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Fractures of the Stifle in Horses

By

Jane C. Boswell

, MA, VetMB, CertVA, CertES (Orth), DECVS, MRCVS, The Liphook Equine Hospital

Last full review/revision Sep 2015 | Content last modified Oct 2015

Fractures of the Patella

Fractures of the patella usually result from direct trauma, most commonly when a horse is kicked by another horse or hits a fixed obstacle while jumping. Prognosis depends on fracture conformation. Sagittal fractures of the medial pole of the patella are most common. These fractures are usually intra-articular and involve the attachment of the parapatellar fibrocartilage of the medial patellar ligament. Complete horizontal fractures are rare but considered serious injuries because of fragment distraction due to the massive pull of the extensor muscles. Complete sagittal fractures may be more amenable to internal fixation, because there is less distractive force.

Fracture of the patella usually results in marked lameness initially, with swelling and edema over the patella and effusion of the femoropatellar joint. In less severe or nonarticular fractures, lameness may improve within a few days. Diagnosis is confirmed by radiography. Standard radiographic projections of the stifle, together with a cranioproximal-craniodistal oblique projection of the patella, are used to determine fracture configuration.

Management options depend on fracture configuration. Horses with small, nondisplaced, nonarticular fractures may be treated conservatively with stable rest for 6–8 wk and have a good prognosis for return to athletic function. Articular fractures of the medial pole of the patella can be removed arthroscopically or via an arthrotomy and are also considered to have a good prognosis. Larger, mid-body sagittal or horizontal fractures require repair by internal fixation. These injuries carry a risk of catastrophic breakdown during anesthetic recovery but can have a favorable outcome.

Fractures of the Tibial Tuberosity

Fractures of the tibial tuberosity are not uncommon. There is little soft tissue covering this area, and fractures usually result from direct trauma. Fracture configuration may range from small fragments off the cranial proximal part of the tuberosity to large fractures of the whole of the tuberosity extending into the femorotibial joints. Fracture of the tibial tuberosity usually results in marked lameness initially with localized swelling and edema. Lameness will often improve within a few days. Diagnosis is confirmed by radiography.

Small and nondisplaced fractures may heal with conservative treatment. Stable rest for 6–8 wk is advised. During the first 2–3 wk, the horse should be prevented from lying down by tying or the use of slings to prevent fragment displacement. Larger intra-articular fractures should be repaired by internal fixation. Fractures generally have a good prognosis for return to athletic function if appropriately managed.

Fractures of the Femoral Condyles and Femoral Trochlear Ridges

Fracture of the femoral condyles is usually the result of direct trauma. Large, intra-articular, displaced fractures in adult horses are catastrophic and have a grave prognosis. However, traumatic fragmentation of the femoral condyles or trochlear ridges can also occur. Such injuries usually result in acute onset, moderate to severe lameness with joint effusion. Diagnosis is confirmed by radiography. Treatment involves surgical removal of the fracture fragments to prevent development of osteoarthritis. This is usually achieved arthroscopically but may require arthrotomy. The prognosis is usually considered to be good after surgery, so long as there is no significant concurrent soft-tissue damage.

