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Splint Bone/Fetlock Bone chip Removal after effects ~

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  • Splint Bone/Fetlock Bone chip Removal after effects ~

    Hi there! I am wondering if anyone has had experience with splint bone and fetlock bone chip removal surgery and recovery.

    My 13 year old arab gelding got into a argument with a gate and of course the gate won...Had the vet out on an emergency call and they did digital xrays immediately. He broke his splint bone and had a chip off of his fetlock joint. The area was cleaned and wrapped and he was put on SMZ's until they could get a surgeon to come and do the surgery to remove both the chip and splint bone. That was two weeks later and he was on stall rest the whole time. Surgery was on Dec. 15th of 2008. He had the surgery which went well. His recovery has not been. The bone chip moved into his fetlock joint. It originally was on the side of the fetlock. They removed it, cleaned out the fetlock joint. The fetlock swelled up and the vets thought that he had an infection in it, so he was on Gentomiacin and Naxcel for 10 days. If it was infected, it cleared up. But the fetlock is still swollen. No heat from it. He has had two injections of Irap therapy and shockwave therapy (twice). I am thankful I insured him to pay most of the costs. We are handwalking and are up to 30 minutes a day.

    The fetlock joint is still swollen and is very stiff so we have been doing passive flexing of it daily, but is not loosening up at all. He is not lame at all at the walk and accidently he shyed at something and trotted a few steps and is very lame. We wrap that leg and put on DMSO every 2 to 3 days.

    He is on a joint supplement called "Myristol" which is close to Cetyl M, but in higher doses. You can only order it thru your vet and very expensive. I have also added a powdered HA supplement. Apparently there is alot of scar tissue in the fetlock area. Apparently my gelding is a unusual case of not healing after a fairly simple surgery.

    My question...Has anyone ever gone thru this and how did it turn out for you? Did your horse recover? If so, how long did the recovery take? This is my show horse and he is a hunter on the flat. Not sure if he will continute his show career or not or will end up as a pasture pet.

    PLMK. Thanks so much! Jeanne

  • #2
    Have they rexrayed the leg?
    "Kindness is free" ~ Eurofoal
    ---
    The CoTH CYA - please consult w/your veterinarian under any and all circumstances.

    Comment

    • Original Poster

      #3
      No not yet. However, I have thought about it...In your opinion would you have it done?

      Comment


      • #4
        Absolutely! There may be a different problem altogether or perhaps he is developing arthritis in the joint and needs injection to get a handle on it.

        Having had quite a few horses have chips removed, and some experience w/splint removals, I would not be satisfied with a stiff joint with no really good explanation... all my surgeries of such have gone very well with excellent results.

        Hoping things get cleared up soon.
        "Kindness is free" ~ Eurofoal
        ---
        The CoTH CYA - please consult w/your veterinarian under any and all circumstances.

        Comment


        • #5
          couple of thoughts. you had major joint surgery to remove a chip. you should expect some swelling in the area to persist for a couple of months as the joint heals. it takes a minimum of 6-8 weeks just for the soft tissue to begin to heal properly. cartilage heals much more slowly than that if ever. you are also going to have some swelling locally where the splint bone was removed. that is close to the fetlock area and some of the swelling is going to settle downward due to the effects of gravity to the area of the fetlock joint.

          secondly you do not know if an actual infection is ongoing or not in the joint without tapping the joint and examination of the synovial (joint) fluid. the joint was tapped in order to inject the irap - was the fluid analyzed? if a joint infection is indeed suspected, antibiotics locally into the joint are far superior to just antibiotics given systemically in most cases. if the joint was not injected early with antibiotics nor fluid analyzed, it appears the antibiotics were given more to possibly control a suspected mild infection - decent preventive medicine but not great practical medicine. there are of course reasons to avoid injecting a joint post surgery, so i do not presume to second guess the vets involved - just asking if synovial fluid analysis was done. it would appear that some diagnostic were done involving the joint fluid and infection ruled out or why would the irap be started. local infections within the joint also add to the healing time as they cause fairly dramatic inflammatory reactions - certainly enough to prolong the inflammation of the joint (thus swelling and stiffness) long past a routine rehab time.

