The Acute and Conservative Management of Fractures

In a horse with a suspected fracture, a diagnosis should be made as soon as possible to allow appropriate treatment. For fractures below the carpus and tarsus, external coaptation with a Robert Jones bandage, splinted bandage or commercial splint is both effective and fairly easy to perform. Stable, more proximal fractures are difficult to stabilise affectively and the pros and cons of attempting external coaptation should be considered on an individual case basis. Non-steroidal anti-inflammatory drugs should be administered to provide analgesia and to reduce overload of the contralateral limb. Antibiotics should be administered if there is an associated wound.

The majority of racehorse fractures are stress fractures rather than complete fractures. The increased use of gamma scintigraphy has allowed the earlier, more accurate diagnosis of these injuries. As they have become more commonly recognised, radiography and ultrasonography have also been more accurately utilised. In a study of fractures in Thoroughbred racehorses over a two year period in our Newmarket population, conservative treatment was 80% more likely to be utilised than surgical management.

For proximal stress fractures such as of the tibia or radius, there is no realistic surgical option and box rest for a minimum period of 4-6 weeks is recommended. For a more distal stress fracture such as a tarsal slab fracture, there are surgical or conservative options. These fractures have an approximately 75% return to racing percentage with either surgical or conservative management and this is little to justify the additional cost and risk of surgery. Even some small intra-articular chip fractures can be managed conservatively and medically whilst successfully carry on racing.

Thus with appropriate case selection, conservative management, even when surgical treatment is a valid option, can be the treatment of choice in a racehorse population.

Even fractures due to external trauma such as radial fractures and splint bone fractures can respond well to conservative management, often with fewer complications than excessively complicated surgical treatments.