Sesamoid Fracture

[equuestrian]

My mom’s gelding, Tank, was just diagnosed with a fractured sesamoid in his right hind on Tuesday. Our vet came out and did xrays and his diagnosis was a proximal sesamoid fracture with a suspensory avulsion fracture. At least that’s what I can read on the paper he left.

He gave him a poor prognosis for long-term soundness and being rideable. Then told us our options were wait 9-12 months to see how it heals and hope it goes well without any complications, but that it was very unlikely that would happen. So we were left with euthanasia as the other option.

I was just looking to see if anyone else has had experience with a sesamoid fracture and if they can give me any advice. We’re sending his xrays off for a second opinion as well.

When the injury first happened he was pretty much dead lame and slowly he is getting his soundness back. Today he was walking really well, but not quite normal. So he is improving and that is whether he is on his painkillers or not. So we are opting for waiting it out and seeing how it heals, but any other advice on what I can do to help things keep progressing smoothly and maybe increase his chances of going back into work successfully would be great. He’s not in heavy work. He’s my mom’s trail mount and they only ride out occasionally and only at a walk too.

Anyway here are his xrays. If anyone needs any other information just ask and I will do my best to answer all your questions! Thanks guys!

Not sure how to post these encoded so they show up, this forum is different from my usual one, so here are the direct links to them

http://i251.photobucket.com/albums/gg306/Digitalchocolate345_2008/TarrKim.Tank.4-19-Jan-2016_zpsejgpzm0f.jpg

http://i251.photobucket.com/albums/gg306/Digitalchocolate345_2008/TarrKim.Tank.7-19-Jan-2016_zps8uc4u5g0.jpg

[Whyevernot55]

If it were me, I’d take my horse and his radiographs for consultation with an equine surgeon. Depending on your vet’s experience with this kind of injury, there may be options that he is not aware of, some of which may offer a different prognosis. In the meantime, strict stall rest! I am a little surprised no other options were offered, and if your horse isn’t already in a bandage or a splint of some kind, he probably should be.

As far as the fracture itself goes, knowing where in the sesamoid bone it is would be helpful (apical, basilar, etc) as the different types of fractures carry different prognoses, but many of them have an EXCELLENT prognosis. I personally know a horse who is back in work and jumping a year after an apical fracture.

[Texarkana]

Did the vet take more views than those two? I’m assuming yes. I’m by no means an expert, but I’ve looked more sesamoid fractures than the average horse owner and I can’t make a whole lot of judgement based on those two films.

Definitely get a second and maybe even a third opinion. Even if you don’t take your horse for a consult anywhere else, the surgeons at most major university hospitals will at least look at radiographs as a professional courtesy. It can’t hurt to email the rads to whoever is willing to look (as it sounds you’re already doing).

Sesamoid fractures are so incredibly tricky. Like Whyevernot55 said, it depends on the location and the degree of suspensory involvement. I’ve rehabbed a lot of them and have had them go both ways. Whatever the outcome, it’s a pretty long haul. Not to sound grim, but it’s worth asking yourself if you and the horse can handle a year of rehab, especially when it’s very likely to be for pasture soundness at best.

Good luck and many jingles for Tank!

[whitney159]

Get another opinion. I’m not an expert but years ago had a mare fracture a rear sessions. Hers had a good prognosis and she came back 100 percent. Another mare at the same barn fractured one a month later, same vet said terrible prognosis, due to severity and location. Owner refused to give up. Mare came back to flat work and stayed sound from what I heard after I moved out. But stay on stall rest absolutely! We did two months stall rest then into a 24x16 foot turnout for several months, then small turnout until vet gave ok for full turnout. I think it was a year before I brought her back to work.

[horsenut_8700]

We have a TB who fractured a sesamoid (RF) on the track. Because he’s a gelding and was then worthless, they gave him away to someone who was going to send him to slaughter to make a few bucks. He was three legged lame and emaciated when we took him home. Our vet came out and xrayed; at that point it was partially fused and there was nothing to do but wait. In his opinion, if they had taken him to surgery immediately a full recovery would have been possible.

We kept him wrapped and confined to a stall with a small paddock for 6 months. That was almost 10 years ago now. He does have a head bob at the trot because the joint is fused and has no range of motion. There is arthritis in that joint and we keep him lean to minimize the stress. He is a lesson horse w/t/c and small crossrails with our vet’s blessing. Sometimes if he overdoes it in the field with his buddy, he’s a little sore afterwards. I’d say get another opinion and wait to see if you can keep him comfortable!

