Pelvic or Femur Fracture? Better Check for Both
During a presentation at the 2015 American Association of Equine Practitioner’s Convention, held Dec. 5-9 in Las Vegas, Georgette Shields, DVM, a resident at Colorado State University’s Veterinary Teaching Hospital, in Fort Collins, described “William,” who went in for a veterinary exam six weeks after he’d fallen due to lameness that failed to resolve. An earlier ultrasound of William’s pelvis and lumbosacral and sacroiliac joints of the spine had not revealed any abnormalities. However, a current nuclear scintigraphy exam (bone scan) showed radioactive marker uptake in a specific part of the upper hind limb—the third trochanter of the femur—indicating inflammation and injury.
The third trochanter is a bony protrusion on the femur located about halfway between the hip and the stifle, Shields explained. The area is difficult to radiograph due to the overlying large muscle mass. It’s more conducive to ultrasound exam, which in William’s case—once veterinarians at the referral hospital knew to look there based on the bone scan results—revealed a large fracture fragment where the gluteal muscle’s tendon and tensor fascia muscle insert. Because this protrusion doesn’t bear weight and is not involved with the stifle joint, a horse can still use the leg even though he’s quite lame.
Shields reviewed abnormal imaging findings of the femoral third trochanter, describing a case review of 20 horses examined at the University of California, Davis Veterinary Teaching Hospital, from December 2004 to June 2014. Veterinarians used ultrasound to diagnose 14 horses presenting with acute lameness due to third trochanter fractures. Ultrasound exam also showed focal fluid (blood or serum) accumulation, muscle tearing, and/or hemorrhage around the fracture site. The majority of the horses were Grade 3 (out of 5) lame, said Shields
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