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  Discussion on Core lesion
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Member:
Kstud

Posted on Wednesday, Sep 20, 2006 - 12:45 pm:

Hi all, my 4yo fractured a splint in early may in front and did some damage to the suspensory ligament. Originally the vet hospital felt the damage was mild and did not seem too concerned. He was operated on successfully to remove the lowest 2cm of splint which healed 100%. He has had his 3 months of complete box rest and 3 doses of shockwave therapy after which he was scanned each time and the lesion was healing well. However after the last scan as there was still a visible defect I was told he had to have 3 more months box rest. The original lesion was a core lesion in the left branch. My question is has anyone else gone through this and had their horse return to full function. I had hoped to event this guy and he had been placed in Young Event Horse classes before this happened. Initially the prognosis seemed great as the original injury was a kick to the splint bone and now I am a bit dejected and worried as they are saying that the lesion may not actually heal and that he will be susceptible to reinjury.
Thanks Catherine
Member:
Mrose

Posted on Wednesday, Sep 20, 2006 - 2:06 pm:

Catherine, I feel for you. Did they say why they don't feel the lesion will heal? And, what about the suspensory ligament; has it healed?
New Member:
Lisarose

Posted on Wednesday, Sep 20, 2006 - 2:36 pm:

This is a somewhat controversial thought- I have no idea if it applies to your case- Old time racing vets say that the best way to treat suspensory injuries is to turn the horse out in a big field and leave them alone for 6 months. The thinking is that stall rest leads to disorgainized scar tissue that is inherently weak and prone to re-injury. Letting the horse move and find the amount of movement they can handle causes strong tissue to form. I believe this was the rehab used on Seabiscuit. I know that modern vets suggest stall rest and hand walking- but the old suggestion makes some sense to me. I'll be sending good thoughts to you and your boy.
Member:
Kstud

Posted on Wednesday, Sep 20, 2006 - 3:04 pm:

Hi Sara, the core lesion is in the suspensory and this is what does not seem to be fully healing but they seem to think that this is not unusual.
Lisa I would be afraid to turn him out as that is how the injury occurred originally. He is 16.1hh and I turned him out with a little old 12.2hh pony for company! I could not put him out on his own as he would try to break out to other horses and anyway I think he would gallop around and act the fool and possibly do more damage. He is on a programme of in-hand walking at the moment but the problem seems to be lack of am=ny fibres, not their organisation.
Member:
Kstud

Posted on Wednesday, Sep 20, 2006 - 3:05 pm:

oops...... any fibres!
Member:
Mrose

Posted on Wednesday, Sep 20, 2006 - 5:02 pm:

I'm just wondering why the lesion wouldn't heal in time. Have there been tears due to adhesions, thus no healing? Any word on that? IMO, btw, I'd stick with the hand walking, though I have to say I can see sense in the ideas of Lisa. Thoughts, Dr.O.?
Member:
Osage

Posted on Wednesday, Sep 20, 2006 - 11:30 pm:

Hi Catherine,
I have a gelding who had the same injury and had surgery to the splint bone on May 2, 06. His suspensory had a 23% lesion, the suspensory diameter was 2 cm, normal is around half that. So his damage was graded "severe". His prognosis was "guarded". The injury was on the medial branch, adjacent to the broken section of splint bone.

He's been on stall rest with controlled exercise. We didn't do any shockwave or stemcell, my vet doesn't think they help much.
Our exercise program consisted of handwalking starting week 2 after surgery. I began ground driving at the walk at about month 1. I added trotting about month 2. Riding at walk month 3, riding at trot after another couple weeks into month 3. When I ride at trot I trot one long side of the arena and add a side every week. I'm at 6 long sides now, going to add corners pretty soon.

Up until about 3 weeks ago, the leg was still extremely swollen. But we did do an ultrasound at week 8 and the lesion was no longer showing up and the ligament was almost normal size.
Also during this time I have done a lot of work on the leg, wrapping it for the first 2 months, sweating it and blistering it on a cycle, icing it every day. I don't do any of that anymore but I do use a cold laser to warm up the ligament before work. I use Surpass if I see any heat, and back off work. I use a digital laser thermometer to check the temp. of the leg everyday.

Right now the leg looks almost totally normal. Suddenly the swelling just went down 3 weeks ago and has remained this way. He's also been going sound since month 3, before that he was very lame. My vet did some steroid injections at week 8. I also give the supplement Jiaogulan, which was found by the Horse Journal to have an effect on healing. I worked on his foot balance, he had sheared heels and the breakover was bad.
That's all I can think of. This horse now looks and seems totally sound but I will keep up with the controlled exercise at least until I hit the 9 month mark. Basically I'm following the rehab protocol described in this site. Except I added the trot earlier and more gradually.

I did most of this on my own, but I told my vet about most of it and he agreed it seemed to be working very well. One thing I did that I think helped the most, was start the exercise early. I think the exercise helps speed the healing.
I think you might see what I did, a major sudden improvement. Hang in there, I know how it feels. I want to turn my horse out so badly, he's such a pig in the stall. But I'm going to try and hold out the 9 months.
Janice
Moderator:
DrO

Posted on Thursday, Sep 21, 2006 - 9:11 am:

Catherine, I am having trouble putting your case description together: the kick by the pony created a core lesion to the left branch of the suspensory? Was there external evidence of trauma? There are internally generated fractures of the distal splint bones associated with branch desmitis which might be more consistent with what has been described so far. I wonder if this was a subclinical problem that became evident on the examination for the fracture and might explain the slower healing.

