Highlights of recent clinically relevant papers

Abstract

The aim of this retrospective case series by Suzy Hall and coworkers in the UK was to describe the presenting signs, diagnosis, treatment and outcome of horses diagnosed with rib fracture.The clinical records and diagnostic images of all adult horses diagnosed with a rib fracture at three referral centres over a 15-year period were reviewed. Seventy-three horses met the inclusion criteria. Horses presented due to either resistance to ridden work and poor performance (clinical signs included poor response to rider aids, bucking, bolting, napping, rearing or a reluctance to jump; n = 41), lameness (n = 21) or trauma (n = 7). In four horses, the presenting complaint was not recorded. Clinical assessment and palpation localised the site of injury in 18/47 cases where recorded. In 64 horses (88%; 95% CI 79-94), one rib was affected; in two horses, two ribs were affected; in three horses, three ribs were affected, and in four horses, four or more ribs were affected. One horse had fractures on both the left and right sides, but in all other horses, the fractures were unilateral: 40 on the left side and 32 on the right side. The 18th rib was the most commonly affected (n = 32; 42%; 95% CI 32-54). Nuclear scintigraphic examination identified all fracture sites in which it was performed (59/59). In 10/ 24 horses, radiographic examination confirmed rib fracture. Ultrasonographic examination confirmed rib fracture in 58/ 59 horses (98%; 95% CI 92-100). Six horses underwent surgery due to ongoing clinical signs and nonhealing fracture; all other horses were managed conservatively. Fifty-five horses were available for long-term follow-up (>1 year), of which 28 (51%; 95% CI 38-64) returned to their previous level of exercise. Twelve horses did not return to their previous level of exercise due to lameness unrelated to the rib fracture, and seven horses were subjected to euthanasia, of which three were due to the rib fracture. Eight horses did not return to their previous level of exercise for other reasons.Although uncommon, rib fractures should be considered in cases of reduced performance or resistance during ridden exercise. Palpation may be unrewarding. Scintigraphy and ultrasonography are useful in identifying the fracture site. Rib fractures in horses carry a fair prognosis and can be managed conservatively in most cases.