Latest from Horse & Hound in Fractures-and-bone-chips

AI trained to detect fractures in horses opens door to preventing catastrophic injuries

Lucy Elder — Mon, 09 Mar 2026 17:15:25 +0000

An artificial intelligence (AI) system that can detect and pinpoint fractures in horses has been nominated for a top award.

Research from the Royal Veterinary College (RVC) has been shortlisted for the STEM for Britain 2026 award, in recognition of its work in applying AI to improve fracture detection in animals.

The research team compiled a databank of images, including 100 equine fracture cases, 70 feline cases and approximately 4,000 human fracture images from a public database.

The researchers built an AI system that can identify the type of scan (such as an X-ray, CT, or MRI), recognises the image angle and detects and locates fractures. They found the system was effective in finding fractures in horses, using knowledge gained from thousands of human fracture images. This is known as transfer learning.

It meant that the model could be trained on human scan images then adapted for veterinary use. The system reached an accuracy of 71 to 84%, without needing “an unrealistically large number of equine images” to learn from.

The study, funded by the Horserace Betting Levy Board, was led by Ruby Chang, associate professor of statistics at the RVC, and carried out by Hanya Ahmed.

“Dr Ahmed has brilliantly translated expertise in medical image analysis to the veterinary field, developing a novel AI system to detect fractures in racehorses,” said Dr Chang.

“This exceptional work has now also been published in Bioengineering. This dual recognition is a testament to Dr Ahmed’s skill and dedication and a wonderful celebration of our team’s collaborative effort to advance diagnostic technology.”

The team has also expanded its collaboration with the Hong Kong Jockey Club to explore whether AI can identify early bone changes in racehorses before a fracture happens. It is hoped that, if successful, this could support efforts to prevent catastrophic injuries.

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B61Y5H Horses' legs, galopp race, racetrack in Munich Riem, Upper Bavaria, Bavaria, Germany (Image credit: Alamy Stock Photo)

Researchers find a reason why some horses have a higher risk of fractures

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New study finds genes that may increase risk of broken bones in horses

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‘I don’t know how she’s alive’: ‘miracle’ horse who suffered catastrophic leg break returns to showjumping victory

Eleanor Jones — Sat, 05 Jul 2025 16:58:15 +0000

The owner of a horse who suffered a catastrophic hindleg fracture but has returned to showjumping victory has paid tribute to the mare’s character – and shared her story to give hope to others.

Abbie Shackell’s mare Moet, who was seven at the time, broke her cannon bone in January 2024. Surgery was not an option as the damage was too severe. But by the end of the autumn that year, Moet was back in the ring, and has gone from strength to strength since.

“I call her a miracle horse, because I don’t know how she’s managed it,” Abbie told H&H. “She’s the loveliest horse in the world, not a bad bone in her body, which is probably how she’s managed to come back.”

Abbie had bought Moet, her “dream horse”, as a two-year-old and put in all the years of work so they were winning in the ring.

Then in January 2024, Moet came in from the field with a wound in her hindleg.

“It was quite deep but she was only a little bit lame on it,” Abbie said. “I sent a picture to my vet and he said he thought it should heal on its own, but a week later, I rang him and said it wasn’t closing up. He came out, and could feel it was broken, so he took an X-ray, and it was in quite a state.”

Abbie said Moet had been walking around in the yard comfortably, hardly lame, before the vet arrived.

“We all sat there for a while, he was looking at the X-ray, and looking at her, and thinking, ‘I don’t know how she’s even standing on it’,” Abbie said. “If someone had sent you that X-ray, you’d have said ‘That horse has no chance’.

“We asked about surgical options and he said it was almost in too many pieces. You couldn’t put it back together because it went in four different directions, it was in too many bits to pin. I truly believe a different vet might have said ‘Nothing can be done here’; it was horrendous and I thought that was going to be it, she wouldn’t recover.”

But the vet took into account the fact Moet was able to bear weight, and was very sensible, and said “Let’s give it a go”. He splinted the leg, and the mare spent some time in cross-ties, then on general box rest with a very deep, big bed.

