Fractured Ischium

[flower549]

Also posted in Veterinary, then I thought that competion riders may have come across this sort of injury.

I would really appreciate some advice on care and prognosis from anyone with experience of a horse with a fractured Ischium (seat bone)

My otherwise fit and healthy 16.2 14 year old Thoroughbred mare was injured 3 weeks ago - cause unknown. (I am investigating...)

She had horrific swelling inside her left groin, left side of her udder, vulva, left buttock - the vet had never seen anything like it.

We treated the symptoms, so antibiotics and Danilon with walking in hand, but as soon as we took her off the pain killers, she started dragging her toe on her left hind in walk and was obviously miserable.

Back on the pain killers, then a scan on the outer aspect of her haunches - some 12 inches away from the original swelling -revealed a shattered left ischium.

Noone at my veterinary practice has any experience of this injury, or how to treat it, manage the horse, or the long term prognosis.

It appears to be an uncommon injury but not unknown, particularly in race horses.

From what I can ascertain in the UK we don't operate. In the U.S. they would.

All I can seem to find is that most horses are kept on box rest for 2-3 months, the majority are put to sleep and in racehorses only 10% return to racing.

That does not seem to be positive...

I can manage her mental health - I had her on box rest for 7 months when she was 4, but it's the management of this particular injury that I need help with.

The mare's pelvis has already dropped quite badly on the left side and there is some muscle wastage.

She is being walked 15 minutes twice a day, basically because we were doing this when we thought she was just bruised and were trying to reduce the swelling.

She is marching out happily and appears to be more than comfortable (rather too bright!) then stands quietly in her box, munching hay for the rest of the day, so that part is working well.

I am worried that if everything heals with the pelvis drooped, that it will affect stride length etc and at best she will be unlevel

 

[flower549]

, at worst lame and uncomfortable.

I am desperate to return her to full soundness if at all possible, as she was a talented girl, with beautiful dressage paces, a love of cross country and a fantastic jump of 1.4m+

This is not for me. The horse owes me nothing, but she loves competing (not with me, I am not brave enough!) so restoring her merely to "pasture soundness) is not going to be enough for her.

She is very bright and loves being the centre of attention, so being relegated to a field ornament will not be right for her.

What can I do to help her?

The veterinary advice I have been given is basically wait for 3 months and see how it turns out.

Obviously the fracture needs to heal, but has anyone else tried the following with this same injury:

1 Massage 2 McTimony 3 Magnets 4 Herbs - for healing and well-being. 5 Specific exercise e.g. polework etc.

It would be brilliant to know exactly what you tried e.g. massage for 20 minutes, manipulation of the hind limb, 20 minutes walking, etc.

Please let me know what worked - and what you wish you hadn't tried

It would also be good to know how good a recovery your horse made, or, God forbid, when you realised it wasn't in the horse's best interest to continue.

Please PM if that's easier.

I don't want her to suffer, but I know she's incredibly brave and resilient and loves life.

Right now she's desperate to be ridden (obviously out of the question for 3 months!) is in no pain and is full of mischief. I can't possibly consider putting her down when she's so bright and full of life, but I would like the best chance in helping to restore her soundness completely, if that's at all possible.

I am grateful for any help you can give.

 

[Leg_end]

I've not used it myself but the arc equine unit is getting rave review so may be worth getting in touch with them...

 

[Nic]

No experience of this, however Would it be possible for you/your vet to speak to a vet or owner in the states who has operated to perhaps give you a fuller picture?

I would worry about the injury being stable enough to allow manipulation.

 

[cundlegreen]

You want to get on top of the muscle wastage asap. I use a neuro muscle stimulator. These are easy to source on Ebay, as I recently bought a new one. You put electrodes on both ends of the muscle, and select the programme that you want. I brought back a young filly with the most horrendous shoulder wastage. Her shoulder blade was literally flapping about due to the muscles over the scapula had suddenly disappeared after a fall. It took several months but she came back as good as new.
Good luck with the fracture, I've never heard of that one.

 

[flower549]

Thank you for the responses.

I agree, everything must be done very gently until the fracture is stable. It's quite a bad one - the vet described it as "smashed" from the scans and my heart sank as I watched the images.

The Arc Equine Unit sounds brilliant. From other threads on here it's about £400, which is way beyond my pocket money. Perhaps the manufacturer operates a hire scheme. I will ask.

The neural simulator also sounds a possibility. I certainly can't just stand idly by for 3 months watching her muscles deteriorate to a point where exercise (once the fracture is completely healed) won't restore her symmetry, comfort and performance.

