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Discussion on Incomplete ossification of tibial crests of 3 yr old gelding

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Kristi Albin
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Username: kristia

Post Number: 1
Registered: 3-2008
Posted on Saturday, Mar 29, 2008 - 12:04 am:   Edit PostPrint Post

I am new here, but have been lurking for 2 yrs. Finally decided to join. To quickly sum up my gelding's life, at 8 months he had colic surgery to remove 1/2 the cecum, chronic diarrhea until a year ago, liver disease twice, but normal now and I could go on and on.
Anyhow, I have finally received a diagnosis for his lameness over the last 2 yrs. He has delayed patella release in his left hind. We also discovered he has incomplete ossification of the tibial crests on both sides. We are giving him time off from training and letting him be a horse for a couple months, then will x-ray again to see if the void is filling with bone. His growth plates are still open in his knees as well. What I am wanting to know is, how common is the incomplete ossification and should I expect it to fill the void. Should I give him any particular supplement? He is currently on 10lbs Strategy, coastal hay and now being turned out on pasture. Any additional information would be great.
Left Tibia
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Kristi Albin
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Username: kristia

Post Number: 2
Registered: 3-2008
Posted on Monday, Mar 31, 2008 - 7:08 am:   Edit PostPrint Post

bump
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Robert N. Oglesby DVM
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Username: dro

Post Number: 20364
Registered: 1-1997
Posted on Monday, Mar 31, 2008 - 8:43 am:   Edit PostPrint Post

Welcome Kristi,
I had to wait until I got in the office this morning to review some anatomy texts to be sure I answer this one correctly.

Your above finding is not that abnormal assuming your horse is a young three. Though the tibial tuberosity fuses with the proximal epiphysis at 1 year of age it may not completely fuse to the metaphysis until 3 years of age. The radiolucent line in your radiograph represents this physis. I suspect these will ossify in the next year and the best help you can give it and your horse is to evaluate your current diet for adequacy as a balanced diet is your best assurance of proper growth. Which physis in the knees are not ossified yet?
DrO
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Kristi Albin
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Username: kristia

Post Number: 3
Registered: 3-2008
Posted on Monday, Mar 31, 2008 - 2:04 pm:   Edit PostPrint Post

Thanks DrO. I had a feeling this was quite a complicated issue and would require research. My horse is 38 months old. His has been quite compromised as a young horse and just started receiving a complete balanced diet at the age of 24 months. I expect this to be the cause of his late maturing. Both his knee and tibia growth plates are not fused yet. I do have x-rays of one knee if you would like for me to post.
To make sure we are on the same page, we are discussing the void of bone and not the growth plate? I am having a little trouble following your posts.

Here is an x-ray of a complete tibia crest and my horse(Merlot) on the right.
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Kristi Albin
New Member
Username: kristia

Post Number: 4
Registered: 3-2008
Posted on Monday, Mar 31, 2008 - 7:02 pm:   Edit PostPrint Post

I had a little bit of time to google what you were referencing and I think you and I are on the same page. If I understand correctly, by looking at the open growth plate it would indicate that the ossification of the tibia crest will take time as well. My other concern is that my horse has had intermittent patella release for 2 years now, only on the left side. I was wondering if void of bone would cause this, but he has this void on both sides.
I am also wondering if his colic surgery has anything to do with the patella release, because this didn't start until afterwards when we was well enough to go play with other horses. I had read in a message board that this could be the cause of not being able to extend the leg (falls short, but not back) at the walk.
Anyhow, enough for now.

Thanks.
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 20367
Registered: 1-1997
Posted on Tuesday, Apr 1, 2008 - 9:04 am:   Edit PostPrint Post

Kristi, how many months old is your horse exactly?

The "void" is a notch seen in growing horses and fills in from the growth plate where the tuberosity joins the bone. The irregularity of the bone lining the notch suggests it is still very active so yes, I would not judge this until the horse is skeletally mature.