‘It was like she knew’

“It was like she knew,” Abbie said. “She just stood there and was good as gold. She just must have known what she had to do, because every time she got up, she was really careful. She didn’t put any weight on it, she didn’t do anything silly in the stable, even when we first turned her out, she’s a competition horse, but she just went out and was really calm. She’s just amazing, she’s got such a nice attitude, and I think that’s the thing that saved her.”

But the vet was hopeful that if the bone healed, Moet would be able to get back to doing what she loved.

“He said if it worked and it all came back together, she should be fine, and have a career, do everything,” Abbie said. “Everyone who asked me, I said what he’d said, and they all looked at me like I was stupid. I was thinking ‘Am I? Is she going to come back, or not?’ And she has.”

After about eight months, X-rays showed the bone had healed, and Abbie was given the go-ahead to start the long process of bringing her back into work, including plenty of water treadmill sessions and strengthening.

Rehabilitation

“It was just a case of mainly building her fitness once the bone had healed,” she said. “I put her on some really good feed, and tried to help boost her nutrition-wise but she was so sensible, and it healed quite quickly. But I do think that if another vet had looked at it, they’d have said ‘No’. She’s a lucky girl.

“When we went back to a show, my mum and I were both in tears,” she said. “It was only a 90cm but she went in the same as a year before and was as good as gold. We were both crying, and it took three or four outings every time, I couldn’t believe she had gone round.”

Moet built her fitness and stepped back up; she jumped – and won – her first 1.30m in May, and has been placed at almost every show this year.

“Even then, I thought ‘I don’t know how you’re alive, let alone winning’,” Abbie said. “Even if we have a bad round, which is rare on her because she’s such an honest horse, I still think, ‘Well, she’s on the box, she’s alive, which is more than what we thought we’d have.

“And I hope that seeing her come back from this might give someone some hope, because it’s so devastating when the horse gets injured. She’s a truly remarkable horse to come back from such a catastrophic injury the way she has.”

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Researchers find a reason why some horses have a higher risk of fractures

Lucy Elder — Thu, 15 Feb 2024 09:17:25 +0000

New research has found a reason as to why some thoroughbreds have a higher risk of fractures than others.

A team led by Royal Veterinary College (RVC) senior research fellow Dr Debbie Guest looked into genetic risks of fracture in thoroughbred horses. They found that horses with lower levels of collagen type III – a gene required for normal bone formation – have a higher risk of fracture.

The findings have enabled the RVC to develop systems to identify genetically high-risk horses.

“In this study, we established a cell model to investigate the genetic factors involved in fracture risk,” states the study. “We found that collagen type III is expressed at lower levels in cells from horses with a high genetic risk of fracture and identified a novel DNA variant that is significantly associated with fracture and can affect the expression level of collagen type III.”

More research is now being carried out to validate the risk-scoring system in another cohort of horses. It is also hoped that further studies building on these findings and systems will help identify other genes and processes, to better understand why some horses are inherently more susceptible to fractures than others.

“We know that there are many environmental risk factors for fracture and much has been done over the years to reduce these risks. Despite this effort, fractures sadly still occur, and we know that some horses are genetically more predisposed to fracture than others,” said Dr Guest.

“The development of a polygenic risk score for fracture will allow us to identify horses that are at high genetic risk, to allow the targeted use of diagnostic imaging and close monitoring of their bone health.

“This study has also demonstrated the power of using cell models to work out what differences exist in bone cells from high- and low-risk horses and therefore why some horses are at high risk. This is vital to develop new interventions for high-risk horses in the future so that they are less likely to suffer from a catastrophic fracture.”

H&H asked Dr Guest what options there could be for mitigating risk for horses with lower levels of collagen type III.

“We think that collagen type III is only a small piece of the puzzle and that there are going to be lots of different genes which are affected in genetically high-risk horses,” she said.

“The effect of each individual gene is likely to be small and so we do not anticipate developing an intervention based on collagen III alone.

