From Veterinary Practice News
By David W. Ramey, DVM
"The size, strength and unpredictable nature of the horse makes accidents almost inevitable. While many horses escape from harrowing situations with relatively minor injuries, sometimes the damage is life- or career-threatening.
Before treating or referring any equine fracture in a field setting, the attending veterinarian must have a good idea of the pluses and minuses of treatment and have frank discussions with the client about the cost of care and potential outcomes. Here are some factors to consider:
1.What kind of fracture is is?
Not all fractures have the same considerations, of course. A fracture inside the hoof capsule is quite different than a compound long-bone fracture. Some fractures have a fairly good prognosis for a complete recovery, while other fracture repairs can result in horses that, while not athletically sound, are comfortable and able to live good lives.
Unfortunately, some fractures pose insurmountable problems, especially limb fractures that occur at exercise. A horse is pretty much built to the limits of its mechanical tolerance. With its muscular body and relatively thin legs, a horse can't be much bigger than it is.
As such, when a horse is running, turning, jumping, pivoting or otherwise exercising, it's putting stresses on its limbs that are up to the maximum of what can be tolerated. When those stresses exceed tolerance, an explosion - almost literally - erupts in the leg.
Under those circumstances, there's little left to fix. Bone not only fractures into pieces, but blood vessels can tear, tendons rupture and ligaments shear off the bone.
Even when repairs of such injuries are successful, secondary complications, such as supporting limb laminitis ultimately can be insurmountable, as was the case with Barbaro, the 2006 Kentucky Derby winner.
2.Where's the break?
A crack in the middle of a long bone might heal during rest. On the other hand, a crack that's into a joint can lead to chronic osteoarthritis. If the joint is relatively low motion, such as the pastern, fracture repair may be possible, but surgical arthrodesis might be required. However, arthrodesis is much more difficult for the horse to tolerate if the metacarpophalangeal joint is involved.
The more proximal the fractures, the more difficult is a successful repair. Upper limb fracture repairs are extremely difficult to repair for several reasons. Adequate surgical access is incredibly challenging and requires damaging excessive amounts of normal tissue to get adequate visualization of the surgical site for stabilization.
The forces placed on the implants in the upper limbs are almost unimaginable. The horse's leg muscle strength can distract the repaired tissues, and forces placed on an implant can bend it easily. In addition, adequate stabilization of upper limb fractures is essentially impossible.
3. How bad is the fracture?
In general, the worse the fracture, the worse it is for the horse. For example, extremely comminuted fractures - so-called "bags of glass" - simply can't be put back. On the other hand, a simple crack in the third phalanx may simple require rest and hoof stabilization. Even the best surgeons can't fix the worst fractures, because there's often very little left to fix.
4. How is the horse used?
Sometimes, even though a fracture may be repairable, the outcome might not be desirable for the horse or the owner. A fracture repair that would result in chronic lameness, such as repair of a metacarpophalangeal joint, might be acceptable to an owner looking to use the horse for breeding but might be completely undesirable if the client wants to ride the animal.
Whereas the cost of surgery may be a worthy investment with a valuable breeding stallion or broodmare, many owners might feel differently about a lame horse that can't be ridden for years after repair.
5. How much is fixing the break going to cost?
In survey after survey, the No. 1 concern of animal owners is the cost of care. The cost of repairing a fracture can be a daunting proposition. Even in the absence of post-surgical complications, a successful repair will cost many thousands of dollars. Furthermore, the cost of surgery often is compared to the cost of replacing the injured horse.
Stated otherwise, deciding whether to repair a fracture often comes down to a single question: "Do you want this horse, or do you want a horse." The cost of surgery, along with the time, pain to the horse and likely outcome, often do not compare favorably with the option of ending a horse's suffering and using the cost savings to start over.
Equine limb fractures can have a variety of outcomes. But there also are wonderful success stories that end with a sound horse, or even a lame horse that goes on to a long, happy life as a pet and companion. And don't forget the occasional inspiring story of a horse or pony that did well with a limb prosthesis after a catastrophic injury.
The decision of whether to try to repair a horse's broken leg has many considerations and always should be conducted in careful consultation with the owner for the most satisfactory outcome.
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