Seems unlikely that the radiographic features of the tibia are related to the UF because, as you say, if this alone were the problem why not the other side? As to a relation with colic I think only to the degree that a horse may loose condition during recovery is it related to the UFP.
DrO
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Kristi Albin
New Member
Username: kristia

Post Number: 5
Registered: 3-2008
Posted on Tuesday, Apr 1, 2008 - 2:10 pm:   Edit PostPrint Post

On April 7, he will 38 months.

You have good news for me for now! I feel good about giving him the time to grow and mature. I will be having x-rays done in a couple of months to monitor the growth and I will update you.
Over the last month he is on the thin side again and seems to be growing taller. He is just under 15.1 and under 15.2 at the hip. His sire is 15 hands and his dam is 15.2. He is of western pleasure and hunt seat breeding.
Thanks for the clarification on the UF. It was worth asking. His lameness is visible at the walk. You can barely tell he is lame at the trot and can't see it at the lope, either direction. After a month of training, he started to show more lameness when we were slowing his trot down and then he started tripping on the front end, at least once during each training session. We are guessing that he is sore in both stifles and just can't hold his body up. He was having trouble holding his shoulders up and pivoting on his right (good) leg while practicing showmanship. I am thinking about added MSM to his diet.
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 20375
Registered: 1-1997
Posted on Wednesday, Apr 2, 2008 - 6:27 am:   Edit PostPrint Post

Kristi, this is the first time you mention your horse having a weight bearing lameness. Lameness is not a regular feature for mild intermittent fixation and if it is related to the fixation suggests more aggressive action needs to be taken to treat the UF. If the goal is to do everything possible for this horse's lameness I would recommend a thorough work up with the aim to get a better handle on the location and cause of the lameness and possible further treatment.
DrO
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Kristi Albin
Member
Username: kristia

Post Number: 6
Registered: 3-2008
Posted on Wednesday, Apr 2, 2008 - 7:36 am:   Edit PostPrint Post

DrO,
He has had the UF since he was a early yearling. I had two vets examine him at that time and both thought it was UF due to the muscle loss from the colic/diarrhea. He did seem to get somewhat better as he got stronger, but it was still there. Basically, I would describe his lameness as he walks short on the left and long on the right. At the trot and lope on a line, I couldn't even see the UF. Last year at this time, I started him under saddle, even though he had the UF. I rode him probably 10-15 times during his 2 yr old year, we had lots of rain and no indoor arena. As far as I could tell, he seemed to not have the UF while riding. I was quite surprised. So, the begining of his 3 yr old, this January, I took him to a trainer. He started out just fine until the second month when he started showing lameness under saddle. That was when we took him to a sports medicine vet and he found that Merlot's growth plates were still open. I brought him home and took him to another vet who diagnosed him with the UF from the flex tests. He wanted me to give my horse some rest, take him back in couple months to monitor the growth. He said to not worry about the UF right now, we could address this later, main thing was to make sure his growth plates were closing and the tibia crest voids to fill in. The UF options were injections or surgery to the ligament (4 small cuts to cause scarring, I think that is what he said). Am I right to wait to address the UF, or should I do it now? I don't know what all is involved with the recovery.
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 20381
Registered: 1-1997
Posted on Thursday, Apr 3, 2008 - 6:35 am:   Edit PostPrint Post

I am still confused Kristi, is the only symptom an unever walk? Let's ignore trying to put a diagosis on it for the moment: has any of the vets who have looked at your horse said your horse is weight bearing lame, particularly at the trot? If so is he still lame at the trot?