“However, we now have the laboratory tools to work out more of the genes and biological processes that are affected in high-risk horses. This might give us a broader picture of what is different in the bones of these horses so that in the future we can develop new interventions to improve bone health.

“In the meantime, identifying high-risk horses would allow the targeted use of diagnostic imaging to allow closer monitoring of horses in racing/training so that subtle changes can be detected prior to a catastrophic fracture occurring, and the horses can be managed accordingly until a return to normal bone health has occurred.”

Dr Guest also told H&H that identifying horses at genetically high risk “would allow owners to make “informed breeding decisions”, such as crossing them with a low-risk horse.

“Over time this would help to reduce the genetic risk in the population, while still maintaining genetic diversity in the breed,” she said.

The study was funded by the Horserace Betting Levy Board, the Anne Duchess of Westminster Charitable Trust and The Alborada Trust.

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Mare defies the odds with successful return to competition after leg fracture

Becky Murray — Wed, 28 Sep 2022 16:11:54 +0000

A mare who was almost put down after she fractured her leg has made a full recovery and returned to competition.

On 4 March Abigail Walker’s 14-year-old Irish mare Ruby was discovered with a deep wound after she broke out of her field along with the family’s other horse Boots.

“Boots was fine but Ruby had scrapes everywhere and I noticed blood on her left front leg,” Abigail told H&H.

“When I took her rug off she had what looked like a puncture on her shoulder and she couldn’t move. I knew something was massively wrong and we phoned the vet.”

Abigail said the vet could feel bone fragments in Ruby’s wound and they had to wait for a portable X-ray machine to arrive.“Because we didn’t fully know how much damage there was, there was a risk if we travelled her to the hospital we could make things worse if there was a fracture across the bone,” she said.

“The X-ray machine showed she had a fracture at the top of her humerus but it wasn’t a crack straight across, it was a fairly large hole. The vets didn’t think they could see any other hairline fractures but the X-ray wasn’t powerful enough to be absolutely sure. There was still a massive risk if we travelled her and there were more fractures, the bone could become dislodged and she’d have to be put down at the other end.”

Abigail said a discussion was had about ending Ruby’s life on welfare grounds, but the vets felt it was worth transporting her the 30 minutes to the hospital.

“The vets were brilliant, one travelled in front of us and one followed behind. By the time Ruby walked off the trailer you wouldn’t know she’d broken something,” she Abigail.

“The vets could see lots of bone fragments and they agreed these needed to come out, but one was quite large. The plan was she would be in the hospital for around three days, but it took the three days to get the last of the fragments out.

“She was kept in for a few more days observation. Then going into the second week her whole leg blew up to about three times its normal size from her shoulder down. The vets took a swab from the wound and she was put on antibiotics for an infection.”

After three weeks in hospital Ruby was allowed to return home to continue her recovery.

“She needed 18 weeks of box rest – and she was a saint. She was never rude or stressed, we couldn’t believe how calm she was,” said Abigail.

“After this we got the go ahead to start her rehab with walking in-hand in straight lines, and slowly building it up each month.”

Ruby has since made a full recovery and the pair have enjoyed their first outing to an unaffiliated dressage competition where they scored 71.5% in the novice class. Abigail hopes to affiliate in the future.

“I took her along but I wasn’t expecting anything from her – I was just happy to have her there, but this was the best test she’s ever done,” said Abigail.

“I still can’t believe she’s still here today. It has been such a rollercoaster and I can’t thank the vets enough for how much they did for her.”

‘His bone was in bits’: eventer who faced being put down comes back to championship win

Eleanor Jones — Sat, 24 Sep 2022 19:52:00 +0000

The owner and rider of a horse who faced being put down owing to a serious fracture last year, but came back to win an eventing championship, said she “couldn’t ask for any more”.

Tamsin Palmer and 10-year-old Bazaars Twister took first place in the 90cm Saracen Horse Feeds Brigante Cup Final at Frickley Park, the culmination of an unaffiliated eventing series held in the north of the country, on 18 September.

Tamsin bought “Twink” as a three-year-old from Bazaars Stud and the pair have competed at affiliated eventing, qualifying for the Area Festivals with hopes of competing in the grassroots championships at Badminton – but last summer, Twink was found on three legs in his field.