OTHER TOPICS IN THIS CHAPTER

Lameness in Horses
Overview of Lameness in Horses
The Lameness Examination in Horses
Imaging Techniques in Equine Lameness
Arthroscopy in Equine Lameness
Regional Anesthesia in Equine Lameness
Disorders of the Foot in Horses
Osseous Cyst-like Lesions in the Distal Phalanx in Horses
Bruised Sole and Corns in Horses
Canker in Horses
Fracture of Navicular Bone in Horses
Fracture of Distal Phalanx in Horses
Keratoma in Horses
Laminitis in Horses
Navicular Disease in Horses
Pedal Osteitis in Horses
Puncture Wounds of the Foot in Horses
Pyramidal Disease in Horses
Quittor in Horses
Quarter Crack in Horses
Scratches in Horses
White Line Disease in Horses
Sheared Heels in Horses
Sidebone in Horses
Thrush in Horses
Disorders of the Pastern and Fetlock
Fractures of the First and Second Phalanx in Horses
Fractures of the Proximal Sesamoid Bones in Horses
Osteoarthritis of the Proximal Interphalangeal Joint in Horses
Palmar/Plantar Metacarpal/Metatarsal Nonadaptive Bone Remodeling in Horses
Sesamoiditis in Horses
Chronic Proliferative Synovitis in Horses
Digital Sheath Tenosynovitis in Horses
Disorders of the Metacarpus in Horses
Tendinitis in Horses
Suspensory Desmitis in Horses
Inferior Check Desmitis in Horses
Bucked Shins in Horses
Exostoses of the Second and Fourth Metacarpal Bones in Horses
Fractures of the Small Metacarpal (Splint) Bones in Horses
Fracture of the Third Metacarpal (Cannon) Bone in Horses
Disorders of the Carpus in Horses
Fracture of the Carpal Bones in Horses
Subchondral Bone Disease of the Third Carpal Bone in Horses
Tearing of the Medial Palmar Intercarpal Ligament in Horses
Osteoarthritis of the Carpus in Horses
Distal Radial Exostosis and Osteochondroma of the Distal Radius in Horses
Carpal Hygroma in Horses
Rupture of the Common Digital Extensor Tendon in Horses
Disorders of the Shoulder in Horses
Developmental Diseases of the Shoulder in Horses
Fractures of the Shoulder in Horses
Bicipital Bursitis in Horses
Infection of the Shoulder in Horses
Suprascapular Neuropathy in Horses
Osteoarthritis of the Shoulder in Horses
Disorders of the Elbow in Horses
Developmental Orthopedic Disease in the Elbow of Horses
Fractures of the Elbow in Horses
Osteoarthritis of the Elbow in Horses
Collateral Ligament Injury in the Elbow of Horses
Disorders of the Metatarsus in Horses
Bucked Shins/Dorsal Cortical Fractures of the Third Metatarsal Bone in Horses
Exostoses of the Metatarsal Bones in Horses
Diaphyseal Fracture of the Third Metatarsal Bone in Horses
Incomplete Longitudinal Fractures of the Plantar Aspect of the Third Metatarsal Bone in Horses
Focal Bone Reaction and Avulsion Fractures of the Third Metatarsal Bone in Horses
Fractures of the Second and Fourth Metatarsal Bones in Horses
Enostosis-like Lesions of the Third Metatarsal Bone in Horses
Disorders of the Tarsus in Horses
Failure of Ossification of the Distal Tarsal Bones in Horses
Osteoarthritis of the Distal Tarsal Joints in Horses
Osteoarthritis of the Talocalcaneal Joint in Horses
Osteoarthritis of the Tarsocrural Joint in Horses
Synovitis/Capsulitis of the Tarsocrural Joint in Horses
Osteochondrosis of the Tarsocrural Joint in Horses
Osteitis of the Calcaneus in Horses
Fractures of the Distal Tarsal Bones in Horses
Fracture of the Talus in Horses
Fracture of the Fibular Tarsal Bone (Calcaneus) in Horses
Fracture of the Lateral Malleolus of the Tibia in Horses
Tarsal Joint Luxation in Horses
Desmitis of the Collateral Ligaments of the Tarsus in Horses
Rupture of the Fibularis (Peroneus) Tertius in Horses
Stringhalt
Curb in Horses
Disorders of the Tarsal Sheath in Horses
False Thoroughpin in Horses
Luxation of the Superficial Digital Flexor Tendon from the Tuber Calcanei in Horses
Gastrocnemius Tendinitis in Horses
Calcaneal Bursitis in Horses
Capped Hock
Disorders of the Stifle in Horses
Osteochondrosis of the Stifle in Horses
Subchondral Cystic Lesions in Horses
Meniscus and Meniscal Ligament Injuries in Horses
Cranial and Caudal Cruciate Ligament Injuries in Horses
Collateral Ligament Injuries in Horses
Intermittent Upward Fixation of the Patella and Delayed Patella Release in Horses
Fragmentation of the Patella in Horses
Patellar Luxation in Horses
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