Going out to the field to find that a horse has impaled himself on a branch, a fence post or other sharp object can be an owner’s worst nightmare.

These traumatic injuries are brutal, but, thankfully, often look far worse than they actually are. In fact, we should normally be more wary of a small puncture than a large impalement wound — the obvious injury is not usually the problem.

The main concern with impalement is whether any of the deeper structures, such as joints, the abdomen, the lungs and major blood vessels, have been damaged.

In most cases the unfortunate horse will have run into an object such as a fence and impaled himself in the regions of the neck, forearm and/or chest. Another common situation is for a horse to rear up or jump and land on top of the object, impaling himself in the axilla (the armpit area, just behind the girth), abdomen or inguinal (thigh/groin) area.

Keep calm — and do nothing

Metal electric fence post impaled in the left chest

Metal electric fence post impaled in the left chest

The first thing to do if you discover such an injury is nothing. Staying calm and assessing the situation may go against all instincts, but this is the most sensible first move.

While it might be tempting to remove the object, this should never be done until the horse has been examined by your vet. The same advice is true with regards to moving the horse; it is better to leave him where he is until the vet arrives.

Movement of the horse or the object could result in inadvertent damage to nearby vital structures. If the object is left in place, it is much easier for your vet to establish which deeper structures might have been affected. And remember, the object may be preventing haemorrhage while it is in place. Dislodging it could result in significant bleeding.

If you find that your horse has impaled himself, you should:

  • Call your vet
  • Make the area safe so that no further injury can occur
  • Try to keep the horse quiet and calm

If the horse is bleeding significantly and appears shaky and dull, he could be going into shock due to blood loss.

Again, try not to worry — blood loss often looks a lot worse than it is. Remember that horses are very large animals and can lose a huge volume of blood before requiring any treatment.

The best thing you can do in this instance, while waiting for your vet to arrive, is to keep the horse warm and try to stop the bleeding.

An effective way to do this is to place a bandage around the affected area and keep replacing or adding absorbent layers until bleeding has stopped. If the wound is in an area that you cannot bandage, such as the chest, you can pack it with clean towels or something similar to stem blood flow.

Assessing the damage

There are no set rules for dealing with an impalement injury.

The aim of any treatment is to stabilise the patient before removing the foreign object and trying to encourage the best healing possible.

Initial assessment of the horse will help the vet to determine if any vital internal structures have been damaged by the object. This is usually achieved by considering the location of the impalement, its point of entry and its likely path through the body.

Techniques for removing the foreign object will depend upon circumstances. Your vet may recommend this is done once the horse is in a more suitable environment, such as a nearby hospital, where any eventuality can be dealt with.

The procedure once the object has been removed is to flush the wound thoroughly to reduce the risk of infection, and then to try to close as much of the wound as possible. In most cases, however, the majority of the wound will heal by secondary intention (on its own).

Arrow in pony's back

Arrow in pony’s back

Sometimes, such as the case where a crossbow arrow had been fired into an unsuspecting pony (pictured, above), it is clear where the object has struck. The arrow was left in place, complete with police evidence bag. This allowed me to determine that it was unlikely to be affecting any important structures and was most probably lodged into the epaxial muscles of the back. Furthermore, this was a smooth, cylindrical object that could be removed with ease under sedation.

Other injuries can be more life threatening simply due to the location of the injury. The main concern is that the object may have penetrated the chest or abdominal cavities.

Further examination at a hospital is sensible, as radiography and ultrasound can be used to evaluate these body regions and the necessary treatment can be performed.

Wooden objects such as railings and fence posts can be particularly difficult to remove, because as they are pulled out it is likely that splinters will be left behind. These may shift further into the body, proving difficult to find. More than one procedure may be needed to remove all the pieces.

The biggest complication is damage to vital structures such as the abdomen and the chest. This has to be evaluated and ruled in or out as soon as possible. Treatment of such cases is complex and beyond the scope of this article.

Complications

Infection is always a significant risk, as penetrating objects are often heavily contaminated. Thorough lavage (flushing) of the wound is required and will often need to be performed multiple times.

Another common complication is emphysema, which is when air is able to enter the wound and pass underneath the skin.

Essentially, some large wounds, especially those in the axilla region, can act as a one-way valve which allows air into the wound but not out again. The air spreads under the skin all over the body, which can be very uncomfortable for the horse and also risks setting up an extensive infection.

A horse with emphysema will usually look bloated. It is an easy condition to diagnose because the skin crackles as it is touched. Eventually the air will dissipate, but these cases must be carefully managed.

As horrific as many penetrating injuries appear at first, prognosis can be good as long as more severe damage to the internal organs has not occurred.

Large wounds may take a long time to heal, but many of these cases make a full recovery.

Ref: Horse & Hound; 7 April 2016