Coffin bone stress fracture and collateral ligament injury
Recent MRI revealed that my 13 year old TB has a chronic coffin bone stress fracture and a severe collateral ligament injury to the coffin joint. Have any of you had any experience with these conditions? Horse is on stall rest for a good long while, plus platelets and special shoes. I'm thinking the best I can hope for is to get him flatwork sound, but would be interested in any stories of better outcomes. Thanks!
I have known of horses to come back fully. Sometimes if there is allot of inflammation inject and rest IRAP altering shockwave can be helpful. What is most important is controlled exercise to encourage the fibers to align properly. Best Wishes!
Yes, my gelding did come back completely although he was not as badly injured. He strained his collateral ligament because his foot was not correctly balanced. He was put on 1 month stall rest with 20 minutes a day on the hot walker. He was brought back into full time training VERY slowly over another months time. As Herbie mentioned the key to recover of this kind of injury is excellent farrier work. My horse is still being shod every 4 weeks and he is moving amazing now.
RIP Sucha Smooth Whiskey
May 17,2004 - March 29, 2010
RIP San Lena Peppy
May 3, 1991 - March 11, 2010
Oh, I feel your pain! I just went through this same injury this past summer. My horses can't tolerate absolut stall rest, so he went out in a "round pen" that was literally the size of a stall. We did that for 4 months (the time it takes for bone to heal), and we did shock wave on the collateral ligaments. He's been back in light work for 5 weeks and he's totally sound. We expect a full recovery and a return to the ring this spring. Good luck!
Not quite as severe, but we pulled a collateral ligament in 2009. Three months of stall rest, hand walking, and then walking under saddle. We came back VERY slowly. Horse ended up lame again due to navicular issues. Changed farrier and consulted with a vet...Horse has been sound ever since
I will say that we were cantering under saddle before even going to turnout other than a very small round pen. I spent weeks slowing increasing the work and only working on straight lines with very gradual curves. Due to finances, I did not do shockwave. Like I said, horse is perfectly sound, used in lessons, and even jumps the occasional cross rail. I'm a happy girl!
There is hope! My mare tore her medial collateral of the coffin joint 75% of the way through and bruised her navicular bone badly at the same time ( diagnosed by MRI). We did Stem cell. 90 days of stall rest/hand walking, 90 days of walking under saddle. The next 6 months were spent building up the trot and finally the canter. She returned to jumping 1 year post injury and was doing fine until another injury to her knee and fetlock. The collateral is still doing fine. The initial prognosis was only 50/50 of even being sound for flat work.
My advise is to follow the rehab plan exactly no matter how long boring or tedious it gets. I credit doing that and the stem cells for my mares return from not only the collateral ligament injury but her severe knee injury that had the same prognosis!
Posting an update because people frequently use the search feature when they have a similar problem and this way the whole story is on one thread.
We did PRP (platelet rich plasma) right after we did the MRI. The vet prescribed 90 days of stall rest, (with controlled hand walking) and that's almost over. We've had three shockwave treatments. On Wednesday, the vet wants to see the horse trot on the lunge line and then will either recommend more stall rest, or a slow return to work, with turnout being added sometime later. The barn has a round pen that's used for rehab turnout, and they will probably move it to a new location with lots of grass underneath in the hopes that he eats instead of plays. Mr. Stall Rest will probably be Mr. Ace for a while.
A lot depends on the horse not being a fruitcake when he's allowed to move about more. The barn has had great success with horses who followed the plan. Being a TB, I'm not entirely sure that's possible. I'm considering getting his AC to "talk" to him. What's another $50 on top of all of the vet bills we've already had??? Will provide updates as the saga unfolds.
My 13 yo gelding had a chronic inflammation of the medial collateral ligament of the coffin joint. Not a very severe injury and he was off and on a bit until we finally decided to do the MRI to find out why he wasn't staying sound when he would get better.
We did IRAP and PRP, paddock turnout for 3 months, then sent him to KESMARK for 6 weeks. He came back looking great and really sound. He did not stay sound once we got to the canter work. I decided to give him a year off and get a new horse to keep me from messing with him. I'm hoping he comes back sometime, but since the issue was 'chronic' it's not looking good.
I think you have a better chance with a TB. Mine is a perch cross, way too big. The farrier will make or break his chances, so that's most important. Following the rehab EXACTLY is also key. DO NOT be tempted to do too much, take it 10x's slower than you can stand!
Vet and trainer say to plan on taking 5 - 8 months to bring him back slowly. I'm nervous and apprehensive, but would rather do this than go horse shopping. He has an awesome farrier who works closely with the vet.
Yes, I am going through this right now, unfortunately! Our coming three year old Han colt kicked his stall and fractured the wing of his coffin bone (no joint involvement). We kept him on stall rest for two months with the bar shoe ect and then re xrayed only to find that yes, the coffin bone was healing nicely, but that he had severely damaged his collateral ligament! Ughhhhh.
Vet gives it about a 50/50 chance of him being sound for sport but I am having a hard time holding a lot of hope. It just seems like that is a lot of insult and instability to that coffin joint??. He has had his second treatment of IRAP and in a few weeks we will see if he is sound. Poor guy, three year old stallion and in a stall 24/7. He is handling it amazingly well though and I am glad to read of so many good endings to similar situations!
Keeping fingers super crossed as we had big plans for this special horse.
Rehabbed a collateral ligament strain with no broken bones after IRAP and shockwave. Got back in full work (3' eq and hunters) maybe 10 months after diagnosis, though the the diagnosis was several months after the initial injury that ultimately led to discovery of the collateral ligament damage.
