Clinical history A 21 year old horse used for jumping suffered an acute injury to the left hind limb making the horse unable to bear weight on the limb (5/5) - she was in a pasture with other horses at the time of injury. Multiple radiographs were made of the left hind limb including the stifle and tarsal joints. Radiographs made at the time of injury - use the position of the fibula to determine angulation of the x-ray beam Additional radiographs made at the time of injury Radiographic diagnosis
- A focal comminuted fracture was evident at the junction of the middle and distal thirds of the tibia medially and caudally
- Adjacent to the fractures was a minimal soft tissue swelling containing a suggestion of pockets of air
- Do you identify any additional injury on the enlargement of the distal tibia on the lateral view???
Multiple radiographs made 8 days later with the limb in a cast show the fracture site with loss of detail Lateral radiographs made on day 14 Final radiographic diagnosis
- The original injury was characterized by a focal comminuted fracture with the distally directed fissure fracture difficult to identify at the time of injury
- The fissure fracture was not identified on the studies made with the limb in a cast
- The fissure fracture was clearly evident with widening on the study at 2 weeks
- Note the periosteal response to the trauma cranially on the last study
Comments Visualization of the fissure fracture is dependent on the central x-ray beam being directed so it is parallel to the fracture line. Apparent increase in width of the fracture line later may be due to
- Widening of the fracture line as the result of early osteolysis expected with fracture healing
- A different position of the x-ray tube permitting the fissure to be seen more accurately
- The result of weight bearing representing extension of the fracture line and separation of the bony fragments - (most likely in this patient)
