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  Discussion on Fracture diagnosis using Zero Radiographs
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Posted on Friday, Jan 11, 2002 - 12:26 pm:

My horse was diagnosed as having a fractrure in the lower aspect of the third metacarpal just above the fetlock joint. This diagnosis was made on findings from zero radiographs taken in Oct. The horse was stall rested for 2 1/2 months and follow-up zeros were taken in Dec. The original fracture line appeared exactly the same, with no changes whatsoever. I had these zeros reviewed by a second source whose opinion was that this was not a fracture in the first place, and that some remodeling would have taken place and would have been evidenced on the films after 2 1/2 months. The history is that the horse took what looked like a bad step on several occassions at the trot and then immediately worked out of it. The last time this happened he stayed lame at the trot and developed some heat and slight swelling in the ankle. My question is this. Is it possible to have a fracture look exactly the same after two months rest, or is it more likely it was not a fracture in the first place? It is difficult to find people experienced at reading zero radiographs and I am open to suggestions.

Posted on Saturday, Jan 12, 2002 - 6:49 am:

Hello Dr. B,
What did the second opinion say the radiolucent line was?

To answer your question, yes it is possible, and it can occur with regular radiographs on a sound horse too. Doing a prepurchase exam 10 yesrs ago I was taking routine surveys of the ankles on a sound horse. There a line showed up that appeared to be a nondisplaced fracture of the cannon that went into the fetlock joint. It showed up on two of the shots but I could not believe it so I went and shot it obliquely to better define it. After viewing this radiograph, it was clearer than ever. So I sent the shots off to the radiologist at NC State and they concurred a fracture!

The horse never did have a lameness problem and my best guess is an old nondisplaced fracture that healed with a little more cartilage than the surrounding bone. There is one weakness with this argument. Since the fracture was articular and the healing imperfect, a jumper should have had arthritis develop in that joint, but over the next two years no problems and the horse was resold at that time.

I guess the moral to this tale is that if you look at enough horses you are going to run into some odd things. I think the best way for you to proceed would be to carefully rule out all non-fracture possiblities and if no other problem shows up treat it like a fracture or in this case a poorly healing fracture. You may get out anouther 2 months and still find it there and at some point have to begin exercising again.
DrO

Posted on Wednesday, Jan 16, 2002 - 8:41 pm:

Dr.O-
The second opinion was from New Bolton Center and they said it was an artifact which appears as it does because the film was a xero radiograph. I just recently took black and white films to see if the supposed fracture line can be visualized, even though it is now three months since the original films were taken. It is, however, only 2-3 weeks since the last set of xeros showed the "fracture" line. I do not have the results of the latest films yet. (Incidently, isn't it a little uncommon to have this type of fracture occur on the medial aspect of the bone?)
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