|
|
Discussion on Articular Type III Mid-Sagittal Coffin Bone Fracture
|
| Author |
Message |
New Member:
Amzizza
|
Posted on Monday, Nov 27, 2006 - 7:25 pm:
Thank you so much for taking the time to help me with my filly. I am a second year medical student, and am trying to get my filly back to the races after a one year layoff. Here’s her story: On the morning of December 23, 2005, the filly, then 2 years old, became unable to bear weight on the left hind leg after a van ride the night before. After 5 weeks, it was finally diagnosed correctly as a P3 articular mid-sagittal fracture, at which time she shipped to Lexington to recover and be evaluated. The vet surgically inserted a lag screw across the left hind coffin bone and achieved adequate reduction of the gap at the P3 articular surface. He also injected the joint with hyaluronic acid and recommended 4-6 months of stall rest during which time she received intramuscular Adequan twice weekly as well as intravenous Legend once weekly. She also began a supplement program from SmartPak Equine that included the multivitamin “Pro-VM”, the joint formulas “Recovery-EQ” and “Grand HA”, the digestive enzymes “Digest-It”, the hoof support formula “Glanzen 3C” and the amino acid “Pure Lysine”. Also, “Equine Performance Minerals” from Platinum Performance was given. Repeat X-rays were taken every 60 days to monitor the progress of her healing. The filly steadily improved over the next 2 months at which time, however, she experienced another bout of lameness due to an abscess in the same foot. We then replaced the original screw with a smaller screw, which does not need to be removed. She steadily improved both in soundness and in physical maturity to the point where after five months, she was turned out in a small round pen for 30 days followed by turnout in a large paddock. At that time, we also reduced the dosages of Adequan to once per week and Legend to once per month. On October 31, 2006, she received her last set of X-rays and another injection with HA. The discharge report said that she could proceed as follows: “Swimming and some very light conditioning on the Polytrack is recommended for the next 2-3 months. If all is well, some light cantering is advised beginning anywhere from Mid-January to early February. After approximately 45-60 days of this light cantering a slow return to galloping is advised.” I have decided to re-x-ray and inject with HA & TA in the end of December and try to start her back after the first of the year as a four year old. I would truly appreciate your advice regarding how best to do it. My trainer has access to a Eurociser and pool. Can you look at this proposed program that my trainer and I have formulated and give your honest suggestions on how best to get her back to the races. She will be able to go to Woodbine on the Polytrack on April 1st. We are planning on giving her repeat x-rays and “½ HA & ½ TA” Injections every 2-3 months as preventative maintenance. I have the highest respect for this forum, and I will be most appreciative to all who help with their time and advice. Thank you in advance. Hope to hear from many of you soon.
Anthony
PHASE 1 (60 Days):
JANUARY: 30 DAYS OF SWIMMING (4X/WEEK) & VERY LIGHT JOGGING ON EUROCISER (2X/WEEK)
FEBRUARY: 30 DAYS OF SWIMMING (3X/WEEK) & LIGHT JOGGING ON EUROCISER (3X/WEEK)
PHASE 2 (90 Days):
MARCH 1 – APRIL 14: 45 DAYS OF JOGGING & LIGHT CANTERING ONLY with SWIMMING
APRIL 15 – MAY 31: 45 DAYS OF JOGGING & A SLOW RETURN TO REGULAR GALLOPING with SWIMMING
PHASE 3 (90 Days):
JUNE: FIRST SHORT & SLOW BREEZES (with SWIMMING if needed)
JULY: CONTINUE CAUTIOUS BREEZING (with SWIMMING if needed)
AUGUST: FINAL BREEZES IN PREPARATION TO RACE (with SWIMMING if needed)
Sample Breezing Schedule:
1) 1/8: in ~15 seconds (June 1st)
2) 1/8: in ~15 seconds (June 6th)
3) 1/4: in ~29 seconds (June 12th)
4) 1/4: in ~28 seconds (June 18th)
5) 1/4: in ~27 seconds (June 24th)
6) 3/8: in ~39 seconds (July 1st)
7) 3/8: in ~38 seconds (July 8th)
8) 3/8: in ~38 seconds (July 15th)
9) 1/2: in ~51 seconds (July 22nd)
10) 1/2: in ~50 seconds (July 29th)
11) 1/2: in ~50 seconds (August 5th)
12) 5/8: in ~1:03+ (August 12th)
13) 5/8: in ~1:02+ (August 19th)
14) 5/8: in ~1:02+ (August 26th)
Images will follow
|
New Member:
Amzizza
|
Posted on Monday, Nov 27, 2006 - 7:35 pm:
here are her xrays
 February 2006
 October 2006
 February 2006
 October 2006
 February 2006
 October 2006
|
New Member:
Amzizza
|
Posted on Monday, Nov 27, 2006 - 7:39 pm:
and here is the filly    
|
New Member:
Amzizza
|
Posted on Monday, Nov 27, 2006 - 7:44 pm:
Dr O,
I forgot to ask you specifically for your advice.
