My horse fractured his knee and was misdiagnosed

If you have been following this blog, then you recall that, on February 13th, my 27 year old Paint colicked with a strangulated lipoma and needed emergency surgery. While he was at Tufts Veterinary Hospital for Large Animals, He was scoped and discovered to have ulcers. Upon returning home (9 days later, on Feb. 22nd), he was doing well. I had him on his ulcer meds for a month. I had to cordon off a portion of his paddock so he could still go outside and be with his friends. After the first month, I opened up his paddock to about 24 feet by 30 feet. This was to stay for another month. 

However, on March 8th, only 3 weeks out of surgery, I brought him in and a friend who boards at the same barn noticed that Kobeejo's right knee was swollen. I had not noticed, as he was not limping nor favoring the leg. He also had a bit of a fever. I called my vet, who came out to check. He spent more time checking his intestines and doing an ultra-sound on his gut. Nothing was wrong there. He deduced the knee issue was a bruise or hematoma, but did not do X-Rays. He gave him some banamine and told me to let him know in the morning how he was. He also instructed me to exercise him more, and to trot him over ground poles to get any stiffness out of the knee.

One thing I did notice was that my horse was no longer lying down to sleep, which was unusual since he was always lying down and sleeping soundly for an hour or more a day/night. Also, though his temperature went back to normal within a day or two, I didn't worry too much. Everyone seemed to be focussing more on his surgery than on his knee. While cleaning his feet, I did notice that if I lifted the leg too far, he would practically "sit" backwards; a sign of extreme pain.

I put a call in to the vet who was there the day he colicked. I figured another pair of eyes couldn't hurt. He didn't even do X-rays. He said to bend the leg just until it hurt a bit (right before he began to "sit back"), hold for 10 seconds then release. He said to do that a few times each day with exercise in between, and to warm the knee beforehand. I recalled when I broke my hand years ago, after the cast came off, the therapist would stick my hand in hot water to "loosen" it before bending my fingers to make them flexible again. I figured that was what he was going for. Kobeejo seemed ok when I bent his knee to clean his feet, even when I bent it a bit past its 50% flexibility. He really seemed to like when I stretched his leg forward and straight. I would hold onto his hoof with my fingers just under the shoe on either side so I could move them quickly if he decided to slam his foot down, which he never did. He simply placed a lot of pressure against my hands in a good leg stretch. Then I would set his leg down carefully.

On April 1st, my vet came back out and did a few x-rays, but said he only saw some bruising to the bone. He instructed me to keep the knee wrapped, using poultice, and continue with his exercise. 

By mid-May, I noticed him limping on his right hind. In the past, he has pulled muscles in that leg, so I assumed he had been running around the paddock and pulled another one. Again, my vet came out. He deduced he had pulled a groin muscle. More exercise. While he was there, I asked him to do a full scope of x-rays on the right knee. Nothing I had done had helped in the past two months and he still could not bend the knee more than 50% without pain. He still had not laid down to sleep (which made me worry about sleep deprivation, as everything I had read said that a horse can only go so long without REM (or paradoxical) sleep). He would roll on his left if put in the arena on soft sand. No trouble getting back up.

 Before he hurt his knee, he was big on rolling all the way over... several times. Now he stayed on the left side. He was also an "all-out-side" sleeper in his stall and paddock. Though he could roll on his left, he did not even try to get down to sleep. He'd have to bend his right knee and it hurt too much.

Anyway, my vet did full x-rays this time, in about 6 different angles. He and his assistant studied the x-rays, but because of Covid-19 social distancing, I couldn't walk over there and see what they were looking at. Finally, my vet turned to me and said he was going to send the x-rays to a "couple of his colleagues" to get their opinions on the x-rays. He said he would email me the x-rays and the results from his colleagues. 

The next day, I waited anxiously for the emails, but nothing came in. It dawned on me then that he had not asked me for my email address, so I texted it to him. The day after that I received 2 emails from him; one was copied text from the email he sent to his colleagues. The other their replies. Both said the "horse had at least one slab fracture to the intermediate carpal bone." 

So, now what? He emailed me the x-rays, but I had no idea what I was looking at. I texted him a lot of questions, so he ended up calling me so he could answer them. My main concern was his lack of lying down to sleep. He told me since Kobeejo was in really good condition, had gained back all the weight he lost in the hospital after surgery and did not seem tired, to not worry. Yeah, right! Worry is what I do best. He told me to keep poulticing the knee to draw out the heat. But that was about all the info I got before he had to return to the patient he was with at that time. 

I looked up YouTube videos on how to wrap a horse's knee, and any article I could find on fractured knees. I used electric ribbon to cut his paddock down to the size of a big stall so he could move around but not excessively. I worried about laminitis. I worried about blood flow. I worried about everything. And I still do.

To this day, I have not yet gotten much info on whether or not I should splint the leg to keep it immobile, and if so, how? I've been going on friend's advice, internet articles and videos. One thing I did learn was that horses can do fine without laying down to sleep. I have been worrying about sleep deprivation, but thus far he seems ok. His hind right leg seems to bother him more than his knee. Still, I want it to heal without any major stiffness or lameness, so I have been focussing my attention on proper wrapping. 

Tomorrow I plan to call Tufts, where he had his surgery, and doing a consult with an equine sports medicine vet. I can send them his x-rays to get an expert opinion. Tufts was amazing with Kobeejo when he had his surgery, so I trust them most of all. I will keep all informed on my findings.