he was on a lot of drugs – he was barely five when he got hurt. He did not come back 100% but he was fine for light riding and trails. His break was severe.

Jingling for you and your boy. You guys can’t catch a break. :frowning:

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Probably unhelpful because I’m a small animal veterinarian, but will second that dogs at least tend to do well without plates/internal fixation…

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He is getting extra bedding, and he can lay down to sleep. He was already doing this by the time we did the ultrasound (which was around day 10). He’s not one to roll in the stall ever. I was very worried about the left front ankle and foot at first and was weighing keeping him up for the shoulder and maybe having laminitis on that other foot. The vets do not think a tie line is necessary, and it’s not the location where he would need to be in a sling. I think if it was closer to the joint, he would have had to have a sling (like Clooney after he got home from Tokyo and tried to kill himself in turnout, right?). I can pick out the left front foot out reasonably well now, so fingers crossed next week he can tolerate getting his shoes pulled and a trim. Of course, the left front has grown the most since he got shod right before this accident. I think we can trim his hinds reasonably well, although this stall rest isn’t doing his SI joints any favors. Hoping to be able to do the fronts well enough, with breaks, that he can continue to stand comfortably and not have his angles get all wonky.

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So sorry your boy is injured! Your description of the whole thing, especially the “crunching” sounds, made me shudder. I can’t imagine how scary that was. It sounds like he’s moving in the right direction though. Fingers crossed for an uneventful recovery!

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Thank you. I didn’t even mention all of the pops and crunches and things that came from his neck and various other body parts over the first few days. First vet on scene thought at the first recheck that the residual noises and sensations :nauseated_face: coming from the scapula area was air pockets in the soft tissue since there was some edema in the area. He pushed and shoved all over the shoulder and horse was like, meh, whatever (although clearly not sound at the walk). When his usual sports vet came out later (with the idea of formulating a rehab plan) and heard/felt it, she was kind of horrified… recalling I had texted her some days before asking if it was possible to dislocate or break off something up in the scapular cartilage area. Upon seeing the pronounced step in the bone on the ultrasound, she says to me, don’t you hate being right?

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This line shows where they think the fracture goes. We tried dozens of shots to try to get it on Xray and couldn’t. Not worth the strain on his body trying to haul him to the clinic for images at this point.

I went through this probably about 20 years ago now. Horse had mounted his mare pasture mate, and gotten kicked on the way down. Very three legged lame, absolutely non weight bearing.

We got him to CSU who still couldn’t get a decent film to fully confirm but we were able to get enough of a view to dx a fissure fracture of the scapula. Their recommendation was to keep him stalled for 6 weeks, not allowed out at all. We kept him sedated so he wouldn’t lose his mind.

At six weeks he was still really pretty lame. He eventually got sounder. But he was never the same after that.

Honestly, if I were faced with the same question again, I would euthanize. I’m sorry to not have a happier story to share.

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@Simkie, do you recall where on the scapula the fracture was located on your horse? According to the radiologist, this is very important to the prognosis.

I’m afraid I don’t. It was a very long time ago. It was a stable fracture, though, with little risk of displacement barring something else catastrophic, if that detail helps at all.

Many years ago I had a rising 3yr old mare fracture her ulna… grade 4 displaced.
Not the same injury but similar. The bone is a flat slab like the scapula and hers was broken horizontally in two pieces.
It took several weeks before we could see any sort of bone growth.
She was on stall rest for almost 9 months and then limited turnout in a tiny paddock for weeks.
She recovered well enough to be backed and started as a 4.5 year old. She did not remain 100% sound doing a lot of circles/ ring work but was great to hack out.
Good luck with your boy…

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Well he’s feeling good enough to do some rearing and bucking at dinner time. And dinner isn’t even that great. A RB, chromium yeast pellet, magnesium, vitamin E and a gut supplement. He will leave that once the daily alfalfa flake arrives. And usually he hasn’t even finished his lunch hay. But exciting times nonetheless. The real good stuff (which hides his meds) arrives later in the evening from Mom which just gets patient whinnies/nickers.

