How bad are bone splints, and what’s the appropriate treatment plan?
Has your horse ever “popped a splint”? Bone splints can range from a cosmetic blemish to serious lameness that requires surgery to correct. The horse develops a painful bony swelling that arises from inflammation of one of the two small bones (splint bones) on either side of the cannon bone below the knee and hock.
Causes and Prevention
Bone splints are common in young horses that are too active or over-lunged at an early age. The inflammation can be the result of blunt trauma from a kick or interference, and can also be caused by excessive strain from overwork or excessive activity, tight circles, or torque on the lower limb.
Mild bone splints involve damage to the ligament that holds the splint bone to the cannon bone. The result is mild or no lameness and a painful bony swelling. With more severe splints, especially when they arise from blunt trauma, the splint bone could be fractured, and lameness can range from mild to severe.
Bone splints can be prevented by using splint boots or polo wraps when working young horses, or for turnout if your horse is playful and active. It is also important to avoid overworking young horses (i.e., no riding until three years of age, and no high impact work until five years) and to limit tight circles and lunging.
Making a Diagnosis
To properly diagnose a splint, your veterinarian will lift up the horse’s lower leg and palpate the splint bones. If the bony swelling is associated with the splint bone, then a splint will be suspected. The veterinarian will check to see how much pain any pressure (palpation) on the swelling causes the horse, and if there is lameness present.
• If there is no pain on palpation and no lameness, then it is likely the splint has been there for some time and has already healed – it’s not an “active” splint. At this point, the splint is simply cosmetic and should not cause further problems. If you are certain the splint just came up and you think your horse is just being stoic about it, it doesn’t hurt to treat it like a mild splint. Otherwise, treatment is not indicated.
• Mild splints are commonly painful on palpation, but there will be no lameness. In this case, a basic treatment plan should be started and continued until there is no longer any pain on palpation.
• If there is lameness present, or the pain or swelling is more severe than your veterinarian usually sees with a mild splint, x-rays will be necessary to rule out a fractured splint bone. In most cases, bone splints are mild and x-rays are not necessary, but when in doubt, have the diagnostics done so you know what you’re dealing with and how to treat it.
4-Step Treatment Plan
The treatment of all active bone splints consists of cold therapy, wrapping, anti-inflammatories and rest. Cold therapy: Apply ice or cold hosing for at least 15 minutes twice a day.
1. Cold therapy: can be applied for one hour three to four times a day or more, if needed in more severe cases. Continue treatment until there is no more inflammation. It is important to note, however, that it is unlikely the bony swelling will ever resolve completely. To tell if the inflammation has resolved, monitor the swelling for heat and pain. It should not be getting bigger, and may even shrink a bit.
2. Wrapping: The limb should initially be wrapped with a pressure wrap (during the first one to two weeks), then support wraps can be applied (12 hours on, 12 hours off) to help minimize complications of long term wrapping. In severe cases, constant wrapping may need to be continued long term, so be sure to consult your veterinarian for an individual time frame. I have had good success with Back on Track products to help improve circulation and healing. Back on Track wraps or a sweat wrap can be used after the initial two to four weeks of anti-inflammatory treatment to help promote healing.
3. Anti-inflammatories: Most veterinarians will prescribe an NSAID such as Bute or Equioxx for bone splints. Depending on the severity, many cases respond well to herbal anti-inflammatories such as Equilite’s Ani-Motion, which contains devil’s claw, yucca, chamomile, white willow and rosehips, and NSAIDs can be avoided. In cases of moderate inflammation, I often recommend the topical NSAID Surpass in addition to an oral herbal formula; there are fewer side effects with topical NSAIDs. When lameness is present or inflammation is severe, it is best to use oral NSAIDs (Bute, etc.), as the long term benefits to your horse outweigh the risks. Topical DMSO treatment can also be very helpful for anti-inflammatory treatment and seems to give the best cosmetic results by reducing the size of the bony swelling.
Monitor for skin irritation, however, especially if the leg is wrapped, and discontinue use if irritation occurs. Otherwise, DMSO can be used for the first month – beyond that, it is unlikely to reduce the size of the bony swelling.
4. Rest: This is the most important part of splint treatment. Mild cases can take three to six weeks to heal, and more severe cases can take three to six months or longer. Basically, the horse should be rested until the splint has completely healed, then slowly returned to work once there is no lameness or pain on palpation of the splint. He should be hand walked during the rest period after the first two to four weeks. As with all injuries requiring rest, your horse’s emotional health must be taken into consideration. A horse that is stressed out, pacing and circling in the stall, and whinnying for his friends is not a horse on rest. In some cases, it is better for the horse to be turned out where he may trot once or twice across the pasture, but be generally calm and quiet, rather than have him separated from his buddies. Ideally, the horse would be stalled or in a small paddock with a buddy next door on the same schedule so that he remains calm and quiet. If there are no other options, using herbal or even chemical sedatives may be your only choice.
• A new treatment that has proven highly effective in acute injuries such as bone splints is SCENAR therapy. SCENAR is similar to acupuncture with E-stim (which would also be helpful for treating a splint), but it works through the biofeedback system to treat the problem with an electrical impulse. You can find out more about SCENAR therapy on our website (CedarbrookVet.com).
• A number of natural topical creams/salves can also be highly effective. I use Traumeel (a homeopathic cream with Arnica) for many acute injuries to help decrease bruising and inflammation. Topical SOD cream (free radical scavenger) can also help decrease pain and inflammation. Dynamite Wound Balm is another wonder salve that seems to help treat most wounds and injuries. Additional herbal treatments containing comfrey and calendula, or in case of fracture, a Chinese medicine herbal liniment such as Zheng Gu Shui (Setting Bone Liquid) can help accelerate healing.
• Local magnet treatment may also be useful after the acute inflammatory phase to help bring circulation to the area.
There are many things you can do to treat bone splints, so in most cases, have no fear – there will not be any lasting lameness or problem other than a cosmetic blemish. Splints are quite common, and if they are mild and no lameness is present, they often go unnoticed until your horse’s annual health check. If you find your horse has a splint, be sure to consult with your veterinarian to have the injury properly diagnosed. A treatment plan can then be tailored to your horse, depending on the diagnosis. I strongly recommend adding alternative therapies as they help decrease the time your horse has to be on rest, and can improve overall healing.
When is surgery needed?
In cases where the splint bone is fractured, surgery is necessary to remove the affected piece of bone. Without surgery, the bone will continue to irritate the surrounding ligaments and can lead to worsening lameness. There are always potential risks and complications with surgery, however, so if it can be avoided, that is ideal. If possible, I recommend trying alternative therapies prior to making a final decision on surgery.
Dr. Hannah Mueller is a 2004 graduate of Oregon State University, College of Veterinary Medicine. She strives to provide the best care possible for her patients and believes her unique holistic approach allows her to do so. Dr. Hannah has a solid foundation in sports medicine and lameness. This, along with her training in acupuncture, chiropractic, stretch exercises, massage techniques and other hands on healing modalities, allows her to rehabilitate horses to their fullest potential. CedarbrookVet.com