Let's move to the potential diagnosis of UFP, has your horse ever been stuck, even for just a second or two, in the typical stance of a fixated medial patellar ligament?
DrO
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Kristi Albin
Member
Username: kristia

Post Number: 7
Registered: 3-2008
Posted on Thursday, Apr 3, 2008 - 7:29 am:   Edit PostPrint Post

DrO,
I have been confused for the last 2 years. I have tried to ignore it, but now that he is showing the lameness under saddle under heavy work, I figure it was time to find the correct diagnosis. When he shows lameness at the trot under saddle, he looks sore to me and weak in the hip. I don't even know if the intermittent patella release is correct diagnosis, but I am assuming the last vet is correct. He has never locked up, just always an uneven walk, though the last vet was able to see the lameness during flex test and trotted off. His short stride on the left causes the fetlock joint to follow through late. Luckily, so far there is no damage to the joint from this. At the walk, he drags his toe, lifts his hip some, and then just short of the completed stride his leg stops motion, he steps down and then the fetlock joint falls down into place. He doesn't have stringhalt. Here are some links to him walking and some of me riding him. I could try and get a better video of him for you. Before I forget, there is one more thing about him that the vets, except one, don't think it has anything to do with this lameness. He has a scar that runs from the back of the buttocks to the inside of his thigh. He has had this since he was a week old.
Here is a picture of it:
http://i115.photobucket.com/albums/n290/kalbinhorse/PICT0022.jpg
Here are the video links. Let me know if you would like something better.
http://s115.photobucket.com/albums/n290/kalbinhorse/?action=view&current=1832b92 a.flv
http://s115.photobucket.com/albums/n290/kalbinhorse/?action=view&current=3efc4e8 a.flv
The two of me riding is last year when I started him under saddle, about the 10th ride. I don't have any of him at the trainer riding at the trot, just the lope. Let me know if I need to download them for you to view.
http://s115.photobucket.com/albums/n290/kalbinhorse/?action=view&current=29b9d93 1.pbr
http://s115.photobucket.com/albums/n290/kalbinhorse/?action=view&current=c7ee571 c.pbr

Kristi
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Elizabeth Kaufman
Member
Username: ekaufman

Post Number: 451
Registered: 3-2007
Posted on Thursday, Apr 3, 2008 - 9:50 am:   Edit PostPrint Post

Hi Kristi,

I've been lurking on this thread for a while. The videos are a bit dark for me to evaluate, and there are other factors (rider, uneven footing) that make these less than ideal for evaluating a stride.

This is a very young horse who is still growing, and clearly does not yet have his balance with a rider. If he is lame (and I can't tell that for sure from the video), then it would probably be a good plan to take him off work and get a qualified vet to do a full lameness evaluation (described in the articles).

Perhaps I'm a lousy trainer, but I find it normal that young horses take the occasional odd stride under saddle, and balancing a rider will often cause them to shorten their stride. If the horse or the rider is off balance, that short stride is going to be more prevalent on the "heavy" side.

It may well be that your guy is lame, but the videos (to me) don't show that well.

Good luck with him. He seems like a very nice guy.
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Kristi Albin
Member
Username: kristia

Post Number: 8
Registered: 3-2008
Posted on Thursday, Apr 3, 2008 - 7:20 pm:   Edit PostPrint Post

Elizabeth,
Reading your post, I feel that I am not able to describe the lameness he has very well. He short strides without a rider, but it is on a scale of 1/5. For those that don't know about it, don't see it as easily as I do. Though, sometimes I think I must be crazy. LOL. In the videos, I see even less of the lameness (if we should call it that), because the rider weight actually makes him complete the stride. When I sent him to training, he was just fine, until we asked him to work more using his back and hind end to elevate his shoulders (collecting) to slow him down. He looked sore and would basically limp on a scale of 2/5. He had trouble pivoting on the hind end as well, like he was weak. One vet thought he might have the beginning of the Wobbles. One other thing I did notice at the trainer's, he would start out sound free longing in the round pen, but after he lopes, he then starts short striding. All this without the rider.
The last vet I took him to is an expert on lameness. He also specializes in the performance horse.
Going back to my original post, right now my concern is his skeletal structure and then address the lameness. I was wanting Dr. O's opinion on if the void of bone would cause the lameness/short stride, as if the ligament was getting caught on the void or rubbing it and making him sore.
Do I make any sense as I feel like I am rambling on. This horse has been a difficult case from the get go. But I love him dearly and want to try as much as I can before I finally give up and find him a home. He is extremely talented, quiet, great personality and lovable. I have owned him since he was 4 months old. He is suppose to be my long time show horse and partner.

