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  Discussion on Swelling after fall getting frighteningly worse
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New Member:
Mmist

Posted on Saturday, Sep 23, 2006 - 11:24 am:

My horse had a very bad fall 2 weeks ago. He was sound immediately after, but a pocket of fluid filled in front of his stifle. I cold hosed it, and also cleaned up and applied topical antibiotics to a couple scrapes inside the leg. because he was comfortable and sound, let him graze. He was totally sound all day and the pocket of fluid unchanged, no heat, no other swelling, by that evening.

Next day the fluid pocket was much bigger and now included the inside of the upper part of his leg, plus he was extremely lame on it and not bearing much weight. No heat and he looked comfortable otherwise, appetite good. I gave him bute for 2 days and then banamine for 2 days, support boots during the day and standing wraps at night. His soundness improved over the next week, he was 100% weight bearing by day 5 and trotting with a slightly shortened stride. The pocket was now very large, but totally to the inside of his uper leg, and the bones of the stifle visible through the skin and showing no swelling or other problems.

In the meantime, though, the fluid bag seemed to be getting much bigger. Still cold and squishy -- swaying as he walked. At one point, the skin started to scurf a bit and crack open, but then it closed back up.

So I called the vet, who couldn't come out until Thursday, thinking she would want to drain it. The vet agreed that there probably wasn't a fracture since he at that point was completely weight-bearing, not in pain, and nearly sound. She also didn't think it was infected -- it is cold and doesn't show any signs of infection. She said it was edema probably from strained and sprained the tendons and ligaments, and she recommended not draining it. My options were 1) rest him for 2-3 months and he may end up with some cellulitis, but it would probably go down on its own. Or 2) hospitalize for full workup with x-rays, ultrasound, possible drainage and other intensive treatments.

The hospital, for a variety of reasons, is not a good option. Veterinary resources in this area are very limited, both in availability and skills. So I opted for home rest. He is older and was semi-retired anyway.

Anyway, that was Thursday. Now he appears to have rolled Thursday night and re-injured getting back up. He was very lame Friday morning, which I initially attributed to the very cold night stiffening up his injuries, but by Friday afternoon there was no improvement.

And this morning, the swelling is far worse, though still cold it now extends down his hock and inside his upper leg is literally pushing against his sheath. Plus the skin is getting white patches across it.

To top it off, his left hind also is showing some strain since Friday (just stocking up at this point).

I've put him back on banamine and put furacin sweat wraps on both back legs. I have a clue what the significance is of the change in his skin around this thing. There's at least a quart if not two of fluid in there.

Has anybody seen anything like this before? Any ideas or suggestions?
Member:
Hwood

Posted on Saturday, Sep 23, 2006 - 12:29 pm:

Hi, Mary, and welcome. Where are you located in Maine?

It sounds like you have done all good things to help your horse. It is too bad that he reinjured.

I had edema in a mare . . . not from injury, but from a badly given dosage (actually two tranqs and a 1/2 bottle of anesthetic) by a vet who injected the muscles rather than the vein . . . and my mare ended up with a grapefruit-sized swelling just below her chest . . . and all her muscles were DrOoping part way down her legs. I did hot, wet, compresses to the swelling, and a 1/2 inch, perfectly round hole opened up and drained the fluid . . . and healed leaving a round scar. I don't know if it would help to do that kind of compress . . . I know that the area in which your horse has the injury and swelling is almost impossible to wrap as was my mare's swelling.

I haven't checked the articles, but look to see if there is one dealing with edema from injury. I expect there is more info there. I will check, too, to see what I can find, and hopefully, other members and Dr. Oglesby will chime in for you today.
New Member:
Mmist

Posted on Saturday, Sep 23, 2006 - 9:21 pm:

Thank you Holly. I tried a warm compress this evening and he would have no part of it. It's very sensitive, although he tends to be very sensitive and touchy in that area even when not injured, so it's hard to tell if it's truly sore.

I've read up on edema and also hematoma and seroma. When the first bubble formed, I was thinking hematoma as it was in the first minutes after the injury. I've been guessing all along the the larger sack of fluid that evolved was serum, and having read up I'm now more certain that is it. I'm still uncertain why, with worsening over 10 days to nearly the size of a soccer ball the vet didn't drain it. She just said she'd read up and they just come back worse and talked about the risk of infection.

I am going to try to get a 2nd opinion as another, very knowledgeable, vet in the area who had lost his license due to personal problems has been re-instated.
Moderator:
DrO

Posted on Sunday, Sep 24, 2006 - 9:31 am:

Mary I have to wonder if there is not a tear to the joint capsule and this is joint fluid secreting under the skin, it would explain the continuing worsening of the condition. Every time there is a severe exacerbation of lameness I also wonder if infection has not finally taken hold. A thorough exam will be necessary to define this however including tapping to define the fluid and ultrasound to locate a tear if deemed necessary.
DrO
New Member:
Mmist

Posted on Sunday, Sep 24, 2006 - 3:05 pm:

Dr.O, thank you for your quick input. I'm going to call my vet again tomorrow to update and see if she will at least draw fluid. I'm still hopeful that it's not as drastic as you're wondering, although the reason I wrote in here is because I'm wondering too. The new injury does appear to be just plain edema -- like he wrenched his right hock and twisted his left fetlock trying to get up. I'm fairly certain that's how he re-injured as he never, ever rolls on his right side, but had shavings on both sides and his back Friday am.

When the 1st fluid pocket formed immediately after the fall, my thought was it was either a hematoma or leaking joint fluid. When I had the vet out, she discussed the possibility of joint fluid as well. She had antibiotics with her, as well as (on my advice) rompum and another strong sedative so she could examine and work on the injury. I sort of had been hoping she would at least syringe some fluid out so we could confirm what it was. She was fairly certain at that point at least that there was no infection.

As an update to his condition since the setback on Friday, this morning he was returned to full weight bearing and his ability to walk was the same as last night and is slowly improving as well. The swelling appears to have stabilized today, although I won't feel sure of that until tomorrow am. His newly injured left hind seems to respond best to cold hosing. The right rear is responding to the furacin sweat at least where I can wrap it.
New Member:
Mmist

Posted on Sunday, Sep 24, 2006 - 3:40 pm:

Sorry, I just want to add that also the right leg and all swellings continue to be normal temp, his appetite continues good and he was out grazing today before it started raining.
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