Rib fractures in adult horses as a cause of poor performance; diagnosis, treatment and outcome in 73 horses

Abstract

Background: Rib fractures in adult horses are poorly documented.Objectives: To describe the presenting signs, diagnosis, treatment and outcome of horses diagnosed with rib fracture. Study design:Retrospective case series. Method: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.Results: Seventy-three horses met the inclusion criteria. Horses presented due to either resistance to ridden work and poor performance (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.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 non-healing 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 as a result of the rib fracture. Eight horses did not return to their previous level of exercise for other reasons.Main limitations: Incomplete data set due to retrospective case series. Conclusions: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.

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“…Only through increasing the understanding of associated risk factors can fractures be effectively diagnosed, hopefully at the prodromal stage, and longer‐term, can preventative measures be implemented to reduce injury rates on the racetrack. Hall et al 21 reported the unusual finding of rib fractures in 73 adult horses and identified the presenting clinical signs to commonly involve poor performance or resistance to ridden work; posing another differential that should be considered in the work up of these non‐specific clinical presentations.…”

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“…The aim of this retrospective case series by Suzy Hall and co‐workers in the UK was to describe the presenting signs , diagnosis , treatment and outcome of horses diagnosed with rib fracture .…”

Rib fracture as a cause of hindlimb lameness in a horse

“…Poor performance was the owner's complaint in 56% (41/73) and lameness was reported in 64% (47/73) of the horses. The most common clinical sign observed in adult horses affected with rib fractures included pain on palpation of the fractured area in 38% (18/47) (Hall et al 2022).…”

“…Palpation is a subjective technique and varies between horses and examiners, only 18/47 horses where palpation was recorded, showed signs of pain or discomfort. Swelling associated with the fracture site is not always noticeable (Hall,et al 2022). Ultrasound examination is often the preferred imaging technique used for diagnosis of rib fractures, especially in foals.…”

“…Therefore, it can be concluded that, regardless of the animals age, ultrasound examination is a sensitive imaging modality. An ipsilateral laterodorsal-lateroventral oblique "skyline" radiographic projection has been described for the imaging diagnosis of rib fractures in adult horses (Hall et al . 2022); this projection has not been reported in foals.…”