Apophyseal avulsion fracture of the greater trochanter of the femur in a Thoroughbred filly

Summary

The case report of a 14-month-old Thoroughbred filly with acute onset of severe right hindlimb lameness is presented. The horse had a severe and sudden abduction of the hindlimbs due to a side effect of an overdose of lidocaine, which had been administered in a constant rate infusion after a colic surgery. Transcutaneus ultrasonography and standing radiography of the pelvis revealed proximal and cranial displacement of the greater trochanter and free bone fragments consistent with an apophyseal avulsion fracture of the greater trochanter. The complete diagnosis was obtained with the horse in a standing position. The filly was euthanatized because of deterioration resulting from the colic condition and of the poor prognosis of the fracture of the greater trochanter. Postmortem evaluation confirmed an apophyseal avulsion fracture of the right greater trochanter. To the authors' knowledge, ultrasonographic and radiographic findings of this fracture have not been described in the standing horse. The diagnosis was reached quite easily with the horse in a normal standing position when the characteristic ultrasonographic and radiographic findings were detected.

Keywords

Horse - femur fracture - radiography - ultrasonography - lameness

• References

• 1 Geburek F, Rotting AK, Stadler PM. Comparison of the diagnostic value of ultrasonography and standing radiography for pelvic-femoral disorders in horses. Vet Surg 2009; 38: 310-317.
• 2 Goodrich LR, Werpy NM, Armentrout A. How to ultrasound the normal pelvis for aiding diagnosis of pelvic fractures using rectal and transcutaneous ultrasound examination. In: Proceeding of the 49th Annual Convention of the AAEP. 2003. November 21-25 New Orleans, Louisiana, USA: pg. 206.
• 3 Hunt DA, Snyder JR, Morgan JP. et al. Femoral capital physeal fractures in 25 foals. Vet Surg 1990; 19: 41-49.
• 4 Embertson RM, Bramlage LR, Gabel AA. Physeal fractures in the horse I. Classification and incidence. Vet Surg 1986; 15: 223-229.
• 5 Dyson SJ. Lameness associated with the pelvic region in sports horses. In: Proceedings of the Focus Meeting of the AAEP - Focus on Lameness and Imaging. 2007. August 1 Fort Collins; Colorado, USA: pg. 149-157.
• 6 Butler JA. The pelvis and femur. In: Butler JA, Colles CM, Dyson SJ. et al. editors. Clinical radiology of the Horse. Oxford: Wiley-Blackwell; 2010. pg. 573-601.
• 7 May SA, Patterson LJ, Peacock PJ. et al. Radiographic technique for the pelvis in the standing horse. Equine Vet J 1991; 23: 312-314.
• 8 Jeffcott LB. Radiographic examination of the equine vertebral column. Vet Rad 1979; 20: 135-138.
• 9 Little C, Hilbert B. Pelvic fractures in horses: 19 cases (1974-1984). J Am Vet Med Assoc 1987; 190: 1203-1206.
• 10 Hogan PM, Bernard WV, Howard BA. et al. What is your diagnosis? Osteomyelitis of the right tuber coxae. J Am Vet Med Assoc 1995; 207: 415-416.
• 11 Barrett EL, Talbot AM, Driver AJ. et al. A technique for pelvic radiography in the standing horse. Equine Vet J 2006; 38: 266-270.
• 12 Tomlison J, Sage A, Turner TA. Ultrasonographic examination of the normal and diseased equine pelvis. In: Proceedings of the 46th Annual Convention of the AAEP. 2000. November 26-29 San Antonio, Texas, USA: pg. 375-377.
• 13 Ringer SK, Kalchofner K, Boller J. et al. A clinical comparison of two anaesthetic protocols using lidocaine or medetomidine in horses. Vet Anaesth Analg 2007; 34: 257-268.
• 14 Murrel JC, White KL, Johnson CB. et al. Investigation of the EEG effects of intravenous lidocaine during halothane anaesthesia in ponies. Vet Anaesth Analg 2005; 32: 212-221.
• 15 Malone E, Ensink J, Turner T. et al. Intravenous continuous infusion of lidocaine for treatment of equine ileus. Vet Surg 2006; 35: 60-66.
• 16 Guschlbauer M, Feige K, Geburek F. et al. Effects of in vivo lidocaine administration at the time of ischemia and reperfusion on in vitrocontractility of equine jejunal smooth muscle. Am J Vet Res 2011; 72: 1449-1455.
• 17 Robertson SA, Sanchez LC, Merritt AM. et al. Effect of systemic lidocaine on visceral and somatic nociception in conscious horses. Equine Vet J 2005; 37: 122-127.
• 18 Cook VL, Shults JJ, McDowell MR. et al. Anti-inflammatory effects of intravenously administered lidocaine hydrochloride on ischemia-injured jejunum in horses. Am J Vet Res 2009; 70: 1259-1268.
• 19 Brianceau P, Chevalier H, Karas A. et al. Intravenous lidocaine and small-intestinal size, abdominal fluid, and outcome after colic surgery in horses. J Vet Int Med 2002; 16: 736-741.