Here’s our guy (scroll down to Three Sevens)
http://whipowillstables.weebly.com/horses-for-lease.html

[equuestrian]

There were more xrays! He took 6 and I can post the rest if you would like me to. Those were just the best and clearest ones I felt.

Our vet himself sent them to a surgeon who has dealt with this type of issue before as well to ask his opinion, so hopefully we’ll hear back from them soon. In the mean time I planned to shoot an email to another vet in the area. She’s a good friend and while she only has a small animal practice now, she has worked on the track as a vet for 30 years beforehand and I really trust her opinion.

I believe the fracture would be considered more apical, but our vet never did specify what it was exactly. Only that it kind of ran up the side and top of the bone.

I also asked about stall rest, but he said he would prefer keeping him out in the pasture because he has been in the situation twice during the whole ordeal where he laid down to take a snooze and then couldn’t get back up because he had laid down on the right side with his injured leg up under him. The vet was worried about the possibility of him casting himself in a stall, thrashing around, and shattering the bone or making the injury worse.

Other than that he never mentioned anything about putting the leg in a splint or wrap which was something that I found a little weird too. All of the research I had done everyone had their horses on strict stall rest and the leg was wrapped. Which would be better, a splint or a wrap? And what kind of wrap would be the best?

Seriously thank you guys so much for the responses. You’re really helping me out and I cannot express how much I appreciate it.

[NancyM]

I think you’ve had great responses here already. Other opinions from other vets are always a good idea. But listen to your horse. If he is game to try to carry on, and if the ankle has not dropped, and if he can escape other, related, cascade effect issues as a result of the original injury (founder in the opposite foot, etc), then you can carry on with him, day by day, and give him a chance to see just how it turns out for him. Let him try to heal, and see how sound he is in the long term. You may still lose the game, he may not be successful in healing adequately. Sesamoids to not heal as well as other bones, due to the lack of a periosteum on that bone. This is why those that can be screwed together tend to go for the surgery. Not cheap. But they can heal with a fiberous union, that CAN be functional, especially with a less than demanding lifestyle. Nobody, veterinarian or not, can foretell the future with 100% accuracy. Good luck.

[LarkspurCO]

My horse had a similar injury to a front limb – suspensory tore and partially detached from the sesamoid bone. His x-rays showed some lucency to the sesamoid bone not unlike these images here. However, I am not in any way able or qualified to read x-rays or speculate on the seriousness of Tank’s injury compared to my horse’s. And I am told that this injury to a hind limb is more serious than the front.

It’s good that you are getting some other opinions. I do think the horse needs an ultrasound to assess the damage to the suspensory ligament. Personally, I would want that done at an equine hospital or a university that has a big, expensive machine and a skilled person doing the scan. It makes a huge difference.

My horse had a lengthy rehab, was confined and hand-walked for many months and not allowed turnout other than a very small pen. He was initially treated with with shock wave, then stem cells (expensive but very effective). He has healed and is back in work and sound.

[Texarkana]

No reason to share the rest of the rads, I just wanted to make sure you had more views when you sent them out.

To answer your question regarding splint or wrap:

I’ve always done standing wraps. I don’t have any experience with ever splinting a sesamoid fracture (I’ve actually not used a splint on anything but foals). But wraps are good because they help limit motion in the area. It’s a difficult spot to heal because they are tiny, wiggly bones that are constantly experiencing the force of the suspensory on them. Plus, like NancyM said, they generally heal with a fibrous union like other bones in that region. Sometimes that union isn’t a good support for the attaching ligaments and you have life-long problems. The less it is disrupted during healing, the better.

Not to second guess, but I find it strange the vet would suggest turning him out. I have never heard that recommendation for a sesamoid fracture. It would not make me comfortable. There are measures you can take to prevent casting. But your horse may have total suspensory apparatus failure if he gets running.

[equuestrian]

[QUOTE=Texarkana;8497177]
No reason to share the rest of the rads, I just wanted to make sure you had more views when you sent them out.

To answer your question regarding splint or wrap:

I’ve always done standing wraps. I don’t have any experience with ever splinting a sesamoid fracture (I’ve actually not used a splint on anything but foals). But wraps are good because they help limit motion in the area. It’s a difficult spot to heal because they are tiny, wiggly bones that are constantly experiencing the force of the suspensory on them. Plus, like NancyM said, they generally heal with a fibrous union like other bones in that region. Sometimes that union isn’t a good support for the attaching ligaments and you have life-long problems. The less it is disrupted during healing, the better.

