Monday, June 10, 2013

Broken Coffin Bone

Broken Extensor Process on the Coffin bone of the horse
We quickly fell in love with the wobbly little cutie, Cassandra, just a few days after she was born. Cassandra was your typical Friesian, pawing at buckets when they were empty saying “more food please” She was all legs and hair and absolutely stunning at every phase of her growing up. She was never unsound in the pasture playing with her best friend Aje. Well it came time to bring her in to saddle training. She loved the saddle and bridle and all the attention and was handling everything in perfect stride, except her stride was off. She was not unsound all the time she ranged from 1 to 3 out of 5 (5 being completely unsound) in her vet exams. It would come and go but never actually went away so it was time to investigate further with xrays.   

 It’s one thing to say “soundness” exam in writing but it’s much easier if you can see the horses movement before treatment. Here is a video of pre treatment Cassandra.
Video of Cassandra pre treatment
It was a sad day when we learned that our lovely long legged full papered beauty Cassandra had a broken extensor process. It was one of the worst prognosis we could have gotten. The extensor process is on the coffin bone in the horses hoof at the front of the hoof closest to the horses body. The reason this part of the coffin bone is so important is because the extensor ligament attaches there to swing the hoof forward in
the stride. So when Cassandra was reaching forward with her leg she was throwing her foot forward using her shoulder muscles, thus the irregular stride. It’s also a very unique “broken leg” for a horse because the hoof acts as a cast to hold the bone in place so they can continue to “walk” on the leg.  That also comes with it’s own faults in that any swelling is incased in the hoof and can  cause more pain. Photo taken June of 2010 showing the broken extensor process (left photo indicating 15.68mm chunk) the 6 is right over the chunk of bone.


Then it was time for the treatment discussion. Our options were: Surgery to remove the chunk of bone, reshape the hoof, treat her for arthritis, Shock therapy to promote bone growth or do nothing and let her live out her life as a brood mare. 

When we discussed the surgery option it came with benefits and risks as does any medical decision. Removing the bone would eliminate the risk of it smashing into the adjacent bones  that would eventually cause more arthritis. It would curb some of the risk of pinching other tissues in the gap in her bone. We were told that the location of the surgery being on the coronet band could cause permanent foot deformity.  As with any surgery it was also a risk of infection during and post surgery that could cause death. It was a big step and we were willing to invest the large sums of money into making her comfortable but there was no guarantee that she would be sound or comfortable post surgery. We needed to make sure that we didn’t just cut to cut.

One suggestion for instant “casting” of the broken bone was to reshape the hoof. We used the xrays taken to figure out what angle would be most ideal to cast the broken bone, but also not pinch her and cause more pain. That was an instant success. Within 1 week the vet saw such a noticeable improvement that he, being a surgeon, even suggested that we wait on surgery.  

It was a no brainer for us to start treating her for arthritis. It was inevitable that with or without surgery she was going to be very arthritic in that area of her foot. The anti inflammatory and lubricating agents for the joints could do no harm and could only offer some help. Arthritis treatment takes a while to get through the body and start working in the joints so we started that the same day we got the news.

Shock therapy to promote bone growth or was another option. Basically a machine sends sound waves at the injured portion of the bone causing the body to kick into repair mode. There is obviously more scientific basis for this type of treatment but it’s a relatively simple non invasive process so we were willing to look into it further. We were very intrigued by this therapy because it’s been used in animals and humans, bones regrowth, muscle therapy, tendon therapy, and even skin regeneration or burn repair and there were no side effects.  There is a lot of specific information behind it’s processes such as what wave length and what intensity and frequency is needed for what type of injury, but we were sold on the idea of no negative side effects, non invasive, and it was reasonably priced.
So we started the shock therapy on top of the joint medicine and hoof alignment. Now with me listing all three things that I did to help her you would say then how do you know which one worked, well The hoof alignment gave her instant relief, she went from a 3 to a 1, but that didn’t make fix the bone from being broken. The joint medicine could not have started working till after the shock treatment was completed and would not work as fast as the recovery we saw. Her protocol took 3 treatments with about 6 weeks in between treatments. We took xrays after the 2nd treatment and saw significant bone growth.

March 2011
May 2011

You can see here in the 2 photos that the gap between the 2 bones started to fill in with new bone growth. She was on a clear path to recovery. As of 1 year after the treatment she was still sound, not sound enough to pursue Grand Prix but healthy and sound enough to live pain free and even be ridden lightly. We were so impressed with the sound therapy unit that we purchased a home ultrasound therapy machine. It was not as powerful as the vet equipment so we would have needed more frequent treatments, but we were very happy that we purchased this unit. It came in handy when we had the filly with joint ill and needed hair to grow back. It was great when one of our mares pulled her flexor tendon in a rabbit hole and it is handy to have around for post chiropractic treatments to help the muscles recover.
Video of her post treatment 

One other treatment that we did not do at the time but would do if this occurs in any of our horses going forward is Magnets. You have to make sure that you have a deep penetrating magnet to get through the hoof wall and you have to make sure that you apply the north polarity side to the horse's hoof to get the desired healing affect. But it works like the ultrasound to stimulate self healing in the body. Magnets like the ultrasound have been  successfully used for tendons, bone and skin therapy. I personally like to use the Neodymium magnets because they are stronger/deeper penetrating per size of the magnet. Be careful with how long you use magnets because they are heat producers. You can alternate with cold therapy and magnets but don't alternate with heat and magnets. With or without surgery you can try using Magnet therapy to help ease arthritis and inflammation. Also check with your vet to see if any injections  or medications you are using are not suitable to be used with Magnets.

I have since had a few people contact me with the same issue with their Friesians. There is no medical research to suggest that it is genetic. But with the frequency and power that a Friesian paws at things they can injure themselves in this way very easily. It happens in other breeds, but because our main breed is Friesians our horses and situations will be Friesian based and the people who come to us for information tend to also have Friesians.

 Here are some photos of the other horse that had something similar.

They decided to do surgery because this bone fragment was fully disconnected and floating, thus causing more damage as it moved around. When I know more about the horses recover I will post information. This horse did recover from surgery but I don’t have any soundness or arthritis or hoof growth reports back yet.

This is a Mare. The x rays were taken when she was 6 years old.
She was shown at a Keuring as an adult scoring a Studbook 3p with this injury, no nerve blocks, no drugs per all rules. As Friesian people know unsoundness is not tolerated and judges would have excused her if any visible signs of unsoundess were there on the day so she was quite sound considering the x rays. Also it should be mentioned as long as the ground is flat the mare is sound but if the ground is lumpy or the mare runs around being silly she comes up with a limp.
There have been 9 more cases brought to me in Australia not all people shared x rays and not all people wanted information about their horses posted on the web page. The common thread is that people say the unsoundness is sporadic so people tended not to rush to get x rays for their horses. 
This is not to say that all mild or sporadic unsoundness are this problem, but it is just one more thing to consider.
 I have just found a new article about a research study done on the removal of the fragment. I am just going to post the article here incase someone is trying to make the decision to remove, or not remove a fragment in their horse.
 if the link does not work please e-mail me and I will e-mail you a pdf (I can't upload pdf's to the blog??)

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