Not seeing the lesion it is difficult for me to comment on therapy and prognosis but sometimes it takes a year and a half for core branch lesions to resolve and usually present a guarded prognosis for return to eventing. We do have some specific recommendations for treatment in the Suspensory article for single branch desmitis. I wish I had better news.
DrO
Member:
Dres

Posted on Thursday, Sep 21, 2006 - 10:25 am:

Dr. O could you explain your comment ""There are internally generated fractures of the distal splint bones associated with branch desmitis which might be more consistent with what has been described so far.""

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

Posted on Thursday, Sep 21, 2006 - 5:32 pm:

Thanks Dr O, We were kind of baffled too but there was a lovely pony shaped hoof mark on the medial aspect of the left fore right where the fracture was. The horse had been sound 10mins earlier when I turned him out with the pony and I did not see them galloping about BUT she was in season. So I was sure it was an injury but when I had her scanned they felt like you Dr O. However when he was x-rayed there was a callous on the splint so it seems that he may have fractured the splint before I bought him, most likely due to suspensory desmitis, but the fragment was not displaced and nothing was picked up at the vetting. He is totally sound and other than initially his leg has never been swollen. I know he is sound because you nice Americans have sent a hurricane over to us and I was trying to walk him but ended up trying to hold onto him as he cantered 10 meter circles, both reins, on the concrete yard! I hope that does not set him back or do damage.
Whilst the initial lameness resolved rapidly there is still a lesion to be seen on the scan. From what I was told the suspensory was not much thickened but he felt that there might have been a healed lesion there. This new lesion though has not resolved yet on a scan. I know this is the impossible question but is there any chance he will come back to his former level of soundness? He is only 4 and I never normally buy geldings so I am at a huge loss as to know what to do with him.
Catherine
Member:
Kstud

Posted on Thursday, Sep 21, 2006 - 6:46 pm:

Dr O, another question for you! I brought up the possibility of stem cell therapy or ligament splitting today with my colleague who is dealing with this case. He got a bit upset and said that he would have suggested it if he thought it would help and that my horse would not be a candidate for it. I do not know too much about these therapies but I have heard of very encouraging results with the stem cell therapy in very similar lesions ie core lesions of the branch of the suspensory. What would be your view? He has another scan in 2 weeks and if the lesion still has not resolved I would like to try anything that may help.
Moderator:
DrO

Posted on Friday, Sep 22, 2006 - 6:29 am:

Ann internally fractured means the fracture occurs because of internal forces on the bone. In a way this is a type of avulsion where ligamentous attachments pull on the bone creating the fracture.

Catherine with a non-healing core lesion I would want to know why he is not a candidate for ligament splitting? You are right I cannot offer a prognosis on your horse the best I can do is reiterate my earlier statement that in general suspensory branch desmitis has a guarded prognosis for returning to eventing. Less strenuous endeavors have a better prognosis however.
DrO
Member:
Kstud

Posted on Tuesday, Sep 26, 2006 - 3:32 pm:

Hi, more problems with my 4yo., This evening when he was getting his 20 mins in hand walking he used some vague pretext to spook, rear clean up and managed to pull away from my husband. He galloped up our drive (hard core), galloped around the yard(concrete) did a few abrupt changes of direction then back down the drive then up again then saw the mares in a field and galloped through the lower yard (hard core) and jumped the gate (a good 5ft) and galloped around the field like an idiot for a good 10 minutes after that. We had to catch all the mares and bring them in before he eventually let us catch him. Of course the lead rope was trailing the whole time too. I must say that he appeared 100% sound the whole time but obviously this is a disaster as he is supposed to walk only for the next three months. I have cold hosed his leg for 20 mins and left it for 20 mins and then put an ice pack on. There is no heat or swelling at the moment but my question is, how much of a disaster could this be Dr 0. What are the chances that he will be ok? He was supposed to have another scan this Friday, should I bring it forward to tomorrow?
Catherine
Moderator:
DrO

Posted on Tuesday, Sep 26, 2006 - 6:22 pm:

I can only begin to guess Catherine. We will have to see how he looks in the morning and from that decide if the exam needs moving up. But on the other hand it is just diagnostic, I don't see why hurrying it up would make much difference.
DrO
Member:
Frances

Posted on Wednesday, Sep 27, 2006 - 9:12 am:

Heartfelt sympathy, Catherine - that is just so typically HORSE.

You never know, he might be right as rain - they will always surprise us one way or another.

Keeping my fingers crossed for you.
Member:
Kstud

Posted on Wednesday, Sep 27, 2006 - 3:02 pm:

Good news, (I think). Rebel is sound this morning! His two hind legs are up but his fron legs are fine, no swelling, maybe the teensiest bit of heat at the fetlock and is walking and turning 100% sound. He is so funny today because he is feeling quite sorry for himself and behaved really well when hosed and walked today. Did you see the picture of Cody, Angies horse that got impaled on the branch? Well he is Rebels twin, he is a white grey with a blue mane and tail too, are they all accident prone?
Catherine
Moderator:
DrO

Posted on Wednesday, Sep 27, 2006 - 6:01 pm:

That is excellent news Catherine.
DrO
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