I appreciate everyone's help in this matter. I know it will be long process to treat him and help him become completely sound.

Kristi
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Elizabeth Kaufman
Member
Username: ekaufman

Post Number: 453
Registered: 3-2007
Posted on Thursday, Apr 3, 2008 - 7:50 pm:   Edit PostPrint Post

Hi Kristi,

Clear as mud!

Can you please post a copy of the lameness vet's diagnosis and recommendations? Maybe that will help.

My own vet here recommends against heavy training of horses when their knees, hocks etc. are still open. Even if that has nothing to do with your current concerns, it may contribute to the longevity of this horse if you let him grow up some before placing such demands on him. Weakness behind is typical of young horses without pathology. Remember that all horses travel on the forehand naturally. It typically takes months and years (not weeks and days) to get even an adult horse strong enough to transfer weight to the hind-end under saddle. Trainers sometimes feel pressure to finish young horses before the horses are ready to act finished.

But if you would post the results from the lameness exam, I bet we'd all be interested to see them!
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Kristi Albin
Member
Username: kristia

Post Number: 9
Registered: 3-2008
Posted on Friday, Apr 4, 2008 - 8:28 am:   Edit PostPrint Post

Elizabeth,
Here is the vet report on 3/21/08. I think the lameness he is experiencing under saddle is linked the to the lameness he has been experiencing for 2 years, not being under saddle.

Digital Radiology Stifle Series; left
Digital Radiology Stifle Series; right
Lameness exam : Grade 1 out of 5 lame left hind
baseline - stiffer gait and abducts limb with less
stifle flexion.
Will knuckle and buckle bilateral hind and will
intermittently catch patellar ligament.
Flexions:
Right hind fetlock and spavin - both negative.
Right stifle - 1--/3.
Left hind fetlock - negative.
Left spavin - 1-/3.
Left stifle - 1/3.
Dx : Bilateral delayed patellar release equaling
upwrd fixation of patella with left stifle
soreness in femoropatellar joint.
No definitive neuro signs.
Gave 1.5m1 Sedivet iv.
X-ray left stifle (3 views) : Still has open
tibial crest physis and incomplete ossification of
tibia crest with large void of bone in crest.
X-ray right stifle (1 view) : Has same findings -
incomplete ossification of tibial crest.
X-ray left carpus (1 view) : For maturity still
see open growth plate - later maturing for a 3
year old.
Treatment options:
1) Can allow to mature and re X-ray in 3
months.
2) Inject FP joint for soreness.
3) Tryr shockwave on incomplete ossification
of tibial crest.

Kristi
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 20406
Registered: 1-1997
Posted on Saturday, Apr 5, 2008 - 12:43 pm:   Edit PostPrint Post

Hello Kristi,
I have not forgot you, I am waiting to review the videos on a large screen high resolution monitor that I have in my office, it is much brighter than my notebook display, it may be monday before I can get to my office however.
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Kristi Albin
Member
Username: kristia

Post Number: 10
Registered: 3-2008
Posted on Saturday, Apr 5, 2008 - 1:33 pm:   Edit PostPrint Post

DrO,
High res would be better and maybe turn the brightness up. I forget that I have a brighter screen and I can see the videos good. I can also email you the videos that have a better quality, but you have to have Quicktime Player to view. It is a free download.
Did you get to read the actual vet report I put up for Elizabeth?
One question, is there a supplement I should give my horse to help for growth (bones). I plan to start him on MSM for now. I have him on 10 lbs Strategy, Coastal Hay, StrongidC 2x and he is now turned out to good pasture during the day.
Thanks,
Kristi
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Diane E.
Member
Username: scooter

Post Number: 1997
Registered: 9-2000
Posted on Saturday, Apr 5, 2008 - 9:15 pm:   Edit PostPrint Post

