Fractures are actually very rare in horses, however they can happen at any moment. Fractures can be difficult to treat in horses for many reasons. Horses have a large body weight which the other limbs must bear when the fracture is unstable or not splinted correctly. Generally, horses are very anxious and scared when a fracture occurs which makes it difficult to restrain or sedate them for treatment. Due to the pain and anxiety, they can become dehydrated from the sweating that occurs. In many places on the limb, there is very little soft tissue present to cover the exposed bone once it is fractured. This can lead to extensive infection and failure of treatment.
It is very important that you get your veterinarian involved immediately. The most important task that your veterinarian will have is to splint the limb appropriately. This has two significant consequences - 1) the horse will become less anxious as soon as they have a 'stable' limb on which they can place some weight 2) it decreases the amount of damage to the fracture site which ultimately leads to a better outcome.
Despite all of these concerns, there have actually been several recent advances in fracture repair which have helped to improve healing rates in horses with fractures. In fact, many fractures in horses can be repaired with just a few screws. These screws are placed to compress the smaller portion of the fracture (the fragment) to the larger, more stable portion of the bone (the parent bone). In addition, new surgical implants (plates and screws) have been developed to improve the outcome in fracture cases. These implants have complementary threads within the head of the screw and the hole of the plate. This allows the plate and screw to 'lock' together and form an extremely stable construct. Which allows the horse to bear more weight on the limb during the healing phase and therefore have a better outcome!
It is very important in fracture cases to make sure the recovery from anesthesia is as smooth and uneventful as possible. There are many different ways to assist a horse to stand such as a sling, a pool or an inflatable mattress. Here at WVE, we have an Anderson Sling which is pictured above. You can see how well the sling supports the horse while it is asleep and throughout the recovery process. Sometimes, we use the sling to support a horse with a fracture or even neurologic/weak horses that cannot stand. Horses can get very tired if they are not allowed to lay down when they have a fractured leg, so sometimes we use the sling to support a horse while it is recovering. They will even get so comfortable that they will sleep in the sling - you can see a picture of a horse sleeping in the sling to the right.
Septic Joints/Tendon Sheaths
Septic (infected) joints and tendon sheaths are injuries that are life-threatening in the horse. When a wound is located over a joint or tendon sheath, it commonly enters the joint, even if it isn't obvious to the common eye. As you can see below, in order to test whether a joint is involved in a wound, we inject saline at one area of the joint and see if the saline will exit the wound when pressure is applied at the injection site. You can see an example below of this occurring in a wound.
It is important to manage infected joints aggressively in horses because once an infection is established, it is extremely difficult to get rid of it due to the environment of the joint. It has rich joint fluid for the bacteria to eat and lots of pockets for bacteria to hide in. Another thing joints do to hide the bacteria is produce a thick protein material called fibrin. The fibrin clots within the joint and traps bacteria within the clot. The bacteria are then isolated from antibiotics and more difficult to treat.
The best management for septic/infected joints and tendon sheaths is evaluation under arthroscopic surgery. There are three important reasons for this:
- To look for any cartilage damage or even bone damage to the joint (this determines the future prognosis of the horse)
- To aggressively debride (take away) any fibrin or excessive synovium (joint lining) which decreases the hiding spots for the bacteria
- To perform high-powered lavage of the joint with sterile fluids which flushes bacteria and dirt from the joint
Procedures performed at WVE routinely: