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Created page with "==Introduction== Fractures of both the distal and proximal splint bones are common. Distal splint bone fracture normally occur during exercise in performance horses and proximal..."
==Introduction==
Fractures of both the distal and proximal splint bones are common. Distal splint bone fracture normally occur during exercise in performance horses and proximal fractures are normally the result of trauma.
=Distal Splint Bone Fractures=
==Signalment==
It is most commonly seen in horses between '''four''' and '''seven''' years of age. Injury most commonly occurs during '''high intensity exercise''', therefore '''performance horses''' such as thoroughbreds are most commonly affected. Splint bone fractures are thought to occur as a result of ''stresses'' placed on the '''splint bone''' by the adjacent '''suspensory ligament'''. It has been suggested that, during hard exercise, the suspensory ligament snaps back against the relatively fixed small metacarpal or metatarsal bones, causing the distal part of the bone to fracture.
==Clinical Signs==
The horse may present with a '''low level''' of '''lameness''' that may only be apparent at faster gaits. '''Pain''' or '''swelling''' may be apparent on palpation of the fracture. Although the fracture is unlikely to heal by bony union, the fibrous tissue or callus that forms does not tend to cause any long-term problems. This callus may be visible if the injury is old.
The adjacent suspensory ligament branch may have been sprained or even ruptured at the time of the fracture. This can cause a persistant lameness, and severe damage to the ligament can cause pain, swelling and dropping of the fetlock joint.
==Diagnosis==
'''Radiography''' - simple transverse fractures are most common. There may be reactive change on the adjacent cannon bone and the reactive change around the fracture presents as a soft tissue density. It has been reported that slightly underexposed radiographs produce a clearer image of the splint bone.
'''Ultrasound''' examination should also be performed to check for suspensory desmitis.
==Treatment==
'''1.''' '''Conservative Therapy'''
advantages: no anaesthetic risk and low costs.
disdvantages: prolonged box-rest (2 months) and heavy protective bandages or plaster casting.
Early return to exercise can result in excessive callus formation or a repeat fracture.
'''2.''' '''Surgical Excision'''
advantages: simple procedure with shorter recover period. No risk of excessive callus affecting the function of the suspensory ligament.
disadvantages: anaesthetic risk and greater costs.
This is the '''treatment of choice'''.
==Prognosis==
Prognosis is dependant on the performance level of the horse and the presence of concurrent suspensory desmitis. Prognosis for a non-performance horse with no concurrent suspensory desmitis is '''good'''.
=Proximal Splint Bone Fractures=
==Signalment==
No breed, sex or age predilection as fracture is normally a '''traumatic''' in origin. As the trauma is normally caused by a kick or collision, fracture of the '''lateral''' splint bone is more common (as it is more exposed than the medial splint bone).
==Clinical Signs==
The horse will often present '''markedly lame''' with both '''pain''' and '''swelling''' of the area when presented acutely. The level of lameness will decrease over time. There is often a wound overlying the fracture which often exudes a '''purulent discharge'''. A '''sequestrum''' or '''osteomyelitis''' may develop. ''E.coli'' and ''Strep'' species are the most common bacterial isolates following culture of the discharge.
==Diagnosis==
Presenting signs of pain, heat and swelling over the proximal splint bone are suggestive of a fracture of the proximal splint bone. Diagnosis should be confirmed with '''radiography'''. If a wound is present then a metal probe may be inserted during radiography to ascertain the direction and extent of the draining tract. Swabs of any discharge from wound should be obtained as aseptically as possible and sent for culture and sensitivity.
'''Ultrasound''' examination should also be performed to check for suspensory desmitis.
==Treatment==
Treatment is dependant on which splint bone is fractured. All fractures except that of the lateral hindlimb splint bone should be treated '''surgically''' if possible, as success with conservative treatment is low. With surgical treatment it is only necessary to remove unstable fragments of bone. Additional stabilisation of the remaining bone may be necessary. All infected tissue should be '''debrided''' and the wound allowed to heal by '''second intention'''. With fractures of the lateral splint bone of the hindlimb '''conservative''' treatment can be attempted as it has reported success in up to 50% of cases.
Concurrent infections should be treated with '''broad spectrum antibiotics''' until culture and sensitivity results can guide the treatment.
==Prognosis==
If infection is appropriately managed and the remaining portion of the proximal splint is stable, the prognosis is '''fair'''.
==References==
May, SA & McIlwraith, CW (1998) '''Equine Orthopaedics and Rheumatology Self-Assessment Colour Review''' ''Manson Publishing Ltd''
Kidd, J (2003) '''Management of Splint Bone Fractures in Horses''' ''In Practice'' 2003 25: 388-395
[[Category:To Do - Siobhan Brade]]
Fractures of both the distal and proximal splint bones are common. Distal splint bone fracture normally occur during exercise in performance horses and proximal fractures are normally the result of trauma.
