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Left ilial wing fracture
 Moderated by: DrDeb  
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CarlaP
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 Posted: Sun Aug 6th, 2017 08:00 pm
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My  26 year old off the track appendix horse sustained a L ilial wing fracture on 11/1/16.  In previous years, he had an adductor muscle injury on the left side, as well as significant abscesses from vaccinations on his right croup. We have been through stall rest and rehabilitation, as well as set backs.  By set backs, I mean that he will become unstable/weak in his hind end.  For example, he will lean to the right and his left leg will remain out to the side, then he will re-position it underneath himself.  Now (at liberty), if he walks a small circle to the left, his front will stop but his hind end will keep going and he will step under a couple of times with his left hind and will then stop. If he is facing the fence (when I bring him in and the gate is on his right, he will not turn and come to me, but rather side pass down.  My vet has suggested that his lumbar may have significant arthritis and that he may be having nerve issues, thus impacting him.  What are some options for him?  I do the Assisi Loop with him, and follow/apply other techniques that I believe are well known to this forum.  Any guidance would be greatly appreciated.  Sincerely, Carla

DrDeb
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 Posted: Sun Aug 6th, 2017 10:14 pm
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Carla, to every good thing there comes an end. Your horse is 26 years old; that is close to the maximum lifespan for any horse and over the average year of death for Thoroughbreds, who are not long-lived compared to say, Arabians or Lipizzans.

What your horse is doing is compensating -- in other words, he's doing his best just to stay alive. If he becomes so ataxic and/or unstable in the rear quarters that he cannot rise, he knows, and you  know too, that the day has arrived for you to have him humanely euthanatized.  It would be smart to start making your hauloff and burial plans now.

Fracture of the left ilial wing is otherwise known as "knocking down a hip". The tensor fasciae latae muscle originates on the point of hip, and is responsible for precisely timing the up-and-down motions of the patella. When horses knock down a hip, it is very difficult to stabilize the fracture because the TFL muscle will tend to cramp up continually, and thus continually pull the broken piece downward toward the stifle. This shortens the distance between the point of hip and the stifle joint, usually so much that after the fractured piece does glue itself back onto the main part of the pelvis (in a lower position than it originally had), no matter how forcefully the TFL contracts it cannot pull the patella up when it needs to. Pulling the patella up at the right time is what keeps the horse from locking the stifle. Part of the stuff your gelding is doing, the sidepassing for example, is a way for him to avoid having the patella get into the locked position. This is also why he abducts the leg on the affected side like a drunken sailor.

What you can do for this horse is -- love him and make him as comfortable as possible. Put him somewhere that other horses cannot chase or harass him, because they will; herd members that are no longer able to "keep up" quickly become pariahs, even unto their destruction. He is no longer able to lie down with any ease, if at all; therefore, he will not be getting a full night's sleep at any time, ever again; so part of what you're seeing is probably also narcolepsy due to inability to obtain REM time.

If you want to go to very great lengths (but then again, depending upon your farm setup, maybe this would not be too hard), put him in an old roundpen or small corral and bed that area very deep in shavings and/or straw, ramping it up against the walls. If the bedding is very deep, sometimes an old boy like this will go ahead and lie down -- he can't bend or squat normally, so he has to let his hindquarters "fall over" from quite a height, like the Dirty Old Man character on Laugh-In. What the extra-deep bedding does is let him fall over from a height without bruising himself up too bad. The privacy of a roundpen may also help him by giving him the confidence that it will be safe for him to go right flat out to sleep.

If you do provide this, keep a fairly close eye on him to make sure he is able to rise. If he has serious difficulty, you can string it out for a few weeks by going in there, haltering him, and you and a friend tug on his head and push on his butt and with this much help he may be able to get up. But we both know that can't go on too long.

Otherwise what you're doing is fine, just don't get too enthused about fixing him with any sort of therapy, because my dear, this horse is circling the drain and you need to recognize that fully. Don't make your efforts at making him well more of a pain to him than the problems he already has; make sure that the one you're primarily nursing is him and not yourself -- that is among the greatest of kindnesses. -- Dr. Deb



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