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  Discussion on Possible femur fracture
Author Message
New Member:
saskjump

Posted on Wednesday, Oct 10, 2012 - 5:08 pm:

6 weeks ago my 6 yr old came up 4/5 lame on right hind overnight in his stall, no noticeable heat or swelling could be appreciated and he did not respond to any hoof testers. The only reaction we could find was he was uncomfortable having his right stifle palpated, crepitation could also be felt and heard through the right hindquarters but location was unknown.

We took him to the vet where they performed stifle x-ray/ultrasound, nerve blocks, and pelvic exam all of which were unremarkable.

I was told to take him home with stall rest for 3 weeks and re-evaluate. He improved slightly over this period but was definitely still VERY lame (3/5 at walk and the vet didn't want him to trot for the exam). Bone scan was then performed, head and neck of femur were both positive as well as LEFT SI joint (likely due to compensating). Horse is still far to lame to lay-down and get x-rays of hip and femur so we performed an ultrasound. The ultrasound shows major roughening of the neck of the femur (although vet says he does not have much experience doing hips); the vets are now saying that they would like to stall rest him for 3 more months and THEN lay him down and attempt to get usable x-rays to provide a diagnosis FIVE months after the initial injury and much $$$$$ later. I would hate to put him through the general anesthesia only to find out that our fears of a femur fracture, are true and we will have to euthanize 5 months after the initial injury...

My wallet is quickly being sucked dry and it kills me to see my horse still so lame. A second opinion may be necessary very soon however it will be difficult to find a vet that has experience with bone scans in my area.

Any advice/experiences would be greatly appreciated!
Member:
dres

Posted on Wednesday, Oct 10, 2012 - 5:44 pm:

yikes ... truly a nightmare! do you have a teaching clinic near by like UCD ? all tho not cheap they usually have all the tools ..

On the first day God created horses, on the second day he painted them with spots ..
New Member:
saskjump

Posted on Wednesday, Oct 10, 2012 - 5:50 pm:

Everything has been completed by the WCVM teaching hospital and they are the only clinic with access to a bone scan in the province.

This horse is supposed to be my forever horse and I haven't even owned him for a year yet...
I am truly devastated.

He was completely sound the evening before he came out of his stall dead lame. I forgot to mention we have also performed x-rays on his foot but it was completely normal.
Moderator:
DrO

Posted on Wednesday, Oct 10, 2012 - 6:50 pm:

Welcome SaskJump,
I am sorry to meet you over such a serious problem.

Assuming all the above is accurate, at this point I believe you need to accept that all that can be done diagnostically has been done and it sounds like therapeutically you are doing all that is possible. You describe a thorough exam that localizes the problem to above the stifle with the blocks, and both the crepitus and scan support this localization with the further information that this is likely related to the neck or head of the femur. If this is true stall rest and anti-inflammatories is the only reasonable treatment available I can think of unless 10's of thousands of dollars are available for further diagnostics and surgery for possible uncurable problems.

It is hard to get to the bottom of such a search and live with the uncertainties presented to you but that is the way it is sometime. The only reason to seek a second opinion would be if you think the work already done is in error.
DrO
New Member:
saskjump

Posted on Wednesday, Oct 10, 2012 - 7:12 pm:

Hi Dr O

Thanks for your quick response. At this point I have financially spent as much as I can on diagnostics, although this is difficult I have to be realistic. The point that I am struggling with is that I am not receiving a definite diagnosis. In your professional opinion should the information above be enough to diagnosis a fracture of the femoral neck? The information above is a summary but I can provide the info directly off the discharge papers if it would help.

Just two more points we didn't block the whole leg but only did the foot and secondly he is experiencing muscle atrophy throughout his right hip and has minimal anterior phase of his walk.

Thanks again
Member:
lrhughes

Posted on Thursday, Oct 11, 2012 - 12:15 am:

Such an unfortunate situation, but Dr. O's advice is very realistic though sad.
Moderator:
DrO

Posted on Sunday, Oct 14, 2012 - 5:14 pm:

No Saskjump, the increased circulation that causes a positive hit on the scan and the crepitus sounds could be other things. Injuries to the soft supporting structures of the skeleton, particularly the joints, can cause crepitis. There may also be fractures of the pelvis that are evident on palpation and with ultrasound.
DrO
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