Patient Information

This case study is kindly provided by Dr. Chris Bell, owner of Elders Equine Clinic, Manitoba. The case details a 12-year-old Quarter Horse gelding, imaged with Hallmarq’s Standing Equine MRI and Vision CT. With combination scanning using both modalities, a coffin bone fracture/fissure (type 2 fracture) and mild DDFT lesion in the medial lobe in the mid-pastern to about the top of the navicular bone margin was diagnosed.

Clinical History

The gelding has had a right front lameness, grade 3/5, for approximately 6 weeks. Blocks to abaxial with partial block to PD. Switches to left front lameness grade 1-2/5. Radiographs show navicular sclerosis, some distal margin surface irregularities, and vascular channel/synovial evaginations but no obvious issue on the bone/joint for the lameness. The referring clinician took X-rays.

Fig1: MPR image showing the intra-articular fissure fracture at the medial P3 bone with sclerosis and fracture bridging with callus in axial view.

Fig 2: MPR image showing the fissure fracture extending ventrally and abaxially into the P3 bone from the articular surface in the frontal/coronal view.

MRI Findings

Fig.4. T1W 3D pTRA MRI image of the fissure fracture and surrounding bone sclerosis at the fracture within the wing of P3.

MRI was initiated and, during the exam, something in the coffin bone and the tissues surrounding the wing of the coffin bone and DDFT was apparent. This prompted a call to the owner and the suggestion that the horse be moved straight to CT following MRI.

CT Findings

Fig 3 MPR 3-D reconstruction of the distal limb with the fracture identified with the green ball marker.

The fissure/fracture in the wing off the coffin bone was not appreciated or visible on the plain radiographs. However, it showed up clearly on the CT with MRI for supporting comparison of the extent of the fracture. The client appreciated the CT image of the fracture the best as a full 3D reconstruction was done on the premises and made available to her immediately.

“This was a very neat case. I’m glad the client decided to proceed to CT/MR, I don’t think we would have appreciated the extent of the fracture and soft tissue injuries without both modalities available.”
Dr. Chris Bell BSc, DVM, MVetSc, Board Certified Equine Surgeon (DACVS), Equine Surgery, Lameness and Sports Medicine, Elders Equine Veterinary Service

The Diagnosis

With combination scanning, a coffin bone fracture/fissure (type 2 fracture) and mild DDFT lesion in the medial lobe in the mid-pastern to about the top of the navicular bone margin was diagnosed.

The Recommendation

It was recommended to fit a bar shoe with quarter clips and float the medial heel with a recheck at 4 months. In addition, stall rest for 4-8 months depending on healing was advised. Recheck MRI or CT at 4-6 months. Prevequine 1 tablet once a day for 60 days. Ice the foot (optional) daily for 2 weeks.

A recheck MRI and CT will be performed to confirm fracture healing and whether consideration for surgical repair will be necessary.

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