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  1. #1
    Join Date
    May. 21, 2008
    Location
    Sonoma County, California
    Posts
    2,523

    Default Avulsion fracture in horse's knee --- ideas?

    My daughter's 22 year old horse has just been diagnosed (after 10 months of unresolved lameness despite a lot of effort) with an injury to his medial palmar intercarpal ligament. Basically it's a little ligament deep inside the knee and it's believed he has an avulsion fracture there (where the ligament attaches to bone it has popped a piece of bone loose). The bone fragment is believed to be kind of encapsulated inside the ligament. Surgery is not an option due to location.

    This bone fragment is likely causing constant irritation in the joint. The vets tell me that it's unlikely the horse will ever return to soundness, BUT it's possible. At the least, I want to give this horse the best shot at pasture comfort. They said that sometimes the body will demineralize the fragment over time, but that the scarring around it could remain and cause chronic irritation.

    Vet is going to inject the upper and lower knee joints with steroids/HA in a week as a diagnostic tool and see what happens.

    At this point, I'm over $5k into vet bills on this horse in just a year and need to rein in the costs. So things like PRP are being placed on a back burner.

    Meanwhile, I am sitting here wondering what all I can do to support my horse's body's ability to heal itself and give him the best chance for comfort possible. Ideas are:

    Adequan loading dose w/or without Legend?
    Oral joint supplements?
    Getting a nutritional consult, hay analysis, etc and make sure he has optimum nutrition.
    Other nutritional support?
    As much movement as possible once he's transitioned off stall rest.
    Pentosan? How is this different from Adequan and Legend?

    What else could I discuss with the vet? Thanks!



  2. #2
    Join Date
    Jun. 18, 2006
    Location
    New England
    Posts
    1,380

    Default

    My horse was just diagnosed with navicular avulsion fractures and besides shoeing changes and stall rest, the next treatment my vet recommended was shockwave. I have no idea if it would offer any therapuetic value in your horse's case (for my horse, there is hope the bone fragment will heal back to the rest of the bone), but maybe ask about that?
    "And I saw heaven opened, and behold a white horse..." ~Revelation 19:11



  3. #3
    Join Date
    Jun. 30, 2009
    Posts
    6,799

    Default

    One consideration is the level of metabolic activity in this horse - I don't know if there is a reasonable way to measure this in horses - his ability to "heal" or respond to treatments (whether $ or $$$$) is going to be greatly affected by this.

    Has the horse actually been on stall rest for 10 months? do the vets at Davis believe this has been an existing condition for several months? ask for hard numbers & case details on the treatment options.

    They said that sometimes the body will demineralize the fragment over time
    I'd speak with a holistic vet about this & look for dietary suggestions (it worked for an aquaintance but horse is a very active mid teen).



  4. #4
    Join Date
    May. 21, 2008
    Location
    Sonoma County, California
    Posts
    2,523

    Default

    Quote Originally Posted by alto View Post

    I'd speak with a holistic vet about this & look for dietary suggestions (it worked for an aquaintance but horse is a very active mid teen).
    That is a very good idea. I will do that. Horse has been on stall/small paddock rest for 4.5 months and lameness has gotten worse with rest.

    History is basically this:

    December 2011: Horse comes up slightly off during warmup for a lesson after he spooked and stepped sideways onto a hill --- most likely hyperflexing his leg. He is barely 1-/5 off.

    January 2012: Horse still barely 1-/5 off and only on circle going opposite direction of bad leg; sound on straightaway. Vet exam, blocks, ultrasound, xrays. Horse did not block sound even at proximal suspensory level. Ultrasound was clean. Vet feels the issue is in the knee and suggests a knee injection. I am not comfortable injecting the knee at this point without a better diagnosis.

    Horse gets January to June off, turned out in pasture, with tons of bodywork and chiro. He improved and went sound. Once we started trotting in June, he went off again.

    June 2012: 2nd opinion with top lameness vet. Horse blocked sound at proximal suspensory. Ultrasound showed small avulsion fracture at prox. suspensory origin plus slightly enlarged check ligament. Did 3 rounds of shockwave. Horse gets stall/paddock rest with handwalking.

    August 2012: Back to vet. Horse is now 2/5 lame on a straightaway. Avulsion fracture nearly absorbed. Check ligament looks pretty good. Vet concerned at the increased lamness. More rest.

    October 2012: Back to vet. Ultrasound shows total healing. Horse even more lame! Repeated blocks from ground up. Blocks 90% sound at proximal suspensory. Referral to UC Davis and subsequent diagnosis of knee injury and all the pieces of the puzzle fall in place.

    UC Davis does not have much in the way of hard numbers and case details for this exact injury. Since it's too deep in the knee to do arthroscopic surgery, it's generally only treated with injections. PRP and such is considered experimental. I'll ask about Shockwave.

    My gut feeling is that keeping this horse on rest is contributing to the lameness, so I am starting the process to transition him to turnout again. We shall see.

    Would love to hear from someone regarding the use of Pentosan versus Adequan and Legend. I have heard some positive things about Pentosan and think it's worth a shot. This horse is currently on Adequan.



  5. #5
    Join Date
    Jul. 27, 2010
    Posts
    3

    Default

    I went through this exact same thing...could not locate the lameness..thought it was high front suspensory...had to flex to make lame...turned out it was adhesions in the knee..He would go from (initially) .5 lame (only undersaddle) and then stall rest and hand walking twice a day...and 4 months later he was a 4 on the lameness scale...took him for an MRI and we saw the adhesions. My vet said to ignore the acute lameness process (it was ignore or surgery at that point and I couldn't stand the thought of more time in the stall after surgery) and the vet at New Bolton and the vet at Fairfield discouraged me as well..said to give him time and let the adhesions break up. We did inject the knee. The more controlled- (no insanity in the field-though it still happens) movement for him the better. He seems to have broken up all the adhesions. I did have the suspensory ultrasounded regularly before any upping of work..and rehabbed him as a suspensory horse...but images never showed anything.. He injured himself at 3rd level...he is now schooling all the Grand Prix...and every day I am thankful for him, his soundness, and his joy in being a working horse. We are now 3 years on full work and turnout (still careful..no windy freezing cold days- or days I know he won't be happy out.) Good luck to you! Also, I now treat him with Pentosan, but initially with Adequan. I would still do Adequan first.



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