Hi I was just wondering if 10lbs of Strategy isn't alot. I have never used strategy, I know it's pelleted but that's about it. Is it more a vitamin type feed? or is it grain based? Just curious why he gets so much of it?
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Kristi Albin
Member
Username: kristia

Post Number: 11
Registered: 3-2008
Posted on Saturday, Apr 5, 2008 - 11:15 pm:   Edit PostPrint Post

Strategy is close to Safe N Sound or Safe Choice, or a 14% pelleted grain based feed. Recommended feeding is 1 to 1 1/2 % of body weight for young horses. He weighs 880 lbs. He gets 5 lbs twice daily. Yes, it is alot, but he needs as much calories as he can get.
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Kristi Albin
Member
Username: kristia

Post Number: 12
Registered: 3-2008
Posted on Sunday, Apr 6, 2008 - 12:48 am:   Edit PostPrint Post

DrO,
I spent some time reading your write up on UFP. I suspect (as does the vet) he has a mild case of it, especially since he didn't start this until the chronic diarrhea and colic surgery, cause of the massive weight loss at the age of 8 to 10 months. Here is a link to his recovery from Nov and Dec. You can see how thin he got.
http://www.hopescreekranch.com/sales/merlot/recovery.html
His yearling and 2 yr old year he was under weight. I have many more pictures as he was aging, but don't have them easily assessable, but I could put that together for you.
Also, I recall the vet stating that he has straight hind legs - conformationally. So, without the proper muscling and the conformation issues to work the stifle correctly, he has this problem. Is is possible that when he was at the trainer, his stifle would lock up and cause him to trip or go down on the front? His tripping seemed like as he was about to place the hoof down, he would not get the hoof out front and he would fall on this fetlock. I am sorry if I keep posting the same information. I am trying so hard to figure out what is wrong with him and how to help him. I still wonder if the scar tissue is an issue as well.

Kristi
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 20419
Registered: 1-1997
Posted on Monday, Apr 7, 2008 - 12:03 pm:   Edit PostPrint Post

OK Kristi,
I don't see the lameness in the videos so if we just consider the veterinarian's report and the age of the horse I agree that your best treatment at this time should be a period of rest and an attempt to increase his condition. If at that time he continues to have problems with upward fixation you can surgically treat it at that time. Before I injected the FP pouch I would want the lameness localized with IA anesthesia of the pouch.

Concerning feeding I would recommend you follow our regimen given in the Overview of Nutrition article. If gives a complete explanation of how to properly feed a horse. I don't think the MSM will be of much help but if the veterinarian feels this is a joint problem there is no problem with beginning a oral joint supplement. Check out Treatments and Medications for Horses » Anti-inflammatories (NSAID's, Steroids, Arthritis Rx) » Glucosamine, Chondroitin Sulfate, and their use in Arthritis.

Concerning some of the other questions they really are not possible for me to answer not having observed the events but a trip just prior to putting the foot down is not likely to be UF which occurs at the beginning of the anterior phase. I would suspect toe length.
DrO
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Kristi Albin
Member
Username: kristia

Post Number: 13
Registered: 3-2008
Posted on Monday, Apr 7, 2008 - 4:34 pm:   Edit PostPrint Post

Thank you DrO for looking into this for me. It has been quite an adventure with my horse.
I also want to thank you for the advise on the block before jumping into treatment. I would want to make sure I am doing the right thing.
I will look up your nutrition article. I am at a boarding facility right now and limited to choice of feed, but I will share with the BO.
I will rest him. Will do x-rays end of next month and will update on his growth.
You have been so kind to try to figure out what all is going on with him.
I will continue to lurk and I am sure I will have other questions for you.
Kristi
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 20422
Registered: 1-1997
Posted on Monday, Apr 7, 2008 - 10:11 pm:   Edit PostPrint Post

I will be interested in how the tuberosity calcifies in but cannot figure that it will be a likely cause of problems no matter what it does from here. Keep an open mind and realize a radiographic "variation" is not the same as a lameness. Justify treatment with accurate localization of the pain.
DrO
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