Not to second guess, but I find it strange the vet would suggest turning him out. I have never heard that recommendation for a sesamoid fracture. It would not make me comfortable. There are measures you can take to prevent casting. But your horse may have total suspensory apparatus failure if he gets running.[/QUOTE]

I was second guessing when he said he would rather have him in turnout rather than stalled and wrapped too, so don’t feel bad about that. I was also second guessing when he was poking and prodding Tank in the leg and dropped him to the ground when it was totally preventable :no:

I think I am definitely going to go ahead and start stall rest and do standing wraps. I’m assuming I’ll need to wrap both hinds right?

Again thank you so much everyone who has replied. You guys have been wonderful and so helpful!

[TheHunterKid90]

I currently have one on stall test for a longitudinal fracture of the sesamoid.
The higher up the sesamoid the fracture occurs, the better the prognosis. If it breaks completely, they are lucky to be a broodmare or pasture ornament.
The sesamoid heals poorly because of its poor blood circulation to begin with. We are on month 6 of stall rest and monthly X-rays continue to show improve the in the fracture so we’ve chosen to keep letting her rest. When the month to month X-rays stop improving, we will know we have given her all the time necessary to heal and it’s all in gods hands. We will then bring her back to work slowly.
In addition to stall rest, we are doing everything we can to increase blood flow to the area. We have water blistered her several times as well as magnetic tendon and pastern boots.
Sorry to hear we’re both in the same boat - these injuries suck!!

Edited to add - I just read that your vet recommended turning him out. ??? Concussion on Hard ground is one of the worst things for sesamoid fractures. Stall rest and either hand walking or turn out in an indoor round pen in good footing if your horse won’t be silly.

[joiedevie99]

For what its worth, I knew one horse that had a sesmoid fracture about 8 years ago. Horse was kept on stall rest, with an extra-long standing wrap/old school shipping bandage (fitted down to the coronary band) for about 4 months. For at least the first month (probably longer), he was kept on a high line so he couldn’t lay down.

He healed, although was never perfect again. Last I knew him, he was happily retired in a big field with four other horses to boss around.

[Whyevernot55]

Sesamoids heal slowly not because of poor blood flow, but because of high motion. If you look at the way the suspensory attaches to them, you can see that every time the horse weights the leg, they are going to move. This is why bandaging or casting is recommended - to limit motion as much as possible. Particularly after surgery, but even if you’re doing medical management, I would 100% NOT turn this horse out and I would already have him in standing wraps until I could get an opinion from a board certified equine surgeon - who will have experience with both surgical and medical management, and be much better able to talk to you about prognosis for your horse and management.

Agreed with whomever above asked about more radiographic views. The ones posted don’t really tell me what’s happening, so I am glad you have more and they are being sent out!

[Laurierace]

I don’t see anything on those views but seriously question your vet’s advice. Turn out would be a death sentence in my opinion. We use a Robert Jones bandage for the first few weeks then switch to a regular standing bandage. As little movement as possible so tranq as necessary and don’t even take out of the stall for cleaning. I have never had one not become at least light riding sound as long as the suspensories were still intact. If the suspensories blew as well we euthanize. Sorry you are getting such bad advice.

[Texarkana]

The thing to remember about general practice field vets is that they have to be jacks of all trades. And we all know how that idiom ends.

I hate to second guess a professional diagnosis, especially when the vet has seen the horse and we’re just a bunch of internet strangers. The vet hopefully has some better xray views to more clearly understand the extent of the injury. But… vets sometimes make bad judgement calls, especially if it’s the type of injury they don’t have a lot of experience with. They’re human, too. I’m wondering if that’s not the case here. I don’t know where you live, but even a very good vet who has been doing general practice in an area without a lot of racing/sport horses could go their entire career and never see a sesamoid fracture.

If it were me, I’d keep the horse inside and wrapped until you receive that second opinion. Contact the closest veterinary university, even if it’s not within driving distance, and ask if a surgeon would be willing to give some further insight on some radiographs. Specifically ask what type of rehab they would recommend (without mentioning the turnout thing first). They are going to likely be diplomatic and try not to step on your vets toes, but at the same time, I don’t believe there are many veterinarians who would recommend turnout for any sesamoid issue. The risk of further irreversible damage can be very high.

