Dealing with Rib Fractures in Horses

Rib fractures occur in neonatal foals and in adult horses from trauma. Rib fractures are associated with significant pain in people and it must be assumed they are painful in equine patients as well. Therefore analgesia should be an important part of any management program.

Adult Rib Fractures: These can occur from blunt or penetrating trauma. Commonly adult rib fractures do not require fixation. Recently S Peters et al (2013) reported on a horse with blunt thoracic trauma that broke a rib next to the heart with subsequent concerns over the fracture ends lacerating the vessels around the heart. This rib fracture was repaired using a plate, screws and wires. Fortunately this was a blunt trauma and thus implants were used in a sterile fashion. The majority of rib fractures occur from penetrating trauma. Use of ultrasound is essential in adults to assess rib fracture where they are not exposed and occasionally scintigraphy has been used when blunt trauma in the past is suspected. Ultrasound can also identify underlying conditions that may need to be treated such as hemothorax or pneumothorax. The underlying condition can be treated and in the case of blunt or open trauma the need to address the rib fracture itself can be assessed. Conservative management is commonly used with the odd exception as outlined above when the fracture is close to the heart on the left side. Additionally broken ribs caudally may be more freely movable and at risk of lacerating lung or diaphragm. If a rib fracture does require surgical stabilization a variety of methods may be employed depending on the situation. There is currently no established method of repair with evidence based medicine and many techniques are likely sufficient to prevent displacement of the fracture ends. When the rib fractures are exposed then they are treated as with the wounds with debridement, removal of loose fragments, debridement of exposed and contaminated bone and appropriate dressing and bandaging. The use of negative pressure wound therapy will encourage rapid growth of granulation tissue to cover the defect if necessary. Even those horses who have a flail chestwhen a rib is broken in more than one location and moves opposite to the normal chest wall excursions- conservative management is usually sufficient. [...]