=Distal Splint Bone Fractures=
==Signalment==
It is most commonly seen in horses between '''four''' and '''seven''' years of age. Injury most commonly occurs during '''high intensity exercise''', therefore '''performance horses''' such as thoroughbreds are most commonly affected. Splint bone fractures are thought to occur as a result of ''stresses'' placed on the '''splint bone''' by the adjacent '''suspensory ligament'''. It has been suggested that, during hard exercise, the suspensory ligament snaps back against the relatively fixed small metacarpal or metatarsal bones, causing the distal part of the bone to fracture.
==Clinical Signs==
The horse may present with a '''low level''' of '''lameness''' that may only be apparent at faster gaits. '''Pain''' or '''swelling''' may be apparent on palpation of the fracture. Although the fracture is unlikely to heal by bony union, the fibrous tissue or callus that forms does not tend to cause any long-term problems. This callus may be visible if the injury is old.
The adjacent suspensory ligament branch may have been sprained or even ruptured at the time of the fracture. This can cause a persistant lameness, and severe damage to the ligament can cause pain, swelling and dropping of the fetlock joint.
==Diagnosis==
'''Radiography''' - simple transverse fractures are most common. There may be reactive change on the adjacent cannon bone and the reactive change around the fracture presents as a soft tissue density. It has been reported that slightly underexposed radiographs produce a clearer image of the splint bone.
'''Ultrasound''' examination should also be performed to check for suspensory desmitis.
==Treatment==
'''1.''' '''Conservative Therapy'''
advantages: no anaesthetic risk and low costs.
disdvantages: prolonged box-rest (2 months) and heavy protective bandages or plaster casting.
Early return to exercise can result in excessive callus formation or a repeat fracture.
'''2.''' '''Surgical Excision'''
advantages: simple procedure with shorter recover period. No risk of excessive callus affecting the function of the suspensory ligament.
disadvantages: anaesthetic risk and greater costs.
This is the '''treatment of choice'''.
==Prognosis==
Prognosis is dependant on the performance level of the horse and the presence of concurrent suspensory desmitis. Prognosis for a non-performance horse with no concurrent suspensory desmitis is '''good'''.
=Proximal Splint Bone Fractures=
==Signalment==
No breed, sex or age predilection as fracture is normally a '''traumatic''' in origin. As the trauma is normally caused by a kick or collision, fracture of the '''lateral''' splint bone is more common (as it is more exposed than the medial splint bone).
==Clinical Signs==
The horse will often present '''markedly lame''' with both '''pain''' and '''swelling''' of the area when presented acutely. The level of lameness will decrease over time. There is often a wound overlying the fracture which often exudes a '''purulent discharge'''. A '''sequestrum''' or '''osteomyelitis''' may develop. ''E.coli'' and ''Strep'' species are the most common bacterial isolates following culture of the discharge.
==Diagnosis==
Presenting signs of pain, heat and swelling over the proximal splint bone are suggestive of a fracture of the proximal splint bone. Diagnosis should be confirmed with '''radiography'''. If a wound is present then a metal probe may be inserted during radiography to ascertain the direction and extent of the draining tract. Swabs of any discharge from wound should be obtained as aseptically as possible and sent for culture and sensitivity.
'''Ultrasound''' examination should also be performed to check for suspensory desmitis.
==Treatment==
Treatment is dependant on which splint bone is fractured. All fractures except that of the lateral hindlimb splint bone should be treated '''surgically''' if possible, as success with conservative treatment is low. With surgical treatment it is only necessary to remove unstable fragments of bone. Additional stabilisation of the remaining bone may be necessary. All infected tissue should be '''debrided''' and the wound allowed to heal by '''second intention'''. With fractures of the lateral splint bone of the hindlimb '''conservative''' treatment can be attempted as it has reported success in up to 50% of cases.
Concurrent infections should be treated with '''broad spectrum antibiotics''' until culture and sensitivity results can guide the treatment.
==Prognosis==
If infection is appropriately managed and the remaining portion of the proximal splint is stable, the prognosis is '''fair'''.
==References==
May, SA & McIlwraith, CW (1998) '''Equine Orthopaedics and Rheumatology Self-Assessment Colour Review''' ''Manson Publishing Ltd''
Kidd, J (2003) '''Management of Splint Bone Fractures in Horses''' ''In Practice'' 2003 25: 388-395
[[Category:To Do - Siobhan Brade]]