Changes

==Introduction==  

==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.

Fractures of both the distal and proximal [[Equine Phalanges - Anatomy & Physiology#Metacarpals and Metatarsals|splint bones]] in 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=

==Distal Splint Bone Fractures==

 

===Signalment===  

==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. It is thought to be caused by the '''suspensory ligament''' (which lies adjacent to the splint bone) placing '''stresses''' on the '''bone''' causing a fracture. Fracture of the distal splint bone occurs during hard exercise when the suspensory ligament snaps back against the comparatively fixed metacarpal or metatarsal bones.

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. It is thought to be caused by the '''suspensory ligament''' (which lies adjacent to the splint bone) placing '''stresses''' on the '''bone''' causing a fracture. Fracture of the distal splint bone occurs during hard exercise when the suspensory ligament snaps back against the comparatively fixed metacarpal or metatarsal bones.

==Clinical Signs==  

===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. Normally the fracture does not heal by bony union, instead a '''fibrous tissue''' or '''callus''' forms, which may be visible on clinical exam if the injury is old. This does not tend to cause any long-term problems.

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. Normally the fracture does not heal by bony union, instead a '''fibrous tissue''' or '''callus''' forms, which may be visible on clinical exam if the injury is old. This does not tend to cause any long-term problems.

'''Damage''' to the adjacent '''suspensory ligament''' may have occurred 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.

'''Damage''' to the adjacent '''suspensory ligament''' may have occurred 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==

===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.  

'''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.

'''Ultrasound''' examination should also be performed to check for suspensory desmitis.

==Treatment==

===Treatment===

 

1.'''Conservative Therapy'''

'''1.''' '''Conservative Therapy'''

:Advantages: no anaesthetic risk and low costs

 

:Disadvantages: prolonged box-rest (2 months) and heavy protective bandages or plaster casting

advantages: no anaesthetic risk and low costs.

:Early return to exercise can result in excessive callus formation or a repeat fracture.

 

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.

 

advantages: simple procedure with shorter recover period. No risk of excessive callus affecting the function of the suspensory ligament.

: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.

:Disadvantages: anaesthetic risk and greater costs

 

:This is the '''treatment of choice'''

This is the '''treatment of choice'''.

 

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'''.

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=

==Proximal Splint Bone Fractures==

==Signalment==  

===Clinical Signs===

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).  

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 [[:Category:Streptococcus species|''Strep'' species]] are the most common bacterial isolates following culture of the discharge.

==Clinical Signs==  

===Diagnosis===

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.

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.

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 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.  

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.

Concurrent infections should be treated with '''broad spectrum antibiotics''' until culture and sensitivity results can guide the treatment.

==Prognosis==

===Prognosis===

If infection is appropriately managed and the remaining portion of the proximal splint is stable, the prognosis is '''fair'''.

If infection is appropriately managed and the remaining portion of the proximal splint is stable, the prognosis is '''fair'''.

[[Category:To Do - Siobhan Brade]]

[[Category:To Do - Manson review]]

[[Category:Musculoskeletal Diseases - Horse]]

[[Category:Expert Review - Horse]]