 

[cundlegreen]

Heres a link to the ebay page. http://www.ebay.co.uk/sch/i.html?_trksid=p5197.m570.l1313&_nkw=muscle+stimulator&_sacat=0&_from=R40
You need an EMS machine, mine does massages, tens and deep muscle stimulation. They are much cheaper than they used to be. You will also need a physio to show you where to attach the electrodes.

 

[flower549]

Thank you so much for the link.

The machine looks very interesting - and it's a bit more within my budget!

 

[gunnergundog]

You should NEVER NEVER use massage on a fracture site; it is one of the few conditions contra-indicated for massage.

Likewise, I would never use a muscle stim or similar in such a situation.

Can I suggest that your priority has to be the stabilisation of the injury; atrophied muscles can be dealt with (very effectively) later. PLEASE talk to your vet or a CHARTERED physio before attempting anything yourself or buying any equipment or you will do more harm than good.

I know that your intentions are good but inadvertently you could totally mess the rehab up.

 

[TarrSteps]

You should NEVER NEVER use massage on a fracture site; it is one of the few conditions contra-indicated for massage.

Likewise, I would never use a muscle stim or similar in such a situation.

Can I suggest that your priority has to be the stabilisation of the injury; atrophied muscles can be dealt with (very effectively) later. PLEASE talk to your vet or a CHARTERED physio before attempting anything yourself or buying any equipment or you will do more harm than good.

I know that your intentions are good but inadvertently you could totally mess the rehab up.

I would agree. If the site is not stable or attachments have been compromised you could end up with a bigger problem.


I have now experience with this injury but I did know a horse that severely fractured her pelvis, badly enough to need surgery. (Not the usual stress fractures you quite often see in race horses etc). I think success depends on how you define it . . .the owners worked very hard and got her looking pretty good, although still a bit dodgy in the canter. When time came for her to be backed though things were really not right. She was clearly uncomfortable doing any kind of significant work and it didn't do her mind any good. The owners took her home for their kid to hack around the farm (interesting choice, I felt) but I heard later even that did not go well and she was retired to the field. Sorry to be gloomy but I've met a few horses over the years who have been rehabbed from serious injuries to look almost perfect but they were not really able to work. Of course others come back, so it's worth trying, I guess.

 

[quizzie]

You should NEVER NEVER use massage on a fracture site; it is one of the few conditions contra-indicated for massage.

Likewise, I would never use a muscle stim or similar in such a situation.

Can I suggest that your priority has to be the stabilisation of the injury; atrophied muscles can be dealt with (very effectively) later. PLEASE talk to your vet or a CHARTERED physio before attempting anything yourself or buying any equipment or you will do more harm than good.

I know that your intentions are good but inadvertently you could totally mess the rehab up.

Would 100% agree with this, you need as much stability & lack of movement at the fracture site(s) as possible. Anything that encourages mobility of the region is totally wrong until there is good bone union & reasonable calcification.

However, I would try to talk to Ian at ARC equine.....look on the thread about it recently, there is mention of pelvic healing in an event rider, who was back competing within a few months. It cannot do any harm, & could assist the healing process.

 

[dressage_diva]

Not sure where in the UK you're based but have a look at the Equine Therapy Centre at Moulton College and all their spa/hydrotherapy facilities (including therapy livery). I did some work experience with them a while ago and we had a horse in which had fractured it's pelvis and the transformation when it started doing water treadmill therapy was incredible. It's a great to get the horse doing gentle exercise in a straight line to help with muscle build-up and we had horses there that were doing swimming/treadmill/spa work prior to starting turnout again and it was safer than trying to walk them in hand.

 

[gunnergundog]

Not sure where in the UK you're based but have a look at the Equine Therapy Centre at Moulton College and all their spa/hydrotherapy facilities (including therapy livery). I did some work experience with them a while ago and we had a horse in which had fractured it's pelvis and the transformation when it started doing water treadmill therapy was incredible. It's a great to get the horse doing gentle exercise in a straight line to help with muscle build-up and we had horses there that were doing swimming/treadmill/spa work prior to starting turnout again and it was safer than trying to walk them in hand.

OP......you may want to investigate something like this for much further down the line, but NOT now when your horse is only three weeks post-injury.

Talk to your vet and CHARTERED physio for suggestions as they are the only ones that have seen the x-rays and who can advise.

 

[dressage_diva]

OP......you may want to investigate something like this for much further down the line, but NOT now when your horse is only three weeks post-injury.

