Equine orthopedic surgeon Dr. Lawrence R. Bramlage, DVM, of Rood & Riddle Equine Hospital, discusses the treatment and diagnosis of bone chips in ex-racehorse Thoroughbreds.
In the first of quarterly, health Q&As with the internationally renowned Kentucky veterinary practice, the award-winning surgeon, author of 66 referred articles and six book chapters, answers questions about the often highly treatable, common equine injury.
Among his many accomplishments, Dr. Bramlage has been a major contributor to horse medicine and horse-welfare organizations. He has chaired the Grayson-Jockey Club Research Foundation, the largest equine research funding organization in the United States, and has worked as a television consultant for the Breeders Cup and as the on-call vet for the Kentucky Derby.
In the following Q&A with Off-TrackThoroughbreds.com, Dr. Bramlage shares his insights on bone chips, and demonstrates bone-chip surgery in a You Tube video. Later this year, Rood & Riddle veterinarians will also discuss managing weight gain after the track, roarers, and Thoroughbred feet.
Q: What are some of the causes of bone chips in ex-racehorses?
A: Chip fractures in joints, sometimes called osteochondral fragments, are caused by accumulation of micro-damage that first weakens the bone before causing a fragment of bone to separate.
Though chip fractures can occur in any horse, the racehorse is the horse that most often develops a chip, due to the amount of high-speed exercise that can create the chip fractures.
It is not clear why some joints in the same horse will get a chip fracture, while other joints in the same horse show no problems.
Sometimes it can be explained by conformation, which can cause uneven loading of a joint surface, increasing the load and the damage in some areas.
In most instances the bone can respond to the exercise and strengthen itself to prevent chip fractures. In some instances the response is inadequate or too slow and the bone breaks off a small fragment that we see on the radiographs as a “chip fracture.”
Q: How is a bone chip diagnosed and rated in terms of severity, and how are they treated?
A: The presumptive diagnosis is made based on the clinical signs of lameness, increased joint fluid, and response to flexion/manipulation during the exam.
The diagnosis is confirmed by radiographs, which show the damage in the bone.
The degree of severity is a product of the size of the fragment, which is an indication of how much joint surface it damaged, and the location of the fragments— some areas of the joint are more important than others because they carry more weight per square millimeter than other areas.
The best treatment is almost always arthroscopic removal of the fragments. Very large fractures are re-attached with screws. If the chip fracture irritates the joint during exercise, irreversible (degenerative) arthritis and lameness will result.
Q: Does the presence of bone chips necessarily impede an ex-racehorse from becoming a sport horse?
A: It depends on where the fragment is located, how much joint surface is damaged, whether the fragment will do more damage during exercise, and what the hoped-for level of exercise will be.
In some locations such as the top joint of the knee, chip fractures can often be tolerated for all but the highest level of jumping.
In the lower joint of the knee, conversely, chip fractures are troublesome for all but the lightest of trail riding.
So, there is no rule of thumb to use, other than the higher the level of athletic activity the less tolerant the joint will be of any insult.
Your veterinarian is the best source of information on this question as there are many factors, some of which I listed, that need to be considered in this judgment.
9 responses to “Bone chips: a Q&A with Dr. Lawrence Bramlage”
Karleigh bykewich I have a comment my mare cherry banged her knee in the trailer on our way to a trail ride we thought nothing of it and I rode her hard everyday unless I felt heat in her knee that was three or four maybe fife years ago now she has had her ups and downs but it like when the e weather us bad and cherry stays still she stiffens up but when she moves like the minus forty weather we had here in Olds alberta canada she was with another mare and she was making this other mare run around cherry is the Dominant mare of the two cherry can turn left and right in small circles no problem but a bug circle clime a barrel cut I was barrel racing her before not competitively just doing a fast lope and the come from the third barrel home i have not ridden her lately with a saddle cut my cousin says it will hurt her one vet who came to look at cherry said she’s not that bad and tried giving her a steroid but it didn’t help I also asked my other cousin whines a vet about it but again he has not seen cherry I’ve only told him what has happened he said I don’t see why u can’t just breed her the way she is I would breed her but my cousin thinks it’s would be mean but anyway I was wondering u there was anything an body could tell me to help me I phoned Moore equine I Calgary Alberta canada and they said maybe that they could use remove the chip and let it grow back in on its own but I just want a second opinion.