Anthony
|
Member:
Dres
|
Posted on Monday, Nov 27, 2006 - 8:07 pm:
Anthony she is lovely.. and I wish you luck..
On the first day God created horses, on the second day he painted them with spots..
|
New Member:
Amzizza
|
Posted on Monday, Nov 27, 2006 - 8:19 pm:
thanks Ann, i appreciate that.
|
Member:
36541
|
Posted on Monday, Nov 27, 2006 - 11:49 pm:
Anthony, has there been a discussion of why she had the fracture to begin with? Was the bone thought to be weak just in that one foot, and so possibly fractured during a routine transport? Rather, was it assumed she did it kicking in the van? Has there been a measurement of her bone density(Dr. O, can they do that?) or is it a "try her and see" philosophy?
Is she sound at all gaits and on all surfaces, ie concrete, grass, dirt? Will she be shod? She looks quite the athlete - what is her breeding? Hope its not too many questions, best wishes for both of your careers...Stacy
|
Member:
Amzizza
|
Posted on Tuesday, Nov 28, 2006 - 12:41 am:
hi stacy, never too many questions....
it was assumed she did it kicking the van.
There has never been a measurement of bone density, but there is no reason to think that she has any unusual condition that would predispose to that. Right now, it is a try and see if she tolerates training after one year of rest and a gradual reintroduction to training.
She seems to be sound on all surfaces though on her last exam, the vet said that she may be a grade 1 out of 5 on the lameness scale. This is mainly why I decided to wait another 2 months to start her training.
Currently, she has a bar shoe in place and will train with a bar shoe with a continuous rim and rim pad on the injured left hind and shoes with a continuous rim and rim pad on the other three feet for extra support.
She is physically quite a specimen. her breeding is not commercially popular however. She is by marco bay out of an unraced dispersal mare who has had three foals to race and all of them winners. In fact, i have owned two of them. Perhaps this is why i have a special attachment to this one. i am sure it is.....marco bay does improve his mares considerably, and is the sire of millionaire Buzzard's Bay.
Thank you for the good wishes!!
Anthony
|
Moderator:
DrO
|
Posted on Tuesday, Nov 28, 2006 - 6:30 am:
Welcome Anthony,
I do have a few questions before we get into rehab. First what is the filly doing now? I am also interested in the prognosis you received from the surgeon after the last set of radiographs? I am concerned because the last lateral radiograph distinctly shows periarticular changes consistent with osteoarthritis and, more subjectively, is the narrowing of the joint space compared with earlier images.
DrO
|
Member:
Amzizza
|
Posted on Tuesday, Nov 28, 2006 - 10:04 am:
Dear DrO,
First, I'd like to thank you for having this forum and responding to me. I appreciate it very much.
At this point, the filly has been in a large paddock for about the past 4 months. She runs and is sound now. Her surgeon said that it is reasonable to think that she can make it back but with this type of injury one never can know what the horse tolerate until she starts breezing. He said he was fairly happy with the radiographs. I will attach a better copy of the last film.
Anthony
|
Member:
Amzizza
|
Posted on Tuesday, Nov 28, 2006 - 10:19 am:
Here's a close-up:
|
Moderator:
DrO
|
Posted on Wednesday, Nov 29, 2006 - 7:07 am:
Nice images Anthony but my concerns are not allayed. Notice in the first image what appears to be a joint mouse at the top of the coffin joint space? The periarticular osteophyte is at the insertion of the coffin joint capsule onto the coffin bone. I have to wonder if this area will put up with the stress of running full out for several minutes. But take heart I suspect the surgeon is a better judge of what is possible here than I am Anthony.
My next consideration is the screw that remains. I am not familiar with racing with such an appliance in place and maybe it is done all the time o object. I would discuss with the surgeon the problem of a object that does not move like the surrounding bone when placed under intensive exercise and consider having it removed as it may weaken the bone. Following removal I would wait 6 more months before beginning training.
You should train and possibly race this horse with a bar shoe. One study found a significant decrease in the incidence of refracture in racing horses with previous coffin fractures when bar shoes are used.
I think your rehab schedule is reasonable in consideration of what the horse is doing now. I have mixed feelings about the triamcinolone acetonide injections but think I might choose this route in your place since there are already signs of DJD. Following its use you have a transient period where the joint will not respond as well to the stresses of exercise. If you decide to do them I would give the horse a 3 week pasture rest following the injections before continuing training.