          also irap often causes some local inflammatory changes when first injected. most would not inject it until the joint had quietened down completely. certainly would possibly avoid if actual low grade infection existed.

          now to most obvious question - where was the chip specifically? if it moved into the joint, that infers it came off of the bones within the joint itself. that would take a very traumatic event to cause that - enough to cause some damage to the collateral ligaments, joint capsule, or other significant structures within the joint - which would cause a lot of swelling that could easily persist for a couple of months. in addition, cartilage damage would follow a chip moving between the joint surfaces. most likely, some of the tendons that surrond the joint would have also suffered from the same traumatic event and you could have some major tendon damage that would require ultrasound to diagnose. if the chip came off of the proximal sesamoids on the back of the joint, that involves the flexor and suspensory tendons specifically as they insert in that area. a chip often is where the tendon / ligament snaps away from the bone and takes a piece of bone with it - therefore a chip is seen (it just happens to also be a significant tendon injury as well). that type of chip takes many months to heal after surgery. x-rays show bone damage but not always soft tissue. ultrasound is required to evaluate that damage. surgery involving just a chip on an x-ray can sometimes overlook other just as significant soft tissue injuries that can have even more long term affects.

          there are many reasons for a joint to remain swollen and somewhat stiff. one simple reason is that there was a lot of trauma involved both in the cause of the chips, and in the surgery itself to remove them. you need to be patient. you do need to be very aggressive to diagnose and treat any infection if actually still present. that can only be determined with tapping the joint. when the joint is tapped, it is a great time to inject it with a large dose of hyaluronic acid for specific lubrication (with an antibiotic to prevent further infection from this injection while you wait for the fluid to be evaluated). if infection - aggressive therapy. no infection - very restricted exercise, local anti-inflammatory liniments, dmso, etc topically, but allow the joint some time to quieten down some - be patient there.

          if the joint does not have any actual infection left - back off a little. quit injecting it, wait a little while on the sound wave therapy. allow the body to heal - if you keep doing something to it, in effect you could just be keeping the inflammation going by constantly pounding on it. those treatments may make it look better quicker in the ideal situation, but they do not make up for the fact that it will take a certain amount of time for the joint to heal - that time will be the same either way. his body can only heal at a certain rate and sometimes those other therapies make it appear to be healed when it still has a long way to go. then you get on him too quickly and destroy the process completely from ever having a chance to be sound again. there is also a time to be conservative (when you know there is no infection).

          only your vet has seen the horse and knows what has been done. so i do not presume to be second guessing them. just pointing out some experiences i have actually had in the past with my own horses with major fetlock injuries. some heal easily - they are the ones with minimal damage and no complicating factors. others take very long - they obviously had some very serious damage and / or had some complications that needed to be very aggressively diagnosed and then treated based on facts. i have had both. i still have one horse that had eight pieces of bone removed from one ankle (that's pieces big enough to pick up, not counting all the crushed bone pieces) and he returned to riding for quite some time. he did have a lot of damage to the joint that required almost a year to heal however. he is now retired with a fairly large and stiffer fetlock due to all the degenerative changes that occur following such a traumatic event. they were unpreventable - you can help postpone them and prevent a lot of ongoing damage from occuring - but you can not stop it all. that is why they call it degenerative joint disease now instead of just arthritis. it implies the very fact that it is not normal anymore and degenerative changes can not be stopped (only slowed down) due to the compromises within the joint and surrounding structures.

          wishing you and your horse the best...

          Comment

          • Original Poster

            #6
            There is some arthritis in the joint. He is being injected with "Irap" into the fetlock joint. Supposed to reset the cells so no furthur arthritis developes and there is also an anti inflammatory in the Irap serum. Before he had this injury, he was fine. No lameness. Moved great. I had him on Cetyl M with ha just to help him out.

            Vets cant say whether he will be ok or not. I've thought about getting a second opinion, however it would cost another 500.00 for a lameness exam. I have already spend 5K on him and that is what I paid for him. My insurance is tapped out on him.

            This whole thing has been very frustrating and I am just trying to do right by my boy!

