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S P L I N T B O N E S
SPRING 2011 ISSUE
EQUINE MATTERS
8
If the fracture does not affect stability, is
non-infected, and is simple (the bone
fragments are relatively unified) then
treatment is generally conservative with
heavy supportive bandaging and a period
of enforced rest (12-14) weeks with regular
radiographic re-evaluations to assess the
quality of healing before embarking on a
controlled exercise programme following
conformation of satisfactory healing
figures 3, 4 and 5.)
Treatment of a non-infected
splint bone fracture
Figure 3: Mid body fracture following kick
Figure 4: Healing at 6 weeks
Figure 5: Healing at 12 weeks
Occasionally, despite appropriate rest and
support the healed fracture callus may still
result in a callus which irritates the suspensory
ligament causing a mild lameness. Surgical
debridement of the callus may be necessary,
although injection of local anti-inflammatories
may suffice.
Where the fracture is thought to be secondary
to internal forces, treatment may be either
conservative or surgical, with many advocating
rest to allow the often concomitant ligamentous
damage to resolve; if however the fractured
fragment is avulsed or demonstrating poor
quality healing then surgical ostectomy is again
advocated with removal of the bottom piece of
bone, along with torn ligaments and rounding
of the remaining portion. Occasionally,
involvement of the splint, suspensory ligament
and the proximal sesamoid bones is seen
(often called the three S’s) and all three need to
be evaluated before the appropriate treatment
and prognosis is decided upon and given.
Periodically, trauma may result in infection
and/or discharge either through introduction
of bacteria or through sequestration (bone
fragment death). In such cases antibiotics
and flushing are advisable although surgical
debridement of the wound or removal of the
distal fragment and bony pieces may be
necessary irrespective of the site of the fracture
(figure 6 and 7).
Figure 6: Unstable mid body fracture
Figure 7: Intra-operative radiograph
following resection
THE PROGNOSIS
In the vast majority of cases the
prognosis for return to previous work
is good, irrespective of whether the
treatment employed has been surgical
or conservative. The overriding factor
affecting prognosis is whether or not
the suspensory ligament is damaged
highlighting that ultrasonographic
evaluation of the suspensory early
on in diagnosis and treatment is
advisable as well as regular lameness
evaluations during the recovery course
(3 - 6 months). This may elicit an earlier
surgical interference, indicate the
need for adjunctive therapies such
as extracorporeal shock wave therapy
or steroid injections, or simply alter
a prognosis and the client/patient
expectations.