• 20 Meyer GA, Lin HC, Hanson RR. et al. Effects of intravenous lidocaine overdose on cardiac electrical activity and blood pressure in the horse. Equine Vet J 2001; 33: 434-437.
• 21 Barone R. Osso della coscia-femore [Bone of the thigh - Femur]. In: Anatomia comparata dei mammiferi domestici [Comparative Anatomy of Domestic Animals]. Vol 1°- Osteologia Bologna: Edagricole - Edizioni Agricole della Calderini s.r.l.; 1995. pg. 584-607.
• 22 Barone R. Muscoli della cintura e dell'arto pelvici - Muscoli del bacino [Muscles of the pelvis and hindlimb - Muscles of the pelvis]. In: Anatomia comparata dei mammiferi domestici [Comparative Anatomy of Domestic Animals]. Vol 2°-Artrologia e Miologia Bologna: Edagricole - Edizioni Agricole della Calderini s.r.l.; 1995. pg. 701-709.
• 23 Barone R. Muscoli della cintura e dell'arto pelvici - Muscoli della coscia [Muscles of the pelvis and hindlimb - Muscles of the thigh]. In: Anatomia comparata dei mammiferi domestici [Comparative Anatomy of Domestic Animals]. Vol 2°-Artrologia e Miologia Bologna: Edagricole - Edizioni Agricole della Calderini s.r.l.; 1995. pg. 721-751.
• 24 Blikslager AT, Bristol DG. Avulsion of the origin of the peroneus tertius tendon a foal. J Am Vet Med Assoc 1994; 204: 1483-1485.
• 25 Holocombe SJ, Bertone AL. Avulsion fracture of the origin of the extensor digitorum longus muscle in a foal. J Am Vet Med Assoc 1994; 204: 1652-1654.
• 26 Newton CD, Nunamaker DM. Etiology, Classification, and Diagnosis of Fractures. In: Newton CD, Nunamaker DM. editors. Textbook of Small Animal Orthopaedics. International Veterinary Information Service; 2011. [cited on 2011 May 25] Available from: www.ivis.org.
• 27 Nixon AJ. Fractures of the Femur and Patella. In: Equine Fracture Repair. Philadelphia: W.B. Saunders Company; 1996. pg. 284-293.
• 28 Dyson SJ. Lumbosacral and Pelvic Injuries in Sports and Pleasure Horses. In: Ross MW, Dyson SJ. editors. Diagnosis and Management of Lameness in the Horse. St. Louis: Saunders; 2011. pg. 571-582.
• 29 Newton CD, Nunamaker DM. Fracture of the Femur. In: Textbook of Small Animal Orthopaedics. International Veterinary Information Service; 2011. [cited on 2011 May 25] Available from: www.ivis.org.
• 30 Van Metre DC, Callan RJ, Garry FB. Downer cows: assessment and prognosis. In: Proceedings of the North American Veterinary Conference. 2005. January 8-12 Orlando, Florida, USA: pg. 44-46.
• 31 Ogden JA. Femur. In: Skeletal Injury in the Child. New York: Springer-Verlag; 2000. pg. 857-928.
• 32 Wenger DR, Pring ME. Pelvis and Hip. In: Rang's Children's Fractures. Philadelphia: Lippincott, Williams & Wilkins; 2005. pg. 165-180.
• 33 Craig JG, Moed BR, Eyler WR. et al. Fractures of the greater trochanter: intertrochanteric extension shown by MR imaging. Skeletal Radiol 2000; 29: 572-576.
• 34 McConnell R, Eyres R, Nightingale J. Proximal femur injuries. In: Interpreting Trauma Radiographs. Oxford: Blackwell Publishing; 2005. pg. 187-191.
• 35 Werpy NM. Imaging of the Thoracolumbar Region and Spine. In: Proceedings of the Focus Meeting of the AAEP - Focus on Lameness and Imaging. 2007. August 1 Fort Collins; Colorado, USA: pg. 183-189.
• 36 Pilsword RE. Diagnosis and Management of Pelvic Fractures in the Thoroughbred Racehorse. In: Ross MW, Dyson SJ. editors. Diagnosis and Management of Lameness in the Horse. 2 ed. Philadelphia: Saunders; 2010. pg. 564-570.
• 37 Shepherd MC, Pilsword RE. The use of ultrasound in the diagnosis of pelvic fractures. Equine Vet Educ 1994; 6: 223-227.
• 38 Reef V. Musculoskeletal Ultrasonography. In: Equine Diagnostic Ultrasound. Philadelphia: WB Saunders Co; 1998. pg. 39-186.
• 39 Davenport-Goodall CL, Ross MW. Scintigraphic abnormalities on the pelvic region in horses examined because of lameness or poor performance: 128 cases (1993-2000). J Am Vet Med Assoc 2004; 224: 88-95.
• 40 Ross MW. Bone Scintigraphy: Lessons Learned From 5000 Horses. In: Proceedings of the 51st Annual Convention of the AAEP. 2005. Deccember 3-7 Seattle, Washington, USA: pg. 351.
• 41 Trump M, Kircher PR, Fürst A. The use of computed tomography in the diagnosis of pelvic fractures involving the acetabulum in two fillies. Vet Comp Orthop Traumatol 2001; 24: 68-71.
• 42 Embertson RM, Bramlage LR, Gabel AA. Physeal Fractures in the Horse II. Management and Outcome. Vet Surg 1986; 15: 230-236.
• 43 Jackson M, Kummer M, Auer J. et al. Treatment of type 2 and 4 olecranon fractures with locking compression plate osteosynthesis in horses: A prospective study (2002-2008). Vet Comp Orthop Traumatol 2011; 24: 57-61.
• 44 Gordon S, Moens NMM, Runcinam J. et al. The effect of the combination of locking screws and non-locking screws on the torsional properties of a locking-plate construct. Vet Comp Orthop Traumatol 2010; 23: 7-13.