            Any input is greatly appreciated! Thanks so much! Jeanne

            Comment


            • #7
              Originally posted by LuvThoseKhemos View Post
              There is some arthritis in the joint. He is being injected with "Irap" into the fetlock joint. Supposed to reset the cells so no furthur arthritis developes and there is also an anti inflammatory in the Irap serum. Before he had this injury, he was fine. No lameness. Moved great. I had him on Cetyl M with ha just to help him out.

              Vets cant say whether he will be ok or not. I've thought about getting a second opinion, however it would cost another 500.00 for a lameness exam. I have already spend 5K on him and that is what I paid for him. My insurance is tapped out on him.

              This whole thing has been very frustrating and I am just trying to do right by my boy!

              Any input is greatly appreciated! Thanks so much! Jeanne
              GOOD GOING ON THE IRAP treatment! We had fetlock chips removed surgically without any improvement post-op, then began the IRAP injections, the heat and effusion (swelling) went away and 6years later has never returned! We inject her (3 rounds) once yearly. She is fusing her joint and totally comfortable and sound. I ride her 3times a week.
              Good luck to you and your pony!
              Moribelle

              Comment

              • Original Poster

                #8
                To: Move it Move it ~

                Truly appreciate your thoughts and advice on this and I will mention them to my vet and see what she says. Are you a vet? You are extremely knowledgeable on this! I am ready to be patient with Sol, my gelding.

                I was led to believe by my vet that this was a simple surgery to remove the bone chip and splint bone and he should be fine in 6 to 8 weeks. She didn't tell me exactly where the chip ended up in the joint and exactly what was done in the joint. I can find this out and let you know if you are willing to give me your opinion. Everything you say makes sense.

                The joint is very stiff and he gets upset with me when I do the flexion on it. I'm sure it hurts him. It hardly moves at all. When he is hand walked I have had someone lead him and the joint moves evenly with his other joint. He does not favor it at all at the walk. Very willing to move forward and he walks like he is very bored. Head down with a look on his face of sheer boredom.

                I will ask my vet about checking his joint fluid. There is no heat at all in the joint. Also will ask about injecting some HA into the joint. She wants me to start riding him at the walk. I am hesitant to do this for several reasons. First of all he is an arab and he is quite spirited and has been cooped up in his stall for rest and just out for his handwalking. I am afraid he will just explode and do more injury to the area. My gut tells me to handwalk him for another month. The rehab she wants me to do is this. Ride him for 5 minutes at the walk the first day. Second day, 6 minutes and so on. I am not comfortable at all with this and dont think he's ready. The handwalking started the same way. 5 minutes one day, 6 minutes the next until we are up to 30 minutes, which we are now. Your thoughts?

                Thanks again and look forward to your opinion! Jeanne

                Comment

                • Original Poster

                  #9
                  Moribelle ~ How long did it take for the Irap to take affect? He just received his second injection last weekend. When you say 3 rounds a year, is that 3 times per year or one set of shots 3 times every two or three weeks once per year. How much did you pay for the Irap therapy? My vet charged $ 800.00 plus farm call charges and a charge to give the injection. Very spendy indeed!

                  I appreciate you telling me of your experience with Irap. I do think it is a great treatment we will see if it helps my boy out!

                  Thanks so much! Jeanne =)

                  Comment


                  • #10
                    I did send a horse through chip surgery who was very painful following. IA HA provided pain relief for about 6 weeks, and IRAP made her sound. That was about 15 months ago. She was on strict stall rest with no walking through the IRAP protocol and was sound a week following the third injection.

                    I'd also want new radiographs of the joint, and would be tempted to send the horse back to surgery to scope the joint and see exactly what's going on in there.

                    Comment

                    • Original Poster

                      #11
                      Simkie ~ I would love to put him thru the surgery again, but finances dictate that I cannot do this unfortunately. His insurance has run out too. So I am on my own as far as his bills go now. So far its 5K. I am just going to continue his Irap treatments and inject the joint with HA and see what happens.

                      I will give him lots of time and see what happens. How long did it take before your horse was completely sound after the Irap treatments? I am imagining that this will be months before I see an improvement if at all. I am keeping my fingers crossed!

                      Thank you much! Jeanne

                      Comment


                      • #12
                        My horse was sound directly following the three week IRAP protocol and has remained so.

