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  Discussion on Sesamoid Fracture
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New Member:
grace2u

Posted on Monday, Sep 19, 2011 - 3:12 am:

Dr. O,

I have a 10 year old mare who was shown as a two year old then pretty much retired when my son went off to college 5 years ago. She is in a pasture with her life long friend and fed pellets and alfalfa daily.

Six weeks ago she became 4/5 lame on her left hind foot with swelling in the fetlock. The vet was called, she did a block of the foot, the horse went sound and a diagnosis of abscess was given.

The foot was soaked twice a day followed by a poultice and wrap. It was very dry and the hooves were very hard (did not respond to hoof testers) it was thought it might take awhile for the abscess to pop. However after two weeks I took her in to the vet for radiographs.

When I arrived at the vet, the fetlock swelling was gone, the horse had gone from a 4/5 limp to 1/5. Vet assumed abscess had popped. She dug around a little but didn't see anything on the sole. She did xrays of the foot but nothing remarkable.

I was told to continue wrapping and soaking one week past sound. A couple a days after the vet visit the fetlock was swollen again and she was 4/5 lame. I assumed the abscess had closed up prematurely and continued soaking and wrapping for another week. Finally I had my farrier come out and see if he could do something. He found nothing and said take her back to the vet.

Upon arrival at the vet, the swelling was diminished again and the horse was 1/5 lame. Vet did some blocks, flexion tests, and xrays. Final diagnosis is, "axial necrosis of proximal sesamoid bones and apical sesamoid fracture of medial sesamoid".

He recommended arthoscopic surgery to debride the necrosis and remove the fracture but progrnosis was only pasture sound and the cost was 3-4k. A more conservative approach would be casting the leg for 6 weeks, splinting 6 weeks, then slowly weaning off splint. Again pasture sound was all we could hope for and cost was around 2-3k.

Pasture sound is fine with me. Our son raised and trained her from a weanling and won 3rd place at the 4H State Futurity and 13th out of 170 horses in Youth Western Pleasure at the Houston Livestock Show and Rodeo. She taught him more than any human ever could so she has done her job. However, I can't spend a ton of money for pasture sound. Could we simply do stall rest for 6 months?
Are there any other treatments that would be helpful like cold packs, etc? She is very calm and happy to just stand still. Any advice you can give would be helpful. Thank you for your time.

Karen
Moderator:
DrO

Posted on Tuesday, Sep 20, 2011 - 9:27 pm:

Welcome Karen,
I don't see where your vet says that antiinflammatory treatment and stall rest won't have the same prognosis as the more aggressive treatments that you describe. What does he say about this option?

Areas of dead bone they do tend to become inflammed/infected and cause serious lameness if left behind. However the dead bone can be removed when it starts to cause a problem and it may be the fragments may be OK left behind. Some fragments are also causes of increased lameness unless removed. Size and exact location on the apex can make a difference.
DrO
New Member:
grace2u

Posted on Wednesday, Sep 21, 2011 - 2:28 am:

Dr. O,

Thanks so much for your reply. I think he said she would have to always be on bute and may not be pasture sound with bute. However, she has been stalled for 6 weeks now and on bute for the last week and seems sound. She still has some swelling and is very sore to the touch at the base of her fetlock. I only noticed her being like that for the past couple of weeks. Originally she was not sore to the touch anywhere on her fetlock.

Here are a few more questions.

1. Should I be icing it or anything else besides bute for the swelling?

2. Could it be an infection from the original needle stick when they did the block 6 weeks ago when we thought she had an abscess? that is exactly where the swelling is and she did go sound at that block which is why she was diagnosed with abscess. The vet said only her foot was blocked.It seems to me the fetlock was not originally involved. I only ask because if it is infection, casting it will not help, right?

3. Have you ever heard of casting this injury? I cannot find any research supporting that.

4. I was told the dark spots of necrosis are progressive and the bone will continue to decay. In your experience is that always true?

Thanks again for your help!

Karen
Moderator:
DrO

Posted on Friday, Sep 23, 2011 - 7:39 am:

Karen, without an examination I cannot answer any specific questions about your horse's treatment, at the least that requires a physical exam.

1) If you have ongoing inflammation, cold compresses that use ice may help. As to alternative to bute check out HorseAdvice.com » Treatments and Medications for Horses » Anti-inflammatories (NSAID's, Steroids, Arthritis Rx).
2) You would not want to cast over a infection but I have no way of knowing is that what is going on.
3) Anytime you have a fractured bone that you are trying to get healed, stabilizing the pieces will help. It is very difficult to stabilize the sesamoids using a cast and generally not a recommended treatment for sesamoid injuries.
4) Very little in medicine is always true but see my comment on necrotic bone above Karen. Is your vet sure he is looking at areas of necrosis? It is more common to see osteoporosis (loss of calcium) which would appear as dark spots than areas of necrosis in the sesamoids.
DrO
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