Reinjected coffin joints at roughly one-year intervals after initial treatment (2008). Our 2009-2011 show seasons were exercises in finally getting the horse going and to a few shows when something happened (not always the fault of the horse or even his anatomy), though I had months at home when he was wonderful. Maintained with meticulous shoeing, icing feet, not over-doing, backing off and calling vet at the slightest hint of something wrong. The 2011 season ended with a realization that something was clearly not right even after the annual injections. My gut said to keep digging and we ultimately found neck arthritis that could have been driving the foot issues all along. IRAP neck (and other injections) done in Sept 2011, slow back to work, and we are now finally to the point of doing circles and transitions between and within gaits (much to the relief of all, especially the horse). Horse seems happier and more correct than in some time (these things creep in slowly and it's not always easy to see there's a problem). I haven't even asked the vet about jumping because I figure whatever answer I get could change anyway. Guess we'll let the horse tell us. But the horse is now 13 (or will be at the end of the month) and I figure that I probably won't be given another chance if I mess it up this time. Sigh...
But, having said (or written) all that when we went for the second MRI this past fall, the vet said that re-injuries of the collateral ligament strain of the type that Star had is unusual, especially given the vet that did the treatments. He feels that the neck was the problem all along.
Moral of story (and a long way from the OP's question): if you get a nuclear scintigraphy done, get the whole horse done.
Here's an excerpt from the MRI results, in hopes of answering the questions in the post above. I don't have a diagram.
There was a regional abnormal low signal intensity at the junction of the medial wing and body of the coffin bone in the right forelimb, with a focal area of abnormal high signal intensity at the axial aspect. These abnormalities represent a chronic stress fracture with bone sclerosis and resorption.
As far as management, MRI was done in December. Vet worked with farrier and advised how to shoe the horse. Vet and farrier have worked well together for years. Management has been PRP, stall rest for 90 days, hand walking, three shockwave treatments. Now we are starting on 5 - 8 months of gradual return to work.
Coffin bone fracture and collateral ligament tear.
Well I have had both but the injuries were in two different horses. As someone above stated balanced farrier care is essential for both injuries, poor farrier care was what got me into this mess, good farrier care and vet care got me out. For the fracture, hers was on the wing of the coffin bone and showed up on an MRI along with bone sclerosis and ossification of the lateral cartilages. After reading the MRI write up she was diagnosed with navicular and a coffin bone fracture. A bone scan was used to pin point the lameness, and in addition to her right front her hocks looked like Christmas trees. Her left hock, lateral to the right front with all the issues was to far gone
, she was only 8, so we elected to alcohol fuse both hocks. We also Tildren dripped her, did hock injections, put her on Legend, and after six weeks layup for the coffin bone fracture, we shod her in Eponas, found a new farrier and she has been sound since. The horse with the medial collateral ligament tear, also diagnosed by MRI was done with stem cell, the first did not work, the second time we followed up with a cold laser and he has returned to soundness. He is still in rehab so I can't say since it's only been for four months that he won't go lame again but balanced regular shoeing is essential, I learned the hard way, it was a VERY expensive lesson also someone mentioned IRAP and during my research that also looked like a very good option. I don't come on here much but if you have any questions about the process or treatments feel free to ask and good luck to you and your horse.
Well, yesterday's vet check did not go well. Horse did not trot sound on the lunge line. So we get another month of stall rest, and hand walking, and then try again. The only good news is that the vet recommended setting up a double stall sized pen on some grass so he could get some outside graze time each day. I'm kind of depressed and want this to be over, but as people above have mentioned, taking the time needed for it to heal correctly is essential.
Updating this in case anyone cares, or in case someone has a similar situation later on in life and uses the search feature here on COTH.
Vet recheck is scheduled for April 11. Between now and then, vet has asked barn to increase turnout time in the round pen (which has been moved to a fresh patch of green grass) and decrease meds for turnout. He started out with 1.5cc of ace, and is currently down to .3cc which is next to nothing. He's been a very good boy throughout, with the exception of one time that he rolled and bucked.
We are all hoping he gets cleared for tack walking.
What a rip-off! Horses shouldn't be so complex down there and be able to break things all packed into the hoof capsule (more or less). Sorry this happened to you.
A couple of ideas:
Has your vet talked to you about Osteon? Platinum Performance. Expensive. Powdery clay-like. It is bio-available silicon and recommended for fractures. Perhaps you guys are past the "get the bone to heal" part of things.
On the soft-tissue side:
Just yesterday I was talking to a vet who had been at a big biomechanics conference in CA. Farrier there (or French anatomist who organized it?) spoke about the possibility of horses' feet being too large. The idea was that the ones with the honkin pie plates torque those collateral ligaments on the turns.
In any case, I believe the shoeing recommendation was to keep the web wide on the injured side and narrow/rolled on the opposite one. The idea was to speed/ease break-over for the side of the foot opposing the ligament you don't want to stretch.
Ask a real live farrier about this; don't take my word for it. And in general, I'd get the best farrier I could find to work on this horse. I think that pro will be huge in keeping this horse as sound as he can be.
Excellent farrier is following vet's recommendations on shoeing, and vet has personally inspected the shoe job. Farrier and vet have worked together for years. Horse is at a top H/J barn and getting excellent care.
Horse gets Platinum Performance CJ and has been getting it for most of the four years I've had him. Since we've had about 120 days of stall rest, the bone should be all healed. I think now we're working on the ligament.
And, yes, it's been a bummer. It hasn't been so bad since he's been allowed to go out. At least he gets to munch grass.