hi I have a 5 yr old that has a bone chip below hock joint his leg has a huge swelling similar to a blood clot swelling but he is not lame and no restricted movement the vet said leave the chip n rest for 3 months what would you recommend please
I used to take a hose and wash down the knee of my trotting mare
worked at the racetrack we used to use all kinds of ways one was to rub sweat into the knee and cover it with plastid( not too tight
of course) another way was to paint the knee and cover it with a wrap so the circulation will increase it and thus heal it you can buy all kinds of leg paints depending on what the vet recommends
my 3 year old gelding came up with a small chip my question is whats best to do turn him out are blister him and stall him to keep him from running out and hurting him more
Found this interesting. I believe conformation has a lot to with chips, especially knees. My 13-year-old OTTB has very flat knees with cannons slightly offset to the outside. He chipped at 2 while racing, had the chip removed, and then chipped again in his last breeze before his first race back at 3. I bought him at 4.5 knowing about the chip (my vet said it was nondisplaced). I had no problems until he was 11, when all of a sudden he took a funny step and wouldn’t put the foot on the ground — I thought it was the abcess. It turned out to be the chip or maybe a new one – Tufts removed a smaller one and the original and smoothed out his joint. That was in 2009. We’re back to regular dressage work; I had planned to do some low-level eventing and start him over fences, but because of his history, but especially conformation, I’m sticking to logs on the trail! He’s also 17 hands, and with OTTBs the bigger they are and more they raced, the more soundness issues I’ve had.
Thank you Susan for the interesting article on bone chips. As you know, my having a 28 yr old OTTB mare, peeks my interest when there is information regarding the health and welfare of the horse. Also, with my own back problems and potential knee problems as well, it helps with the understanding of care and maintenance of me and my horse. I firmly believe in proper nutrition and exercise that coincides with their age, confirmation, etc. I am sorry to see that Kate experienced two truly bad happenings with her horses! As you say, they are so fragile. It is wonderful to see what is being accomplished now and this can only be better for the breed in the years to come.
I am so looking forward to you series. The up and coming article on maintaining weight will certainly prove very interesting. It has always been a problem that not only had my horse experienced but several other horses that I have known have had. Thank you again, Susan!
You are no doubt ready for vet school yourself, after seeing Deena through so many years of care. She is such a lucky mare to have an owner as dedicated as you. I was fascinated with the video on the surgery!
I like your point about trying to keep both horse and owner healthy.
I hope the series on horse health leads to other veterinarian participation! There’s so many topics related to horse health that are so interesting!
I have heard that there was a study done on racehorses – and no, unfortunately I don’t have a reference to cite – that indicated that horses with prior bone chips were significantly more likely to have a subsequent catastrophic fracture. The theory being that bone chips indicated a structural weakness in the bones – whether due to genetics, diet or training. This is of interest to me – I had a TB mare (not raced) who had a bone chip in her knee (she was sound and I bought her after the bone chip occurred) who within the next year (at age 10) suffered a catastrophic multiple slab fracture of the P1 bone while running in turnout – the bone basically disintegrated into 9 pieces. Her full sister (who was 8) subsequently suffered a catastrophic fracture of the shoulder. The vet theorized that something like osteopenia may have been involved – either due to genetics or diet. Since then I have strictly avoided buying any horse with prior chips. It would be interesting to learn what the current thinking is on this.
Thank you for writing in to describe your very sad experience with both your mare, and her sister. I would be very interested to learn more about that study, and will try to find it. But mostly, I am sorry for what you’ve experienced. It’s amazing that such majestic animals can be so fragile. I also see you have a blog too, so I will be sure to check that out. Thanks again for sharing your store here.