Mare With Fractured Ischium

flower549

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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 level
 
No real knowledge but I would ask for a referral or at least a second opinion, several heads are better than one, I would also ask for a referral to a good physio, they may be able to offer some help. There are various non invasive therapies a physio may be able to use, ultrasound or laser being two mine uses to aid healing.
 
Sorry, UNlevel, 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.
 
Flower....am double posting what I wrote in competition riders as it is important that people just reading the thread here do not pick up any wrong messages.

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 (as suggested in Comp riders) 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.
 
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.
 
Hi i have a gelding whos just been diagnosed with this!! though a small fracture not shattered. His fracture is on the right but its the left hes not sound? His left side had dropped a bit (not so noticeable now!) and he isnt tracking up, Was supposed to be back at vets last week to decide treatment but the snow .In the meantime been told to box rest him until we go back for further examinations. Hes been having shockwave therapy which they are going to carry on with but other than that i think its quite rare and vets are a bit unsure. You say your mare is ok to box rest! that should help, mines like an absolute idiot sometimes and i think he may do himself more damage physically and mentally. Please let me know how you get on and what treatment they suggest!! Oh on our second visit to the vet physio put a Tense?sp machine on him and said if there was a fracture he would react violently to it, he stood there munching his hay no reaction at all??? so we didnt expect a fracture at all!!!
 
You cannot massage or ultrasound over the site of a fracture, it is a major contra indication. Likewise manipulation (why on earth you would want to for this injury anyway is beyond me) would be contraindicated. Once the fracture is healed you would then want to look into mobilisations and exercises.
 
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.

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.

Horses do not care if they compete or not. Any horse can be happy retired. There are plenty of ways to stimulate them if you feel they are bored. Clicker training for example. Whilst I hope that your mare returns to full soundness, please do not discount retiring her if she doesn't. I have yet to meet a horse that genuinely does not adapt to being retired if they are not just dumped in some field and forgotten about.
 
Twinkletoes, I am so sorry about your gelding and that you are finding the same lack of prognosis - recommended therapy during and post healing.

I am surprised your vets are using shockwave therapy for this injury, but I have seen it do amazing things for suspensory ligament problems, so why not?!

I hope it does something to help your boy.

My girl is good with box rest, but only with a lot of effort and common sense.

Cutting hard feed right down to prevent tying up and mental frustration, but feeding sufficient quantities to boost healing.

Adding a vitamin and mineral supplement if not already feeding.

Ad lib hay - soak it to remove goodness if you would normally have to limit it e.g. laminitis

Different forages - a bowl Readygrass, or apple chaff, etc. in each corner of his stable.

A nut ball (although my mare finds them too frustrating!)

Perhaps a stable mirror (unless he tries to kill it!)

A radio playing quiet classical music

Lots of fuss (unless he hates that)

Equestrian massage

Graze in hand for ten minutes am and pm, if you have a strip of grass near his stable (he might box walk more in frustration than the distance you walk him to and from the grass!)

If he has a particular friend, bring him / her to your horse's stable every day, so they can see /sniff each other (although caution is advised, as bosom buddies in the field can become trolls in a strange environment!

A salt lick

A mineral lick

Lickits

Stable toys (unless your boy hates them)

Just spend time with him (wrap up warm and read a book outside or inside his stable depending on how mental he's being that day.

Be careful not to spoil him, though, otherwise he may become too much of a little prince, who won't listen to you when the time (hopefully) comes to bring him back into work.

I am going to look into magnetic therapy and herbal therapy, mainly for her emotional state.

Like your boy, she's lost her normal life for now and that's very upsetting for a horse.

It is odd the way that one side of the pelvis drops. For my mare, it's on the same side as the fracture for your gelding, the opposite.

Does he have swelling away from the site of the fracture?

My mare has and it's the swollen, haematoma area that I intend to massage (with veterinary approval.)

It would-be far too sore to massage over the site of the fracture!

I will let you know anything that seems to help - although you know what horses are like - what's amazing for one equine is totally hopeless for another!
 
quite a few years back, my old mare suffered avulsion of the capsule joint. There weren't many vets in the UK that had any experience of it let alone knowledge. Luckily, when I was younger, John McEwen was my vet, so I made a call and he put me in touch with a vet in Colorado. If not for that vet, my mare would have been PTS.

So...if they do operate in America, I would be getting on the phone or starting an email conversation with a specialised vet over there and see if you can figure out a way for that vet and yours to communicate and share knowledge. I have never known any vet turn down a chance to either teach knowledge to another or learn from another, so it is always worth a try.

At least that way you and your vet will have some experienced advice behind you.

Good luck and I am sorry to you and the other poster that is also going through this. x
 
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)

Many thanks to everyone who has made suggestions so far.
 
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