Going into week 5, despite some calorie cuts, Mr. easy keeper is already putting on some fat. This is going to be a long road.

But his scapula doesn’t make so many sounds anymore :nauseated_face: :face_vomiting:. He is starting to really enjoy PEMF and laser directly over the injury, versus nearby.

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Farrier came to pull shoes and trim, and he did fantastic. No drugs needed—vet suggested a small dose of Dorm for some relaxation and pain control, but he didn’t need it. I’m so relieved that step is done and it looks like we’ll be able to keep his feet in good shape through this process.

We will give shockwave a try in the coming weeks.

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Just saw this thread–yikes!
Glad he’s on the mend!

9.5 weeks in, and the ultrasound shows a lot of new bone callus forming. No crepitus at all for the past 2ish weeks. Still a good amount of edema, which on today’s scan looks like it’s coming from down in some deep muscle tissue behind the shoulder. We did take a look at the ribs for the first time and didn’t find anything there. He got 2nd round of shockwave and with a little sedation on board walked to the wash rack (approx 2 stalls over) for a very quick but much needed bath. Walk back (more awake) seemed quite good.

He gets another scan in about 3 more weeks, putting us at the 3 month mark. The vets are hopeful that he will be able to do some hand walking after that. The bath today was his first time out of the stall in 8 weeks.

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We are now 15 weeks in, and we are doing some walk laps in the barn aisle when it’s quiet and the end doors are closed. He has been so well behaved that we even stayed hanging out in the aisle for most of today’s grooming. Granted, as many of you know, this is not my first rehab rodeo, so we have ear plugs, stud chain, and treats on hand just in case, but aside from some positive reinforcement with the treats (stopping when I ask nicely or with verbal cue and not the chain, for example), we haven’t had any moments of panic or needed all the emergency tools. Even today when someone needed to open the doors while we were out and it was windy outside. He is just THE BEST BOY. And he’s quite sound now at the walk. The more he gets out, even for just a few minutes, the quieter he’s been and the better he’s walking.

We also have some core exercises to do in the stall, which he hates so he threatens to bite me. His core is nonexistent and he looks more like a mare getting ready to foal. Next month he might be on more of a walking “plan”, and so my hope is that at some point he could wear a surcingle to incorporate the equibands from time to time before we get to the 6 month mark, but we will see.

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Sounds like a promising update.

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So now we’re at 4.5 months. There is a portion in the middle of the fracture line that isn’t filling in yet that we can see, but from there out to the margins, the callus looks great. Very interesting on ultrasound. Definitely not straight lines, but bright white lines that are all pretty connected, versus more cloudy looking segments from the previous scan.

He also got his first chiro treatment since the accident, and he quite enjoyed it.

Horse doesn’t care for much of his stall exercises except the passive mobilization ones and anything involving cookies, so since he’s been quiet, I have focused more on controlled walking. Had gotten him up to 10 minutes on a good day, and out almost every day in the barn aisle. So, he’s farther along than we thought, and he’s walking really well.

Next steps are tricky because we don’t want any leaping and cavorting just yet. So this week, I’ve been working on getting him up to 15 minutes a day, and out every day. Starting next week, we can add a surcingle every other day or less, to see how he tolerates wearing something there. If that goes well, then we will likely start using the Equicore some to up the walking intensity without upping the time or need to venture into the indoor.

I also have some Ace on hand to test how he will respond to that to maybe work towards the next step of walking over poles in the arena. I’ve been wanting to do my first Ace test by giving him a good bath, but the water heater picked a bad time to be on the fritz. So for now just the usual aisle walking program with ear plugs. Since he’s so quiet 99% of the time, I didn’t want to go to any daily meds like Trazodone.

Next scan in 4-6 weeks.

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