Once you begin breezing in earnest I like the 21 day steps as long as the horse is getting 2 to 3 contiguous days rest each week to allow the skeletal system to respond to that weeks exercise.
DrO
|
Member:
Amzizza
|
Posted on Wednesday, Nov 29, 2006 - 3:42 pm:
Dear Dr. O,
The surgeon said that the screw can remain in place. The latter set of xrays shows a smaller screw because it was replaced in may. he used the smaller one so that it could remain in. According to him, as long as it doesn't bother her, it can remain.
also, what about the value of further imaging like MRI? Would there be, in your opinion, any value in getting more precise knowledge regarding the joint or fracture or is it a situation where if they have 12-18 months off, further rest won't really do any good? would MRI results affect our approach to training? etc.....
She will wear a bar shoe for sure.
Is there another schedule for injections that you would suggest?
What about the time frame and details of the training plan? Is there such a thing in this case of taking too much time? for example, this program is 8 months.
Do you have any other suggestions?
Thanks,
Anthony
thanks again
|
Moderator:
DrO
|
Posted on Thursday, Nov 30, 2006 - 5:52 am:
The problem I see with MRI results is not enough information on what any particular result would mean, so unless you have someone who has looked at a few dozen such injuries and followed up the results I would be slow to recommend it. Your schedule of injections is about as logical as any other. As for the training plan, I only look at it from the stand point of healing and strengthening the fracture in which this looks reasonable.
DrO
|
Member:
amzizza
|
Posted on Thursday, Feb 15, 2007 - 12:11 pm:
Dear Dr O,
I recently got her x-rays again in jan. and she has started swimming as of feb 1st. do you have any thoughts on the new films? also, the vet said the following the injections, 1 day of stall rest and three days of hand walking was all that was needed before she resumes her regular training. any thoughts?
thanks
other x-rays to follow
|
Member:
amzizza
|
Posted on Thursday, Feb 15, 2007 - 12:14 pm:
here are the other views from january.
|
Moderator:
DrO
|
Posted on Thursday, Feb 15, 2007 - 6:52 pm:
From the radiographs the bone appears to be healing and there is minimal increase in evidence of DJD in the coffin bone but none of this tells us if the horse is sound, how is the horse doing soundness wise?
DrO
|
Member:
amzizza
|
Posted on Thursday, Feb 15, 2007 - 7:03 pm:
Hi,
Sorry about that. She is 100% sound at all gaits.
Anthony
|
Moderator:
DrO
|
Posted on Friday, Feb 16, 2007 - 7:02 am:
Excellent Anthony, I look forward to hearing how she does this year.
DrO
|
Member:
amzizza
|
Posted on Friday, Feb 16, 2007 - 8:34 am:
Thanks.....
|
Member:
amzizza
|
Posted on Sunday, May 13, 2007 - 9:59 am:
Hi Dr. O,
Just an update for you and the readers. The filly swam for 6 weeks starting in february, then began 6 weeks of swimming with jogging on the eurociser. After this, she accepted a rider in mid april and added jogging on the track to her her routine. On may 12th she had her first breeze. It was just an easy 3/8 in 38 2/5's seconds but she did it on her own and came back sound. Thanks again for your advice. I hope that she continues to do well.
Anthony
|
Moderator:
DrO
|
Posted on Sunday, May 13, 2007 - 6:59 pm:
A remarkable case and the thanks should all go to the surgeon.
DrO
|
Member:
paul303
|
Posted on Sunday, May 13, 2007 - 11:49 pm:
It's been wonderful to have the opportunity to follow such an interesting case...many thanks to you, Anthony, and Dr.O.
Wishing you and your filly all the luck in the world - you deserve it!
|
Member:
mrose
|
Posted on Monday, May 14, 2007 - 11:27 am:
Excellent news, Anthony! Good luck to her in the future. She's a great looking filly!
|
Member:
amzizza
|
Posted on Friday, Dec 14, 2007 - 10:25 am:
Hi Do O,
The filly has won 2 in a row (her 2nd and 3rd race) by 4 and 14 lengths, respectively! She is doing superbly! We will give her about 6 weeks off now, and bring her back in late January. Her racing name is IMMACULATA! It is a miracle in the truest sense!
Thanks for all of your help and advice,
Anthony
|
Member:
canter
|
Posted on Friday, Dec 14, 2007 - 1:35 pm:
Fabulous news, Anthony. I hope Immaculata (how appropriate!) continues to remain sound and win races for her very dedicated owner.
|
Member:
paul303
|
Posted on Friday, Dec 14, 2007 - 11:41 pm:
How super to hear this news right before Christmas! How kind of you to check in!! Best wishes for continued success in the New Year!!!
