Owner complains: after horseback riding the horse started to limp.

Clinical signs: limping when running and lowering the head when running.
      

Diagnosis: it was detected by looking at the horse running that the horse is limping on the left front leg. Hoof taster examination, palpation, regional Anastasia reveal that the problem is in the hoof. The hoof was treated by friar searching for an abases. An x ray imaging revel there was a fracture in the 3rd phalanx.
      

Treatment: a bandage on the distal part of leg. a bareshoe was placed. and treatment against pain.

Supportive care: the horse needs a long rest with no back riding for a least 3 months.

Pedal Bone fracture (PIII fracture)

A 17 yo Gelding became abruptly lame while trotting on a rocky terrain. He is Bright alert and responsive. Lameness 5\5. Responsive to hoof tester, on the solar surface, especially on the medial side and the toe area. After a mild trim job, in hope of finding an abscess some hemorrhage and bruising was found on the medial side and the toe area of the sole.

We grade lameness from 1-5/5. 1/5 would be a very mild lameness, very hard to recognize. 5/5 is a horse that in not bearing any weight on the leg.

We apply hoof testers on the foot to get an inflicted painful response. A horse that is doing well will not respond at all to the hoof testers if used correctly. when there is a response, we know where to look.

It was decided to take x rays.

On the x rays a fracture was noted on the medial side going toward the toe area. It is a oblique fracture that does not involve the Coffin joint. 

In these fractures we are worried about the involvement of the joint and the age of the horse. There was no involvement of the joint so the chances of recovery are good although the horse is 17-yo and this means that the bones heal slower and weaker than a younger horse.

A bar shoe was placed on the hoof and a cast was applied. Usually ether would do but I thought that the bar shoe was not sufficient, that the clips on the side did not hold the hoof tight enough. The idea is to make sure that there is a minimal amount of movement inside the hoof capsula.

After a two weeks the horse did not show a lot of improvement. After a month the horse improved dramatically and today he is turned out after only two and a half months from the injury.

At first I tried to move the two edges closer with some towel clamps. I had them on while I sutures the lip that also had a fair cut, right through the side of it. That done with I dedicated all my attention and skill as a surgeon ti the facial cut. I quickly found out that there is not enough skin to suture.

A tension suture was elected and revaluation in 18 hours was what seemed to be the only option. At the base of the tention sutures (U shaped, Single interrupted sutures) an small piece of  an IV set line was placed, not to put too much stress on the skin edges so there Will be no necrosis due to ischemia of the blood supply. Towel claps go a long way when trying to suture a place that has a lot of tention.

After 18 hours there was already laying down of fibrin. horizontal tention relieving incisions were made, below and above the suture line. At this time the tention sutures were removed and again using the force of the towel claps the skin edges came together nicely. A staple gun was used to get a very precise suture line and U shaped Single interrupted sutures were put in with the added IV set pieces to minimize the tention on the edges of the suture line.

The result was very satisfying. This all was possible for the use of a lot of Carbocaine, a small amount can go a long way.

Barak Amram DVM

This is a filly that got hurt from a fence while trying to flee from her owner who was trying to catch his 2-yo filly that has never been handled. There is a lesson to be learned here…

The pole from the fence went through all of her superficial ad deep muscles in the flank area and chipped a piece of her transverse process of two lumbar vertebrae. Through the incision palpation of the intestines, uterus and ovaries was possible. A 7- 10 inch hole was palpated. On palpation of the wound and the internal organs, no damage was noted to the viscera and other organs in the abdominal cavity.

On the first examination the wound was very contaminated, so it was decided not to close the wound. Debridement and primary closure was made, with intention of reassessing the wound in three days time. IV fluid therapy and antibiotics were administered at this time. IV and IM antibiotics were given daily for a period of 10 days.

Remarkably the filly remained alert and responsive. No other major abnormalities were noted except for the great discomfort that the wound was causing her. Her heart rate was mildly high (56 p/m) and a slight fever was taken at the time (38.8c).

A week after the initial treatment, granulation tissue and contraction of the space that was left open inside the wound led to closure of more than 65% of the space left from the trauma.

The wound was bandaged every three days (for economical reasons, hospitalizing her was not an option). The space was packed with gauze soaked in saline and antibiotics.

We are still far from the end but it looks promising. Amazing what the body can heal with just the help of fighting infection and stabilizing the animal initially. Contraction of the musculature did most of the primary closure of the dead space left after the injury. Granulation tissue will fill in the rest, from inside out.

Very interesting.