What is your diagnosis? Severe soft tissue swelling over the brachium and antebrachium and an avulsion-type fracture of the olecranon.

The research article describes the treatment, recovery process, and prognosis of a 2-month old Quarter Horse, who suffered from severe lameness in the left forelimb due to an avulsion-type fracture of the olecranon, after suspected trauma.

Background and Initial Diagnosis

• The quarter horse was admitted for severe lameness over a three-day period, suspected to be a result of trauma given the presence of multiple abrasions.
• Before being referred, the horse was given stall rest and anti-inflammatory medication for three days without any improvement.
• At admission, the young horse displayed symptoms of severe lameness, reluctance to move the affected limb, swelling over the humerus and olecranon region, and pain upon palpation of the elbow. There were no abnormalities noted in the distal portion of the limb, carpus, or antebrachium.
• Through radiographic examination, an avulsion-type fracture of the lateral aspect of the proximal portion of the olecranon associated with the apophysis was diagnosed. Severe soft-tissue swelling was noted over the brachium and antebrachium.

Treatment and Recovery

• The horse was given consistent stall rest, a splint was used to support the fractured region, and medication of phenylbutazone (anti-inflammatory) and ranitidine (acid reducer) was administered.
• Over three weeks, the lameness showed slow improvement, however, it worsened again after 24 days. This prompted another radiography which highlighted new bone formation around the olecranon and a possible small displacement of the fracture fragment.
• Continued treatment saw the horse improve over the coming week and it was discharged from the hospital after a 31-day long admission. The owners were advised to continue with stall rest for an additional 35 days.
• Eight months post-admission, the horse showed complete recovery with no signs of lameness, and the prospects for future athletic function were deemed excellent.

Analysis and Conclusion

• The study highlighted the commonality of olecranon fractures in foals and discussed the different types of fracture structures.
• Physical examination and radiography were key tools in diagnosing both complete and non-displaced fractures, and the study underscored the importance of using comparison radiographs for diagnosing musculoskeletal diseases in horses.
• A complete fracture of the ulna would typically lead to a dropped elbow appearance due to loss of triceps tendon function, which was not the case in this instance. A complete fracture requires an open reduction and internal fixation to restore the triceps tendon function.
• A non-displaced fracture of the olecranon, harder to identify radiographically, was diagnosed in this case, evidenced by the fact that the bony fragment was not identifiable on the lateral view with certainty. Such fractures require careful analysis of both lateral and craniocaudal radiographic views.