Pelvic Fractures

Q:My horse was sound when he was turned out one night, and the next morning he was lame in the hind end. It took quite a few diagnostics by my veterinarian before it was determined that he had suffered a slight pelvic fracture. How common is this and what is his prognosis?

A:Unlike in small animals, pelvic fractures in horses are much less common. A 1989 article in the Equine Veterinary Journal reported on the findings of a retrospective review of 100 horses with pelvic fractures. Some of the findings from that study are reviewed here.

Of the pelvic fractures reviewed in the study, 76% occurred in horses less than four years of age with 64% being in females and 36% being in colts or geldings. Of the 100 horses with pelvic fractures, 53 had a history of observed trauma. "A fall was noted in 43 cases and other traumatic injuries in 10 (such as striking a stall door or starting gate, becoming cast, dystocia, or an accident associated with transportation)." An additional 10 horses (eight Thoroughbreds) had histories of developing acute lameness during racing or training.

Clinical examination findings are generally variable and included asymmetry of the hind end, soft tissue swelling, external or rectal crepitation (crepitation is the "crunching" that can be felt or heard as fractured pieces of bone grate together), asymmetry of the pelvic canal determined by rectal examination, the presence of a hematoma in the pelvic canal as determined by palpation, the presence of unilateral hind leg lameness, and/or gluteal muscle atrophy.

Unilateral hind limb lameness was the most common clinical sign in the review, being present in 97% of the horses; soft tissue swelling was present 23% of the time--located in the area of the tuber coxal or in the stifle/upper thigh region.

A total of 50% of the horses in this study had either external crepitus or crepitus noted on rectal examination. This usually is observed by listening in the area of the hip/upper femur with a stethoscope while an assistant manipulates the leg or the horse is walked. Also while performing a rectal examination, crepitus may be felt or heard when the leg is manipulated, the pelvis rocked frdom side to side, or the horse walked while being examined.

Of the 100 horses reviewed, 63 were noted to have had a rectal examination performed---of those, 31 had a palpable swelling on rectal examination. There are several large arteries coursing through the pelvic area and increase the risk for large hematoma formation or even fatal hemorrhage. Of the horses reviewed, 3% died as a result of fatal hemorrhage.

With respect to specific location of the fractures in the aforementioned study, "the ilium was the most frequently involved bone comprising 63% of the cases in which fracture location was known." Other less common fracture sites included the tuber coxal, pubis, pubis and ilium, and pubis and ischium.

A potential concern is if the fracture involves the acetabulum (the cup-shaped "socket" part of the pelvis that joins with the femur to form the hip joint) due to the potential for chronic arthritis in the hip joint. It was shown in the study that "there was no statistically significant relationship between fracture location and long-term outcome." But, the researchers did demonstrate that horses without joint involvement were more likely to regain athletic function whereas those with joint involvement were more likely to be euthanized at the time of diagnosis or become breeding animals.

The only way to confirm the diagnosis is to obtain radiographs. As demonstrated by the researchers, the specific location of the fracture is not likely to change the overall outcome, but other fractures of the proximal (upper) part of the femur may present with a similar clinical picture and require a different course of action.

Successful surgical repair of a pelvic fracture has never been reported for the horse. The large muscle masses surrounding the pelvis and the numerous arteries, and nerves in the area, would make a surgical approach and reduction of a fracture very difficult. The only current treatment option is conservative management with stall confinement; the stall should have good footing and ample bedding. Stall confinement for up to four months is recommended. The use of non-steroidal, anti-inflammatory agents (e.g., phenylbutazone) for the control of pain and to reduce inflammation should be considered.

The study found that 77% of the horses went on to become breeding animals or returned to performance. In addition, they showed that there was no association with location of the fracture or severity of lameness at the time of diagnosis with outcome.

About the Author

Michael Ball, DVM

Michael A. Ball, DVM, completed an internship in medicine and surgery and an internship in anesthesia at the University of Georgia in 1994, a residency in internal medicine, and graduate work in pharmacology at Cornell University in 1997, and was on staff at Cornell before starting Early Winter Equine Medicine & Surgery located in Ithaca, N.Y. He is also an FEI veterinarian and works internationally with the United States Equestrian Team.

Ball authored Understanding The Equine Eye, Understanding Basic Horse Care, and Understanding Equine First Aid, published by Eclipse Press and available at or by calling 800/582-5604.

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