Surgical reattachment is really the only option. I am sorry, but in humans this is the only treatment that has relative success. Otherwise there is a litany of complications and conditions that will prevent the fracture from ever healing.
While in humans these fractures can heal rapidly without surgery, the patient is required to keep the limb immobile for 3 weeks of more. That is impossible for a horse.
I would get the horse to Davis and get a true orthopaedic consultation.
Fracture or Enthesopathy of the Third Trochanter
of the Femur
Fracture of the third trochanter of the femur is a
relatively unusual injury, resulting in acute-onset,
severe lameness that often improves quite
rapidly with box rest. In a lean, poorly muscled
horse it may be possible to elicit pain by palpation,
but in a well-muscled warmblood type this is usually
not possible. There are no particular gait characteristics.
Nuclear scintigraphy is particularly valuable
for tentative diagnosis of a fracture.
There is intense, focal IRU (Fig. 16). Diagnosis
may be confirmed radiographically, but good-quality
radiographs can only be achieved under general anesthesia.
Fractures are often longitudinal, occurring
at the base of the trochanter. There is usually
minimal displacement. Diagnostic ultrasonography
has not been useful in my experience in helping
to confirm the presence of a fracture. It is possible
that some horses with IRU in the region of the third
trochanter have enthesopathy of the attachment of
the superficial gluteal muscles, but I have not been
able to confirm this ultrasonographically. Treatment
is box rest for 2 mo, followed by walking exercise
for another month. Healing may occur by
either osseous or fibrous union. Prognosis is good
I just got off the phone with my horse's normal vet. He hasn't seen many of these cases either. It just IS super rare. BUT, he said he'd have suggested TWO months stall and then out to pasture. we're going to do three months and take a look. he's also in favor of shockwave and PRP.
The question is whether it heals through ossification (bone creation and fusion) or by the fibrous union mentioned in that extract. Fibrous won't be as strong and is also the more likely way it will heal. Odds are greater that we won't be able to jump him ever (still so heartbreaking - he never even started) but he also might. we just have to see how it heals.
He also said that id I just turned him out on pasture it would heal, but we want it to heal "right".
So... fingers crossed?
Here is his xray btw, you can really see it top left
My TB gelding fractured his third trochanter a few years ago when he had a trailer accident. He was diagnosed on bone scan as he had a persistant, grade 3 lameness that would not block out wth nerve blocks. In his case we did 2 months stall rest, then 2 months small paddock. We also shockwaved and injected local steroids. He healed fully from that injury. The prognosis is actually quite good for these with stall rest, etc as is horses the fragments tend to not displace much. We actually bone scanned him again later as he was lame from a suspensory injury and before we did surgery we wanted to confirm the femur had healed. It was fully healed on the second bone scan
Ugh. I so totally feel for you. My horse has an avulsion fracture of the proximal suspensory origin and he's on stall rest.
I'm in Santa Rosa so close to you. Curious who you work with locally. Have you talked to Tom Yarbrough? He's a surgeon and that guy is da bomb for challenging stuff. Worth getting him on the phone and picking his brain.
I've been hauling my lame horse down to Riverside to see Dr. Smith and do shockwave. He comes up from GGF once a week. Anyway, he's another source of info and very good.
As far as other support goes, the advice I got was to test my hay & get a nutritional consult and make sure my horse's diet was as balanced as possible, to support his body's ability to heal itself. I'm also giving him the herb comfrey, which is also known as 'boneset' or 'knit bone' per another consult.
PM me if you want. Maybe we can form a North Bay support group, LOL.
PS, be sure to ask about the difference between radial and focused shockwave and which is best for your horse.
Last edited by Watermark Farm; Sep. 13, 2012 at 06:18 PM.
Sorry just saw this.
Yes my guy laid down a lot! He is a very, very mellow gelding who loves to sleep and eat, and eat while laying down Really with this injury the vets were not concerned with him laying down. We were concerned with recovering him from anesthesia if it wasn't healed (since anethesia recovery can be very rough) but the second bone scan 6 months after the initial one showed it was fully healed. He returned to full work from this injury. Unfortunately his suspensories did not hold up but that is a different story!