Talk to your vet and CHARTERED physio for suggestions as they are the only ones that have seen the x-rays and who can advise.

Ah didn't see the only 3-weeks post injury bit! Yes, definitely follow gunnergundog's advice and consider therapy later down the road. However, it's also worth considering somewhere like Moulton even before your horse is ready to start therapy as they have a veterinary practice on site and lots of links with qualified physios etc and they take horses for hospitaliation livery too I think.

 

[flower549]

Thank you for the advice, Gunnergundog. I have talked various options through with my vet.

You would probably have to be familiar with this specific injury and be able to see the damage to understand why we are concerned about the way this is currently healing.

This is why I posted to ask if anyone else on this forum has nursed a horse through this particular issue and if they had tried any of the options that we had discussed.

 

[cronkmooar]

Just a quick respose before going out and braving the weather.

Mine fractured the tubar ischium at 13/14 the end sort of points down to the floor now if that makes sense. Sacroiliac was damaged and unstable

All that was done was a long hard slog of 1 year box rest to get it to heal.

After it was healed I followed a rehab program of a vet I cold contacted in the US (lovely woman) who specialised in pelvic injuries and was doing new and exciting things. Sue Dyson insisted he would never be ridden again and to PTS

I might be able to find this if you would like - but you are a long way off needing it.

Horse is now 26 - retired last year - my choice not his!

He was never right again on a circle and I never tried jumping him - but on the plus side we hacked everywhere for another 10 years, had some great fun and he turned his hoof at in hand veteran showing which he was extremely successful at

Off to do horses now will be back later if you want more info

 

[flower549]

Thank you, Cronkmooar

(Interesting name!)

I would certainly be interested in the U.S. Rehab programme, if you could post or PM the details when you've thawed out!

The UK view seems to be PTS or only sound enough to potter around the field, which might be ok in certain circumstances, but which I don't think will suit this particular horse.

Our cousins across the pond seem to be far more pro active, both in operating on fractures and in developing rehab programmes post box rest or surgery.

I have also sent pleading emails to US thoroughbred rehabilitation centres that mention horses with this same injury. Hopefully they will share the information with me.

The reaction of Sue Dysons team is disappointing, given that they've written articles on lameness and have access to literally hundreds of case studies of Thoroughbred fracture injuries, where the animal's breeding for several generations, plus feeding, training history etc, so could rule out some of the factors which might influence recovery in other horses where less is known about their history and welfare.

What an opportunity lost!

It's weird, as most vets are all too eager to start a study, in order to collate and publish the results.

I can think of Stem Cell Therapy and Shock Wave Therapy for Suspensory Ligament programmes at the RVC at South Mimms, Herts.

I guess I was hoping that someone in the UK had taken part in a similar study for this injury, but my hopes are fading.

Perhaps we'll take some elements from the US programmes and pioneer our own successful therapy.

Ever the optimist....

 

[popsdosh]

Sometimes you need to be a realist im afraid. If Sue Dyson has advised PTS and not spend anymore money thats pretty telling im afraid!
Just be cautious of work in the States as they tend to be a bit more heroic should I say but not always in the animals interest!

 

[TarrSteps]

I'd say vets in general are more likely to operate here, actually BUT the point is valid. Almost all the big vet clinics in North America are connected to schools and function as teaching hospitals and, as such, are keen to do studies and push the boundaries, in part because it's a 'publish or perish' culture.

I'm sure you've read everything OP but from the bit I've done it seems outcome depends hugely on the original nature of the injury, not just what bit of the pelvis is broken. I'm also interested in the definition of 'success' - how many horses in the US studies return to full function?

 

[flower549]

Thanks for the replies.

Just to clarify, no one has recommended that this horse be PTS - thank goodness!

We have a big publishing culture in the UK vet schools too, it just seems not with this particular injury.

I am still hoping that someone on this forum has experienced this exact issue with a mare and can share their experience.

In the meantime, I will just do the best I can.

I left her last night, all snugly rugged up. Contentedly scoffing hay and carrots and watching, fascinated, as a tiny field mouse scampered round round her box.

You wouldn't know there was a thing wrong with her.

While she's comfortable and interactive, she deserves my support and ingenuity.

We could do with less ice though!

;-)

 

[MrsMozart]

Just a quick respose before going out and braving the weather.

Mine fractured the tubar ischium at 13/14 the end sort of points down to the floor now if that makes sense. Sacroiliac was damaged and unstable

All that was done was a long hard slog of 1 year box rest to get it to heal.