                        Is there a chance that your horse has soft tissue damage from his run in with the gate? Did you ever ultrasound the leg? Perhaps this is not a joint issue--perhaps this is a soft tissue issue?

                        Comment

                        • Original Poster

                          #13
                          Simkie ~ He did have splint bone removal at the same time. Vet said its possible a few of the fibers in the tendon could have been torn. That area has no swelling at this point. Just the fetlock joint is huge. The vet did tell me to take off the wrap for a few days and see what happens. Did that and his leg swelled up HUGE! Put DMSO on it and rewrapped it and have been keeping it that way. As long as he's wrapped the swelling stays down. Vet said his body is now used to being wrapped, so the swelling is normal. I guess we will just try leaving it unwrapped for a day and then wrapping it again until he gets used to not having it on. I feel better having it wrapped anyway to give that leg some support. Your thoughts?

                          Comment


                          • #14
                            Well...the first horse I sent to surgery for remove fetlock chips (I've had two) had a huge joint following surgery and had to be wrapped for a long time. But in her case, she had a TON of cartilage damage. She'd raced on her chips and had grooves down to the bone. I was never able to get her sound, and ended up giving her away as a brood mare.

                            Did your vet tell you what shape the cartilage was in? Do you have pictures from the surgery?

                            Here are the photos from Ya-ya's arthoscopy. You can see that the damage is very bad. This was before IRAP, but I don't think there's anything that would have made this horse sound enough to ride.

                            Comment

                            • Original Poster

                              #15
                              Simkie ~ I will have to ask my vet what kind of shape the cartilage is in and I can let you know. I'll give her a call tomorrow. Looked at those x-rays of yours. All I can say is "Ouch"! Poor mare! I know they x-rayed Sol during the surgery, but I think the reason they did that was to check and make sure they got all the splint bone chips out.

                              Thanks for sending me those x-rays. Very interesting and I'll let you know what my vet says about his cartilage.

                              Have a good night! Jeanne =)

                              Comment


                              • #16
                                Those aren't radiographs. Cartilage cannot be visualized on radiographs. Those are photographs that were taken with a little camera threaded through the scope. That is the ONLY way (other than perhaps MRI?) to visualize cartilage, and why I suggested you may want to send the horse back to surgery to rescope the joint. There's really no other way to see what's going on in there.

                                Comment


                                • #17
                                  Did they re-radiograph the joint after the surgery? You mentioned they radiographed the splint bone during the surgery. It's important to know if they radiographed the fetlock post removal to be certain they cleaned everything out. I've had chips removed from hundreds of thoroughbreds and only had problems once.

                                  Where are you located?

                                  Comment


                                  • #18
                                    LuvThoseKhemos: anytime a leg has been wrapped for any length of time, you will usually experience a quick rebound effect when the bandage is removed simply because the leg was staying somewhat small due to the constant pressure applied by the bandage. when the bandage is removed, the leg will almost always swell or stock up for several days. your horse has been wearing a bandage for a long time - perhaps too long. they are great for support sometimes and also to help with inflammation. but your horse is far beyond that time frame of a bandage providing a lot of benefit. one problem often seen with constant bandaging is actual soft tissue damage just due to a bandage put on too tightly inadvertently. you change the bandages enough and you will get one too tight. it is like someone saying they have never been bucked off of a horse. they are either lying or don't ride very much at all. it happens. i would allow the horse to go through the adaptation period of getting used to no bandages. that does not mean he should not wear one right after an irap injection or other procedure to the joint - but just for a couple of days. allow that leg to go through the process of not depending upon a bandage. run some cold water on that leg for 20-30 minutes daily - hydrotherapy is one of the most proven therapies ever documented and it is very cheap - just your time and the cost of water.

                                    i would be very hesitant to do further surgery and especially to rescope the joint just to see cartilage damage. that cartilage damage, if it exists, would have been there when the original surgery was done - your surgeon knows what that joint looked like and knew the prognosis just as soon as he saw the cartilage in the joint. you do not have to rescope to know the extent of the cartilage insult. further surgery would just further inflame an already inflammed joint. it would be great to follow up with x-rays and you will most likely see some degenerative changes - bone remodeling, spur formations, etc - they are all indications of the severity of the original traumatic event and will give you an idea of prognosis.

