Fractures

Leg Breaks and Bone Fractures

It is important to note that any and all bone breaks/fractures in horses require immediate veterinary attention! Until recent times it was generally considered that a horse must be euthanized if it breaks a leg. The good news is that not all bone breaks mean a death sentence for your equine. Situations and therapies vary with different horses and different kinds of breaks. Yet there is a lot to consider when your horse comes up with an injury such as a fracture or leg break.

Usually a horse will become obviously lame when a bone is broken. Therefore the first sign of a fracture is generally a non-weight bearing lameness, yet there are many other possible injuries and reasons for your horse coming up lame The first thing to rule out is the most common cause of severe lameness in horses, the foot abscess. With foot abscesses the foot is frequently warm and the pulse to the foot is increased. Start at the hoof and work your way up the limb applying pressure every several inches around the limb to check for other sites of pain, heat or swelling. The horse should be confined and a veterinarian called immediately to help differentiate the two. Sometimes with fracture of major long bones the diagnosis is unfortunately very easy due to instability of the leg. With some fractures the goal will be returning a horse to full athletic soundness. In other instances you are attempting to save their life for pasture soundness.

Which ones are good and which ones are bad can be very surprising and should be evaluated by someone specializing in fracture repair. The cost associated for repair of many fractures can vary tremendously depending on the duration of hospitalization, number of implants (plates and screws etc.), type of surgery needed etc Page | 1

Fractures

Types of Fracture
The following is a summary of different types of fractures and important terminology: - Hairline Fracture: Usually evident by mild lameness. The bone is cracked in the outer layer only the fragments do not separate because the line of break is so fine. The tissue surrounding the crack is minimal. Hairline fractures can be difficult to diagnose, the advent of portable digital x-ray has helped but in some cases nuclear scintigraphy may be required to obtain a proper diagnosis. Hairline fractures can become dangerous when not recognized and continued work/trauma may cause further or catastrophic damage to the area. - Simple Fracture / Closed Fracture: Only one fracture line in one bone with no displaced bone pieces which causes little or no damage to the surrounding soft tissues. This type of fracture does not form an open wound in the skin. - Incomplete Fracture: A shallow break in the bone that does not extend through the full transverse width of a bone and which does not entirely destroy the continuity of the bone. - Compound / Open Fracture: A fracture in which a wound through the adjacent or overlying soft tissue communicates with the outside of the body; this must be considered a surgical emergency as the bone has broken through the skin and has introduced risk of bad infection. The compounding may come from within (by a bone protruding through the skin) or from without (e.g., by a bullet wound communicating with the bone).. - Comminuted Fracture: Two or more bones are broken, splintered or crushed, with three or more fragments - Bone Chip / Avulsion fracture: Separation of a small fragment of bone cortex at the site of attachment of a ligament or tendon. A bone chip fracture involves the presence of an isolated bone fracture and is usually called avulsion fracture. It can be the cause of several painful conditions, including Osteochondritis, which can be found in the joints of immature, fast growing horses. Bone chip fractures occur after sever sprains, when a fragment of the bone is broken off. The severity of the fracture can vary depending on the location and if there is any tissue holding the chip in place, they are common in the knees of racing horses but are also seen in fetlocks and the pedal bones in the front legs and hocks in the rear. Page | 2

Fractures - Greenstick fracture: One in which one side of a bone is broken, the other being bent. - Pathologic fracture: One due to weakening of the bone structure by pathologic processes, such as neoplasia (tumour), osteomalacia (softening of the bone), or osteomyelitis (inflammation). - Spiral fracture: one in which the bone has been twisted apart. - Longitudinal fracture: one extending along the length of the bone. - Oblique fracture: One in which the break extends in an oblique direction - Transverse fracture: One at right angles to the axis of the bone. - Impacted fracture: A fracture in which one fragment is firmly driven into the other A break can also be a combination of different kinds of fractures. For example, a horse may have a compound/comminuted fracture (a very devastating kind of break). Obviously the less intense the damage the more chance of successful recovery. Where the broken bone is located and its function is a large factor in recovery process. It isn't a black and white case when a horse fractures a bone. There are many factors to consider when assessing the situation.
These images show the shattered fetlock of Barbaro before and after surgery

If A Horse Breaks a Bone Should It Be Euthanized? Usually a horse will become obviously lame when a bone is broken. The outcome depends on many factors that vary from case to case. Many horses obtain simple or hairline fractures and recover with rest and proper care. Others have complications, or have much more serious injuries. Miracles do occur and horses that should have succumbed to a serious break have come back with flying colours. Other times a mild break causes bad complications. Horses are prone to devastating leg breaks because of their weight and power. Think of a piece of chalk. If you were to push it down with weight and force it would crush into itself and crumble. It is a similar situation with a horses leg bone. An injury like this is often seen on the racetrack and usually results in euthanasia. Yet not all fractures happen this way nor do they all result in death. The biggest challenge facing equine surgeons with regards to fracture repair is the fact that horses for the most part need to remain weight bearing on all 4 limbs. This is true even in the case of a fracture. If a person has a serious fracture of a limb, we are generally confined to bed rest for long periods of time and then transitioned to a wheel chair or crutches and possibly a walking cast if all goes well.
Above a fractured long pastern bone before and after surgical repair

