Lupin's Fracture

 
On 11th September 2016 Lupin was unfortunately the recipient of a kick from a cohabitee in the same paddock.  There was a noticeable graze on the inside of the forearm about 8cm above the knee.  There was some localised bruising and a moderate amount of pain when the area was palpated.  Of greater concern was the degree of lameness which was graded as 7/10 and coincided with the weight bearing phase of the stride.
A comprehensive set of x-rays were obtained the following morning which appeared normal.  The mare was given antibiotics and non-steroidal anti-inflammatories directly into the bloodstream on the day of the injury and continued orally for a further 20 days.  As a result of the lameness, strict box rest was advised, despite the x-rays appearing normal.
A further set of x-rays were obtained 10 days after the first set but once again no obvious abnormality was detected.  Normally at this stage roughening of the bone surface (periosteum) will have become evident at the site of injury, particularly in this area of a horse’s leg where there is little or no soft tissue ‘padding’ (i.e. muscle).  It would have been very tempting at this stage to allow Lupin to be released from stable confinement, as the lameness had improved (3/10).  However the mare remained in her stable but on 26th September 2016 the lameness suddenly deteriorated (7/10) and the injured area had now become sore to touch.  Local application of ice and the administration of antibiotics and anti-inflammatories improved the mare’s condition but it was decided that one further set of radiographs should be taken as the expected clinical improvement had not really materialised.  X-rays taken on 13th October now demonstrated a very obvious (worrying!) fracture line that was running distally towards the knee (approximately 10cm in length).
 

(12.9.16)


(22.9.16)


(13.10.16)

A poor prognosis was relayed to the owner as this type of fracture is indicative of a loss of structural strength in the radius and at any point in time could worsen and lead to a ‘complete break’.  Unfortunately there is no way of stabilising this type of fracture as surgery is associated with too many inherent risks and external support simply provides a cumbersome appendage attached to the leg.  The mare’s temperament was now the major factor on the outcome and although it is thought that lying down and getting up again increases the risk of ‘catastrophic’ trauma to the leg, cross tying (where the mare is ‘forced’ to remain standing) was deemed unwise because a) the mare had been ‘free’ in her stable for 4 weeks since the original injury and b) her owners felt she would object to this procedure.  So with many fingers crossed and plenty of care and support being provided by the staff on the yard, Lupin was told that she would have to endure another 12 weeks box rest and a follow up set of x-rays were booked for 23rd November. 
Remarkably these showed a dramatic improvement in the appearance of the fracture line.
 

(23.11.16)
 
A decision was made to commence daily hand walking for 2 sessions of 5 minutes having administered a small amount of sedalin to Lupin prior to her leaving her stable.  This was gradually increased over the next four weeks up to 20 minutes twice daily (unsedated) in hand.  Ridden exercise at walk commenced at the beginning of January 2017 (see photos) and a small pen was set up in a nearby paddock to enable Lupin to be turned out, albeit under sedation for the first four days.  This was followed by individual turnout in a small paddock (2-3 hours daily) which continued for 3 weeks and at the end of that period she commenced hacking out exercise (20-25 mins) for 4 days.
 
    

Recently (end of Feb) Lupin was re-introduced to her field companion in her usual paddock (4-5 hours daily) and so far so good. With all appendages crossed we are hoping this is a good indication that Lupin will return to her usual lifestyle in the near future.  It seems that Lupin has been a lucky girl, no doubt aided by her wonderful temperament, but then she probably knows we all adore her!