[LarkspurCO]

And without an ultrasound you have an incomplete diagnosis.

[equuestrian]

Okay so my plan is to stall rest asap now with standing wraps. I am going to send all of the xrays to a vet in my area who had 30 years experience on the track before starting her small animal practice here and I also plan on emailing the surgeon at the University of Florida and seeing what they say about it too.

Thanks everyone! I will post an update after I get their responses back.

[schimmel]

Unfortunately I have experience with this injury. My, then 7yr old mare, became intolerant to any work other than a walk in Sept. of 2014. It was a particular hind leg but flexions were negative. She would be okay for a few minutes of trot and then her strides would become uneven and she would balk or rush, trying to tell me something was wrong. Luckily Michigan State is close to us and they had a performance horse specialist there at the time. We did a thorough work up with blocking and U/S and discovered an avulsion fracture of the inner sesamoid on the right hind. It was a small piece and the vet said it would be best to leave it. He suggested 6 months off, in a very small paddock if she kept herself calm. I also administered Surpass and rented a small ultrasound unit (ultroz) that fit into a wrap and put that on for 6 hrs every night for 3 months (at the vet’s suggestion). Then we began hand walking daily and finally undersaddle walking for 1/2 hr day for months. Initially she seemed willing in the summer of 2015 as I slowly began introducing a few minutes of trot. As we progressed to canter, she had a major set back and acted just like when she was first injured. So last summer I took her back for a check up. The ultrasound revealed that the tiny free piece of bone that had come off of the sesamoid had resorbed, meaning it was broken down by the body and disappeared. Nothing else seemed to bother her, so he said keep plugging away at it doing as much as she is comfortable. Well a year after the initial injury (this past September) we decided to have a full body nuclear bone scan to be sure we weren’t dealing with pain elsewhere. The only thing that “lit up” was that suspensory area. I was told by the vet at MSU to give it more time and that what I have this Spring will be what I end up with. This will be a year and a half after the initial injury. So my story won’t end will. I have been trying to work her lightly over the winter but there is no improvement. She looks sound in the paddock, but still can’t tolerate much trot u/s. She will be 9 yrs old this year and her riding career is pretty much over. She seems willing to go on long trail walks and she is a really pretty Palomino, so I am hoping to find someone who just wants a Barbie horse to give her a good home. Or she may stay with us forever, as we tend to collect lawn ornaments! I will say that we experimented (with the vet’s permission) with a 3 week trial of Previcox this Summer. She was MUCH better and more willing to work. At that time I didn’t want to mask any discomfort and delay healing. But I am going to talk to the vet this Spring and see if she might be a candidate for indefinite Previcox. If that is the case, then someone may be able to do training level with her.
I wish your mom the best of luck. I have heard a wide range of outcomes from this kind of injury, and ligaments take a looong time to heal, so don’t give up hope just yet. I hope your horse will come around and have a better outcome than my mare.
Edited to ad that the sports medicine vet at MSU did not suggest any special wrapping (the horse had no real swelling). I do put hind boots on her when I ride because she travels close behind.

[TheHunterKid90]

[QUOTE=equuestrian;8498621]
Okay so my plan is to stall rest asap now with standing wraps. I am going to send all of the xrays to a vet in my area who had 30 years experience on the track before starting her small animal practice here and I also plan on emailing the surgeon at the University of Florida and seeing what they say about it too.
Thanks everyone! I will post an update after I get their responses back.[/QUOTE]

What part of the country are you in? Track vets are often handier and a little more resourceful and old school than a typical small practice vet. I love mine, he’s worth his weight in gold!

[equuestrian]

[QUOTE=TheHunterKid90;8498704]
What part of the country are you in? Track vets are often handier and a little more resourceful and old school than a typical small practice vet. I love mine, he’s worth his weight in gold![/QUOTE]

I’m in Florida in Volusia county. I don’t think we really have any racetracks in this neck of the woods. That’s why I’m super happy to be friends with this particular vet because she worked on a track for 30 years as a vet before retiring and doing a small animal practice here. I really trust her opinion too because she’s helped us out in the past when it came to our horses.

Schimmel, it sounds like the injury your mare has is similar to what our gelding has, down to even the same leg and sesamoid bone. Even if he is only sound for light, walking hacks that would be perfect. I will say that Previcox is pretty great. That’s what we have Tank on right now and it really made a difference in his comfort level. I have noticed that even if he is off the Previcox for a couple days he doesn’t slide backwards in his lameness either.