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Fractures Horses need to be able to put weight on a fractured limb immediately after surgery. Add in the fact that most equine patients weigh well over 500 kg and are fight or flight animals and the challenges become obvious. Most fractures even in large horses could be repaired but the opposite (good) leg needs to be able to bear weight. If the good leg supports too much of the horses body weight for too long a period of time, the support structures of that leg start to break down frequently leading to laminitis. This is why it is better to have a fracture of the hind limb than of the forelimb. Forelimbs must also support the weight of the head and neck. Laminitis of the good leg is called support limb laminitis or "contralateral limb laminitis" and represents one of the most serious forms of the disease
A horse in a rehabilitation sling

Body weight is the primary reason that fractures in foals and ponies tend to carry a much more favourable prognosis than full sized horses. In general, most fractures in foals less than approximately 250 kgs are candidates for repair. As body weight increases, the biggest determining factor for prognosis becomes the bone involved. In general, full sized horses with a fracture below the knee or hock may be candidates for surgical repair. Fractures above the knee or hock in full sized horses carry a poor prognosis unless the bones are not displaced at all. X-rays are generally needed to provide an accurate prognosis. Other factors include where in the bone the fracture occurred (i.e. how close to the middle), whether or not the fracture extends into a joint, the number of pieces involved, and whether or not the skin over the fracture is intact (a closed fracture) or has penetrated the skin (an open fracture). It is amazing what the veterinary surgeons can do nowadays. They can plate and screw bones together. They can fuse joints. There is even an equine external fixation device so the horse can support its whole weight while recovering. If you want it fixed the veterinarians will usually try. But at what cost? And that doesnt just simply mean finances. A number of things must be considered for the welfare of the horse.
Left an external fixation device and right A horse with an external fixation device fitted

A major hurdle with horses is that a fracture that extends into a joint area will almost certainly plague the horse with a lifetime of arthritis (which may be crippling in itself even when the break is healed). Consider the following factors: Page | 4

Fractures Severity, Location and Probable Outcome: Many people have been unfortunate enough to witness an equine accident where the results are so devastating and painful that the only kind thing to do is euthanize. Generally cases like this are obvious when seen. In open comminuted/compound fractures only about 10% of horses survive. Yet there are many cases where the outcome and recovery looks positive. Many breaks in the foot can be corrected with plates, screws and proper shoeing. A broken scapula can often be healed with three to six months of stall rest. However, a broken humerus (or other large bones) is considered life threatening. These are things that need to be discussed with the vet. Is the probably outcome acceptable to you? Would it be acceptable to your horse? Quality of Life During and After Recovery: One must consider the toll recovery will take on the horse. Youngsters do much better with surgery and recovery (often because they weigh much less). Stall rest can prove to be difficult or impossible depending on the personality of the horse. You can keep a horse in a stall but that doesn't mean they won't or can't move. How would your horse cope if it had to be held in a sling? Some horses will be all right being poked, prodded, going under the knife and locked up. Others will fight and want to run. One must think about how their particular horse can deal with recovery and life after recovery. Be realistic with what that horse will be able to do once healed. Be aware of possible arthritis problems, laminitis, recurring infections, and recurring injuries. Broken bones can often mean the end of a horse's athletic career. Will the torture of the whole ordeal outweigh the possibility of healing and recovery? How will the animal's quality of life be after healing is completed? This varies with different horses in different situations and needs to be considered realistically. Economics: As sad as it seems this factor must be considered realistically. A simple fracture can put the owner back thousands of dollars. Any drugs for equines are astronomical because of their weight. How much can you realistically spend on vet bills? When dealing with such a situation one must consult with their vet and discuss the severity of the break, personality of the horse, the realistic outcome and cost. While serious injuries such as broken bones can be devastating to both the horse and owner it is important to do what would be best for the horse. Even if this is a very hard decision your horse will thank you and you'll live forever with the fact that you did the very best you could for your beloved equine. Prevention of Bone Breaks and Safe Riding While you cannot always prevent accidents you can do your best to make the situation as safe for you and your horse as possible. *Do not push your horse past what it can physically handle. Many western performance horses, dressage, hunter/jumpers, and especially racehorses come up with fractures because they are pushed too hard too soon (often on bad ground).

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