After it was healed I followed a rehab program of a vet I cold contacted in the US (lovely woman) who specialised in pelvic injuries and was doing new and exciting things. Sue Dyson insisted he would never be ridden again and to PTS

I might be able to find this if you would like - but you are a long way off needing it.

Horse is now 26 - retired last year - my choice not his!

He was never right again on a circle and I never tried jumping him - but on the plus side we hacked everywhere for another 10 years, had some great fun and he turned his hoof at in hand veteran showing which he was extremely successful at

Off to do horses now will be back later if you want more info

Cronkmooar - please pm me the US lady's details! I have a horse with a bony irregularities on her pelvis. I was told they could not operate as the pelvis is too deep, as in would have to be under anaesthetic for too long, this was a then otherwise healthy four year old DWB.

Sorry to hijack OP. I hope you find resolution.

 

[flower549]

Well, some 6 weeks on from the original injury, the mare is walking nicely, tracking up and generally not looking too bad.

She seems a lot less lop-sided and I am daring to hope that this might actually turn out well.

(Please note we had only continued to walk her 2-3 times a day with veterinary approval. We had started when we had no idea that she had fractured the ischium, but it seems to have been the best thing we could have done, rather than box rest)

Cronkmooar - I've not heard anything back from you, but this is a busy time of year, trying to look after the horses.

I wonder if rather than PMing me, you could list the recuperation regime that worked for your horse, as you will see from this thread that no-one else seems to have experienced this exact injury.

Many thanks to everyone who has made suggestions so far.

 

[cronkmooar]

Thank you, Cronkmooar

(Interesting name!)

I would certainly be interested in the U.S. Rehab programme, if you could post or PM the details when you've thawed out!

The UK view seems to be PTS or only sound enough to potter around the field, which might be ok in certain circumstances, but which I don't think will suit this particular horse.

Our cousins across the pond seem to be far more pro active, both in operating on fractures and in developing rehab programmes post box rest or surgery.

I have also sent pleading emails to US thoroughbred rehabilitation centres that mention horses with this same injury. Hopefully they will share the information with me.

The reaction of Sue Dysons team is disappointing, given that they've written articles on lameness and have access to literally hundreds of case studies of Thoroughbred fracture injuries, where the animal's breeding for several generations, plus feeding, training history etc, so could rule out some of the factors which might influence recovery in other horses where less is known about their history and welfare.

What an opportunity lost!

It's weird, as most vets are all too eager to start a study, in order to collate and publish the results.

I can think of Stem Cell Therapy and Shock Wave Therapy for Suspensory Ligament programmes at the RVC at South Mimms, Herts.

I guess I was hoping that someone in the UK had taken part in a similar study for this injury, but my hopes are fading.

Perhaps we'll take some elements from the US programmes and pioneer our own successful therapy.

Ever the optimist....

Hi

Only just seen this - did check for a bit then forgot about it.

Do you want to PM me your email address and I will try and dig out the US vet plan tomorrow.

Sue Dyson said my horse would never be ridden again and virtually demanded that he be PTS there and then - I am not a fan to be honest

 

[cronkmooar]

Cronkmooar - please pm me the US lady's details! I have a horse with a bony irregularities on her pelvis. I was told they could not operate as the pelvis is too deep, as in would have to be under anaesthetic for too long, this was a then otherwise healthy four year old DWB.

Sorry to hijack OP. I hope you find resolution.

Crikey - everyone is after the info - sorry to have been so slack on this thread

PM me your email address and I will forward the info

I am reluctant to post on here as it was a specific regime and I don't know if it would cause offense to the vet in question. She is a lovely lady and I owe her my horse to be honest

 

[flower549]

I quite understand.

PM sent.

Many thanks in advance for any ideas you may have.

 

[Marydoll]

Thank you for the responses.

I agree, everything must be done very gently until the fracture is stable. It's quite a bad one - the vet described it as "smashed" from the scans and my heart sank as I watched the images.

The Arc Equine Unit sounds brilliant. From other threads on here it's about £400, which is way beyond my pocket money. Perhaps the manufacturer operates a hire scheme. I will ask.

The neural simulator also sounds a possibility. I certainly can't just stand idly by for 3 months watching her muscles deteriorate to a point where exercise (once the fracture is completely healed) won't restore her symmetry, comfort and performance.

If your horse is insured for alternative therapies the insurance compant may pay or partly pay for the unit, its worth a try.