Rehabilitation after pelvic fracture in a horse - a case report

Pelvic fractures can be divided into fractures of the pelvic brim (coxal tuber, ischial tuberosity, sacral tuberosity, ramus of ischium) and the pelvic ring (body of ilium and ischium, wing of ilium, acetabulum, pubis). Due to the anatomical circumstances it is difficult to confirm a correct diagnose of a pelvic bone fracture. Clinical examination can be indicative regarding the localisation of the fractures. But for accurate diagnosis it is necessary to perform diagnostic procedures, such as ultrasound, radiography and scintigraphy. A surgical therapy, like an osteosynthesis, is not possible. The only option is a conservative treatment. Usually the prognosis of pelvic bone fractures depends on its localisation. Pelvic edge fractures seem to have a better prognosis compared to pelvic ring fractures. Permanent lameness and long-term pain are the most common problems. Moreover, the use for breeding could be excluded by a decreased birth canal due to callus formation. Another possible complication is an abdominal bleeding caused by laceration of the internal iliac artery. A twelve-year-old warmblood was referred at depart-ment for horses, University of Leipzig, for an acute and severe lameness of the left hind limb after slipping in the washing station. Up to this day the mare was used in international show jumping up to advanced level. On admission, the degree of lameness was 5/5 on the left hind limb. Remarkable limitation of the adduction of the left hind limb at the walk could be observed. Crepitus and a pelvic asymmetry were also noticeable. Ultrasonographic and radiographic examinations showed a fracture of the body of the ischium. Because of the restricted adduction and severe atrophy of the adductor muscles, obturator nerve damage was suspected. According to the phases of rehabilitation, two different harnesses were customized to support the mare in the stall and to keep her from laying and falling down. A Helicopter-Net was used for emergency care and during the exercise program towards the end. The installation of this net is easy and quick. The disadvantages are both a higher risk of pressure lesions and its rather limited movements inside the stall. A Swinglifter was the main supporting aid for the mare over 4 months of stall rest. This harness allows the horse to move inside the stall. The paddings attached to the Swinglifter protect the horse from pressure wounds. High acquisition costs and the difficult installation are adverse points. The slowly increasing exercise program started after 4 months of strict stall rest. To keep the horse from falling down while walking outside the stall, a customized walking frame was developed. The exercise program included a few steps of walk and was extended within 3 months up to 20 minutes of walk and a few steps of trot twice a day. Additionally, rehabilitation including physical therapy, electrotherapy and chiropractic, was performed. Over a period of the initial 1.5 months the mare was treated with NSAIDs. The horse was discharged after 7 months. At this point the fracture was completely healed. A slight hyper-metria during walking and severe adductor muscle atrophy of the left hind limb could be observed. 18 months after trauma, the mare is ridden in all three gaits and jumping small fences. According to the rather restricted athletic use they decided to breed the mare the following year after the insult. This case illustrates the possible successful treatment of a pelvic bone fracture in an adult horse with the appropriate equipment, like a Helicopter-Net, a Swinglifter and a customized walking frame. After intense rehabilitation, it is feasible to use the horse for breeding and riding. However, it is important to evaluate the expectation of the owners regarding type and intensity of future usage. Even if the only possible option is the conservative therapy the owners have to be aware of high costs and a long-term rehabilitation. Moreover, it is not an option if the horse does not show cooperative behaviour. Despite the positive outcome of the presented case, a satisfactory result cannot be guaranteed.