Received: 17 April 2023 | Accepted: 11 January 2024


DOI: 10.1111/eve.13949_1 C A S E R E POR T


Conservative management of a fracture of the greater trochanter of the femur in an adult horse


Manon W. J. Peeters 1 | Andrew G. Wallace 2 | Matthew J. Chesworth 1 | Dagmar Berner 1 | Andrew R. Fiske- Jackson 1


1 Department of Clinical Science and Services, Equine Referral Hospital, Royal Veterinary College , University of London , Hatfield , UK 2 Buckingham Equine Vets , Buckingham Clinic , Wicken , UK


Correspondence: Manon W. J. Peeters Email: mpeeters@rvc.ac.uk


SUMMARY


An 8- year- old Warmblood cross mare was presented for further in- vestigation of an acute onset lameness of the right hindlimb. Three weeks prior to presentation, the horse was found markedly lame at walk following a fall during exercise. The horse was initially managed with 3 weeks of field rest, but the lameness persisted. On presenta- tion, at walk, a reduced cranial phase of the step was evident. When trotted, a grade 5/10 right hindlimb lameness was confirmed. Atrophy of the right gluteal musculature was evident, and palpation over the region of the right coxofemoral joint provoked a pain reaction. Nuclear scintigraphy revealed a diffuse area of increased radiopharmaceuti- cal uptake in the right femoral head, neck and greater trochanter. During radiography, a left 30° dorsal- right ventral oblique view and a cranio70°ventro30°medial- caudodorsolateral oblique view of the right coxofemoral joint were obtained (Figure 1). These identified a com- plete, slightly displaced fracture of the base of the greater trochanter


of the right femur. Ultrasound examination of the proximal femur demonstrated a discontinuation of the bone surface echo over the caudolateral bone surface of the greater trochanter, extending along its attachment to the femur; this was consistent with the radiological findings. The horse was managed conservatively on stable rest. After 5 months, re- examination found the horse to be sound at walk; how- ever, a grade 4/10 lameness at trot persisted. After a total of 9 months of rest, the horse was sound when trotted in a straight line on the hard surface. Follow- up two- and- a- half years after the initial incident found the horse to be sound and in its previous level of work.


K E YWORDS horse , conservative management , fracture , lameness , proximal limb


Key points


• This report suggests that complete, nonarticular, closed, mildly displaced fractures of the greater trochanter of the femur can be managed successfully with a prolonged pe- riod of complete box rest.


• In cases with adequate patient compliance, in- hand walk- ing exercises could be initiated once the horse is sound at walk; this will stimulate increased bone modelling and faster fracture healing.


FIGURE 1 Left 30°dorsal- right ventral oblique view of right coxofemoral joint, showing radiolucent line across greater trochanter base (black arrows).


• Prolonged periods of box rest should only be implemented when there is robust clinical indication to do so. Attention should be paid to environmental enrichment and social stimulation of the case.


This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2024 The Authors. Equine Veterinary Education published by John Wiley & Sons Ltd on behalf of EVJ Ltd.


Equine Vet Educ. 2024;36:341. aaep.org/wiley-redirect | 341

Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92