                                    my gut reaction without seeing your horse is that there is a huge amount of soft tissue damage around and in the joint -
                                    due to a very traumatic event,
                                    possibly due to the surgery itself (i personally have seen surgeries that were successful in removing a chip, etc - but that failed miserably because of the damage done in surgery itself - you will never be told of anything going slightly awry,...),
                                    a horse that really damaged the joint during recovery from surgery that fell or hyperextended the joint or...,
                                    a secondary infection following surgery,
                                    perhaps a severe soft tissue (ligament and tendon and joint capsule) injury that was never addressed properly

                                    a joint that is stiff and swollen and painful now several months after surgery is not a good indication of things to come. these are all strong indicators of a joint that will be compromised - i wish i had a better experience, but all of the horses i have been around with a persistent lameness and inflammation several months after surgery never returned to competition at any significant level. get some x-rays, perhaps inject the joint with hyaluronic acid to provide some lubrication immediately, very limited exercise (certainly not riding - i would have started with 6 weeks of strict stall rest followed by 6 weeks of limited hand controlled walking if at all possible, and then followed by turnout for another couple of months - but that was for a routine arthroscopic surgery on a joint with some cartilage damage that responded well to surgery), simple hydrotherapy and local anti-inflammatories like the good liniments or mud poultices

                                    i hesitate to recommend a lot of the new treatments mentioned like continued irap (although irap is a good treatment protocol but not if the joint has a low grade infection - nor will it work if the damage is outside the joint in the associated soft tissues simply because it only works where it is put - in the joint) or shockwave until you know what you are dealing with specifically (shockwave has distinct benefits but also has an analgesic effect - in other words a numbing effect for a short time, so the horse may overwork that joint simply because it is numbed for a couple of days - actually doing more damage in some cases). they sound good, but may often be used as alternatives to actually doing basic sound diagnostics to start with. they are good treatments for specific problems but they are not to be used like a shotgun to cover a wide area of possible problems - they need to be very specific to work. just continually doing something to the joint area can often become an exercise in futility if you continue to stir the pot every time. there has to be a reason to do it or it just becomes a madness.

                                    i would also seriously consider a second opinion of the joint by another experienced equine practitioner - certainly before adding another medical procedure to the already growing list. my gut reaction again is that something has gone wrong here - there are too many red flags. i suspect you wonder that also or you would not be posting here. get another opinion from an experienced equine practitioner who is also a surgeon with experience. there are specific reasons for what is happening and you need to know before it is too late.

                                    Comment


                                    • #19
                                      Originally posted by moveit moveit View Post
                                      i would be very hesitant to do further surgery and especially to rescope the joint just to see cartilage damage. that cartilage damage, if it exists, would have been there when the original surgery was done
                                      Unless there were chips or other debris left in the joint, or the potential infection damaged the cartilage. Both of which seem to be not unlikely possibilities.

                                      Comment


                                      • #20
                                        Moveit Moveit,

                                        Legs are not supposed to have a 'rebound effect' when you remove the bandages. If they do, it's because there is still an active inflammation occuring or there has been damage/inactivity (ie standing in the stall) to the lymphatics in the leg. That is not 'usual'. If you allow a leg to swell without a bandage, the horse can develop complications such as cellulitis/lymphangitis.

                                        LTK,

                                        Moveit moveit is correct that an improperly fitting bandage could be the source of the swelling. Are you confident that the bandaging itself is not the culprit? If so, you do need to know if the joint was checked post surgery and may need to go back and do some more diagnostics on that joint. They can go in there and clean up more cartilage if they have to. I would not do anything except keep the joint stable until you know what's going on. It sounds like there is some lack of communication by your vet. The best I can suggest is to pin your vet down on what is going on, or more importantly, the surgeon, and possibly get a second opinion. I am quite surprised that it took two weeks to do the surgery, so I'm curious as to your location. I had a filly come back a little off from a morning gallop at Keeneland, and they shipped her to R&R and removed a chip that evening. Unfortunately, if your horse has developed significant scar tissue in/near the joint, the prognosis for riding will probably be poor.

                                        Good luck and keep us posted!

                                        Comment

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