( YEE HAAW!!!! )
|
Member:
frances
|
Posted on Saturday, Dec 15, 2007 - 7:52 am:
Congrats!!
|
Moderator:
DrO
|
Posted on Saturday, Dec 15, 2007 - 10:22 am:
Love to hear it Anthony, would it be possible to see a image of her in all her colors and jockey up.
DrO
|
Member:
amzizza
|
Posted on Saturday, Dec 15, 2007 - 11:30 am:
Hi Dr O,
sure...I am waiting for the winning pictures to come in the mail. When they do, I will scan them and upload them....
Thanks again for all of your advice and concern!!!
Anthony
|
Member:
amzizza
|
Posted on Wednesday, Feb 27, 2008 - 11:16 am:
Hello Dr O and Readers,
ANOTHER WIN FOR IMMACULATA!!
ON FEBRUARY 23RD, 2008!!!
IT'S HER 3RD WIN IN 5 STARTS!!!!
THANKS FOR ALL OF YOUR HELP AND ADVICE!!!
ANTHONY
|
Moderator:
DrO
|
Posted on Wednesday, Feb 27, 2008 - 8:51 pm:
Wow, where do I put down my wager Anthony? Congratulations!
DrO
|
Member:
amzizza
|
Posted on Wednesday, Feb 27, 2008 - 10:02 pm:
Thanks so much!!! I still need to upload those winning pictures but i haven't received them yet. Her story is such a good example of how your site helps not only owners but horses as well. Keep up the great work!!!
Anthony
|
Member:
paul303
|
Posted on Wednesday, Feb 27, 2008 - 10:21 pm:
Holy cow!! What a thrill!!! That is some filly you have there!
|
Member:
amara
|
Posted on Thursday, Feb 28, 2008 - 7:47 am:
that's awesome Anthony..
any chance you could post her full stats? I grew up in the racing world (NYRA), so am always interested in all the little details
|
Member:
ekaufman
|
Posted on Thursday, Feb 28, 2008 - 10:24 am:
How terrific for you and for your horse, Anthony. Photos and stats please!
|
New Member:
joydcox
|
Posted on Monday, Mar 24, 2008 - 11:47 pm:
Hi Anthony,
Could you please give me the contact information for the vet that advised you and performed the surgery?
My horse was diagnosed with the exact same injury today and I've spent the past 6 hours online researching what to do about it. I want to get advice from the best experts possible.
What kind of costs am I looking at for a treatment plan such as yours including the surgery, injections and supplements (minus the physical therapy/exercise - mine does not have to race)?
I'd also like to know if you had bar shoes on her the whole time she was healing or just when you put her back into work? Did she need to have shoes on all four feet? And did you fill the hoof with impression material as well?
I appreciate you taking the time to help me out - I know you understand how heartbreaking it is to have an amazingly talented horses career cut short by something like this. And I have no idea how he did it!
Fawn.
|
New Member:
joydcox
|
Posted on Monday, Mar 24, 2008 - 11:53 pm:
Oh, I forgot to ask, have you had any signs of Osteoarthritis show up and how are you managing them?
Fawn.
|
Member:
amzizza
|
Posted on Tuesday, Mar 25, 2008 - 8:57 am:
hi joy,
the vet was dr robert hunt from hagyard clinic in lexington kentucky. the surgey was about 1000. the bar shoe was on for 6 months or so. she was injected every 2-3 months with 1/2 steroid and 1/2 HA, and given adequan IM two time a week for at least 1 year. this is probably a bit more than you would consider since your horse is not racing. cost for each injection runs about $150 and the adequan is about $50-80 per shot but you can get it cheaper and give it yourself as i did. no hood impression was used and she did have shoes on all 4 feet. the most important thing is time time and more time with proper shoeing, joint medications and plenty of fun gadgets to keep him/her busy and happy in the stall. there are signs of arthritis on x-ray but as you know that does not always correlate to the horse's clinical picture of the horse. In other words, she has arthritis (on xray) but has never shown any signs of pain since she has been back in training. anything else, just let me know...
anthony
|
New Member:
joydcox
|
Posted on Tuesday, Mar 25, 2008 - 11:54 am:
Hi Anthony,
I called Dr. Hunt today and am having the x-rays overnighted to him. Thank you so much! All of your information was extremely helpful.
Another question - did you have the shoes nailed on or glued on, as I wondered if the trauma of having nails pounded in wouldn't be harmful? Also, you said the surgery was about $1,000. Is that correct or did you mean $10,000? Just wanted to double check!
Thanks so much.
|
Member:
amzizza
|
Posted on Tuesday, Mar 25, 2008 - 12:14 pm:
hi joy,
it was about 1000, but she did have another surgery for 700 a couple months after to place a permanent "smaller" screw. also, her shoes were nailed on. you are in good hands....give my best to dr hunt.
anthony
|
|
|
