Fractures in Horses: What Can Be Done?

For many years now it has been believed that a horse having broken its leg should be put down - that it is the best thing to do. However there have over the years been many who have refused to give the okay.
 
Some of the first people who made a significant impact on the outlook regarding the treatment of broken limbs, was horse trainer Corky Randall and Veterinarian Dr James Bullock. The case involved a Black Arab Stallion named Diamond Night.
 
Diamond Night is one of three Stallions featured as "Black" in the movie The Black Stallion. On Tuesday 29th of June 1982 a few days prior to setting off for the nationwide tour, Diamond Night whilst in training landed wrong after rearing and fell on his right shoulder, fracturing his left leg in several places just below the elbow. The owners were devastated as he was their prize horse and they had intended to breed with him. Keep in mind this was in 1982.
 
At that stage no one would think of operating on an adult horse having sustained such an injury (Diamond Night was 5 at the time). There had been some success with foals, but it was thought that was due to the fact the foals were still growing and the growth plates had not locked, this having made allowances for the bones to knit properly. Popular belief then was in an adult horse the bones would not knit properly and a broken bone on a horse would not heal. But Dr Bullock was willing to attempt the operation that at that stage was considered daring.
 
Diamond Night was in surgery for 5½ hours and in recovery for a further 2½ hours. He pulled through regardless of the fears all had regarding the complications that could arise with submitting a horse to prolonged periods of anaesthesia - one of those being the development of pneumonia. A Kirschner apparatus was used to stabilise the leg and the horse was treated with Pulsating Electro Magnetic Field Therapy, or PEMF, treatment that at that stage was considered pioneering. The horse recovered in what was considered to be record time and went on to become a stud.
 
There have been numerous stories like this throughout the years. So many so that one wonders why the belief of having to put down a horse should it break its leg had not changed.
 
The fact is, it has, and to a great extent.
 
We took a look at the diagnoses, available treatments, possible complications and why the belief that horses should be put down still exists today.
 
To put down or not to put down - that is the question
Why in this day and age where there has been such advances in medical science regarding the treatment of horses, are horses still put down when suffering a fracture? The answer is simple: Money.
 
When a horse fractures a bone there is a good chance it can be treated, however with the cost of treatment and rehabilitation along with the possible complications that can arise after surgery, the costs may not justify the means. This is why so many horses today are still put down after having suffered a fracture.
 
Statistics
Many of the simpler fractures, especially fractures of the knee (commonly referred to as a knee chip) in competitive and racehorses have become routine surgical procedures, with up to 69% of racehorses returning to their racing careers. Nearly all (90%) of racing thoroughbreds treated for hairline fractures on the cannon bone (bone below the knee on the foreleg) have returned to their racing careers, and on average 70% of horses having suffered a fracture on the sesamoidian bone (a little bone found in the foot) have also returned to their racing careers.
 
Please note: These statistics are based on Thoroughbreds in racing, this is mostly due to the fact that these injuries are commonly related to the sport and due to the record keeping found in the industry are easier to track for statistical purposes.

 
Should a horse suffer a fracture, there are several considerations that need to be taken prior to surgical intervention

• The surgeon will need to determine the possible successful outcome of the surgery, taking into consideration what the horse's function will be after rehabilitation,
• the horse's size weight and age need to be considered - younger horses have a better chance at recovery than older horses, larger and heavier horses may develop supporting leg laminitis, and
• the horse's temperament would play a big roll in the decision. Recovery from this type of surgery takes time, lots of time. Does the horse have the compliant nature that would be required in order for it to see through the postoperative therapy?

 
Complications that can arise

Prior to Surgery

• Injuries whilst in transit - transporting a horse with such an injury is a taxing task, and specialized equine ambulances are still in short supply.
• The horses' health - horses suffering from heart complications like irregular heartbeats (Dysrhythmia, Arrhythmia) or heart murmurs could suffer cardiac arrest (heart failure) and horses suffering from respiratory complications like COPD, colds, infections, pneumonia or strangles may not survive surgery. 

During surgery

• Cardiac arrest (heart failure) - this risk is found with all operations that require the use of anesthetics. Older horses are more prone however.
• Possible damage to tendons, tendon sheaths, muscle tissue, joints and ligaments caused by the surgeon whilst operating (known as Iatrogenic complications).
• Blood in the joints (Hemarthrosis).
• Excessive bleeding (there is no blood bank for horses).

 
Post Surgery

Possible secondary fractures

Anyone who has ever been present in a recovery room would know the alarming way some horses fall about when regaining consciousness after anaesthesia.

Infections

Because of the horses living environment these are a constant risk. Any deep wound - especially one going as deep as the bone and having foreign objects inserted - would be prone to infections.

Laminitis (inflammation of the sensitive laminae of the foot) in the supporting leg/s feet

There are a number of opinions as to why some horses develop laminitis in the supporting leg/s. The most accepted is that it is caused by the supporting leg having to cope with more weight than it was designed to do, combined as well as the lack of movement and blood circulation.

Depression or anxiety in the horse

Many horses do not cope well with being locked up or tied up in a sling, although many accept the need, but some become restless and reinjure themselves. Others become depressed and in turn go off their food, which leads to slower recovery times as the body does not receive the nourishment it needs.
 
Therapies found useful after surgery

• Pulsating Electro Magnetic Field Therapy,
• swimming in a saltwater pool,
• physiotherapy (once recovered), and
• acupuncture

 
Having a horse with a bone fracture need not necessarily mean the end of its life. There are numerous ways in which your horse can be helped should it fracture a bone. The medical attention available to you is therefore limited only by the costs and what you can afford. There are however some cases where the injury is of such a nature that little can be done for the horse. In those cases it is more humane to have the horse euthanised. Many horses today are often euthanised only due to the fact that the owners simply cannot afford the cost of the treatments, not because they have to be.
 
For those interested in reading Diamond Nights' story, it was originally published in the Arabian Horse World Magazine Edition 8 of 1983. That is if you're lucky enough to find a copy.

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