Equis ISSN 2398-2977

Tibia: fracture - physeal

Contributor(s): Prof Gary M Baxter, Chris Whitton

Introduction

  • Relatively common physeal injury in foals.
  • Cause: internal stress - lateral to medial bending; external trauma - mare standing on distal limb, direct kick   →   usually Salter-Harris Type II fracture.
  • Signs: acute lameness   Musculoskeletal: gait evaluation  ; no disruption of overlying skin; minimal associated soft tissue swelling.
  • Diagnosis: radiography   Hindlimb: radiography  .
  • Treatment: confinement; internal fixation.

Pathogenesis

Etiology

  • Foal attempts to stand with upper limb trapped.
  • Mare stands on distal limb.
  • Direct trauma to physis.

Pathophysiology

  • Lateral to medial bending   →   fracture line opens on medial side   →   tracks laterally then deviates through the metaphysis to create a lateral metaphyseal fragment.
  • Lateral to medial bending   →   fracture line opens on medial side   →   tracks laterally then deviates through the metaphysis to create a triangular fragment attached to lateral physis and epiphysis.
  • Fracture line courses through proliferating chondrocytes in physis   →   continued weightbearing   →   physeal cartilage damage   →   premature physeal closure.
  • This is a more significant problem in older foals.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • O'Sullivan C B & Lumsden J M (2003)Stress fractures of the tibia and humerus in Thoroughbred racehorses: 99 cases (1992-2000).JAVMA222(4), 491-498 PubMed.
  • Ramzan P H, Newton J R, Shepherd M C, Head M J (2003)The application of a scintigraphic grading system to equine tibial stress fractures: 42 cases.Equine Vet J35(4), 382-388 PubMed.
  • Tapprest J, Audigie F, Radier Cet al(2003)Magnetic resonance imaging for the diagnosis of stress fractures in a horse.Vet Radiol Ultrasound44(4), 438-442 PubMed.

Other sources of information

  • Nixon A J (2003) EdEquine Fracture Repair. ISBN: 0721667546. W B Saunders. Philadelphia.


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