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Cool Case Friday: Hoof Vs Humerus

Hello! In today’s Cool Case Friday we meet a young dog who had an unfortunate tangle with a horse. Meet Delta (name changed for privacy). She was a spirited young female lab who lived on a farm with her mom and dad. They had a number of horses, and Delta loved to help out in the barn and in the fields.


One beautiful summer morning Delta and her dad were outside. Dad had saddled up one of the horses and Delta loved to trot along next to Dad and the horse while they rode around the property. Everything was going well until Delta got a little too close to the back side of the horse. This spooked the horse, whose natural reaction was to kick. Delta was in the wrong place at the wrong time.


Delta’s owner rushed back to the house, called the Animal Hospital, and we told him to bring her right in. On presentation, I could tell that her right front leg was where the point of impact was. But, not wanting to miss any other injuries that she may have sustained, I started with a complete physical exam. Her gums were nice and pink, with a good refill time - meaning that she shouldn’t be bleeding internally, or going into shock at this time. Her heart and lungs sounded good, so I was not suspicious of any chest injuries from this kick. As I checked her skin, other than an abrasion on her right front leg from the impact, no other injuries were seen.

As we then focused our energy on her right front leg, I noted that most of the swelling was at her humerus (the long bone from the shoulder to the elbow). She was very tender, and whimpered as I tried to move her leg forward and back. I asked her owner if we could take an x-ray, and he agreed, so off we went. Her injury is pretty obvious as you look at her picture. What do you see? Yes, the kick from this horse fractured her humerus.


Let’s talk about fractures for a moment. When we diagnose one, we need to be as descriptive in our diagnosis as possible. In Delta’s case she had a Closed, Complete, Right, Mid-diaphyseal Humeral fracture.
To break that down further: Closed (the skin was not open - we could not see the bone), Complete (the fracture goes all the way through the bone, separating it into two pieces), Right (it was her right front leg), Mid-diaphyseal (the middle portion of the bone along its length is called the diaphysis), Humeral (the bone that was fractured is called the Humerus) fracture. This descriptive diagnosis is necessary when referring a pet to a specialist.

And, that was our next step. Delta needed to see an Orthopedic specialist right away for surgical repair of this fracture. Time was of the essence. The sooner she was in surgery, the better her outcome would be. So, after an injection of pain medication, a soft padded bandage on her leg to stabilize the fracture, and a phone call to the specialist, off went Delta and her Dad for surgery.

You may be wondering: “Why couldn’t you just put a cast on her leg and allow her leg to heal?” Good question. Casts rarely work in dogs like they do in humans.
Courtesy: ResearchGate

This fracture wouldn’t have been a good candidate for a cast anyway with how far apart the pieces of bone were, but in a very rare case, a cast can work on animals. With any fracture, we need to be able to control 4 forces on them: Compression (pushing of the bone pieces against each other), Distraction (pulling of the bone pieces apart from each other), Rotational (spinning forces), and Bending (we need to keep the fractured parts in a perfect line for healing). The only force that a cast controls is Bending. And, we can’t REASON with animals that they need to stay perfectly still in a cast for 6-8 weeks for healing to occur.  While this picture is NOT of Delta, this is what her repair would have looked like.

Almost all fracture cases in animals require one of the following: a plate and screws, an intramedullary pin and cerclage wire, or an external fixator to name a few. These allow control of all of the forces placed on a fracture. Healing typically takes between 6-8 weeks, and pets are required to be strictly rested with minimal activity during this time frame.

Courtesy: University of Missouri

Delta had surgery that afternoon, and did very well. In her case, a plate and screws were placed above and below her fracture to bring the two pieces of the bone back together. She rested over the next few weeks and recovered very well. Hopefully she learned her lesson. Horses are great friends, but great friends from about 6 feet away!

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