“The pedal bone was in bits,” Tamsin told H&H. “We didn’t think he’d make it.

“I was away for the weekend, typically, and they went to get him in and he was on three legs – it as awful. As soon as you see the call, you just know, and I said ‘Get the vet out straight away’.”

At first it was thought Twink had an abscess, but his condition did not improve.

“I’ve had fractured pedal bones before, in a front leg, and although he was getting slightly more comfortable in the stable, he was on bute,” Tamsin said. “Then when you tried to walk him, he was hopping again. I said we needed to get it X-rayed, and then we could see he’d really made a mess of it.”

Twink spent months on box rest, being walked in hand, and there were a host of other issues to deal with – for the horse and hs owner.

“There was one day he went a bit colicky so we had to walk him, but that made his foot worse,” Tamsin said. “It was a slow process of increasing the walking by a minute each day – halfway through, I had the great idea of long-reining, which was fine the first time, then the second time, he took off and I ended up sliding head-first down the road – it was a slightly terrifying time.”

By this point, Tamsin said, Twink had about a 65% chance of eventing again, which was significantly better than initial estimates. But he had some back and other issues that needed to be treated, as did the ulcers and the asthma he developed this year.

But, finally, X-rays showed the bone had healed, and “looked fantastic”, Tamsin said.

After a long process of building up the work, the combination were jumping by April, then eventing again in August, “and it was magic to be back on”, Tamsin said.

They qualified for the Brigante Cup by coming third at Shelford, then completed their Area Festival in eighth place; having been in a strong position after the dressage, they had a showjumping sat-nav error.

“I was rusty!” Tamsin said. “I got four faults for the circle and 12 for time, then time-faults across country, so the next event, I thought ‘Right, I’m riding him like I stole him’, and that was the championship!”

Tamsin, who paid tribute to her trainers Richard and Jane Carruthers and Gary Foggon, and her friend Kim Pemberton who helps her at events, also praised the team at Frickley for the championship, which was run like a long-format event with the showjumping last.

“It was really exciting, and just amazing to win,” she said.

“I never thought I’d get him back, I thought I’d lose him so many times, so this was what dreams are made of – a dream come true. After all the heartache, it was just brilliant.”

Olympic showjumper recovering from surgery on broken bone in front leg

Lucy Elder — Thu, 24 Mar 2022 16:02:48 +0000

Olympic showjumper Twentytwo Des Biches is recovering after breaking a bone in her left foreleg in an accident at the final fence of the CSI5* Paris grand prix (20 March).

The 15-year-old mare, ridden by Switzerland’s Bryan Balsiger, was attended by on-site vets, before being taken to the veterinary clinic in Grosbois.

She underwent surgery on Monday (21 March), carried out by specialist Dr Fabrice Rossignol following consultation with Twenty’s regular vet, Thomas Wagner, and vet Anton Fürst of Zurich University.

An update from connections on Tuesday (22 March) said the surgery “went well” and the vets are “very happy with the result”.

“Recovery will obviously take time and the only goal is that Twenty can enjoy the retirement she deserves,” said the statement from her connections.

The Selle Francais mare, by Mylord Carthago, was part of the Swiss bronze medal-winning team at the 2017 Europeans with Romain Duget and the pair finished second at the World Cup final the same year. Bryan took the ride in 2018, and the pair made their international competition debut as a combination in 2019. They have numerous top international wins and placings and were part of the fifth-placed team at last summer’s Tokyo Olympics.

“This event is very difficult for me and I am very affected,” said Bryan. “But I am also relieved today to see that the operation went well and that Twenty is standing and can already walk.

“I now hope from the bottom of my heart that she recovers well so that I can see her as soon as possible at the park. Twenty gave me so much and allowed me to reach my dreams, she means so much to me. I thank everyone for the great support received since Sunday during this period. It touches me.”

Owner Christiana Brechtbühl added that Twenty is a “member of our family and what happened is extremely hard to live with”.

“We have lived through very difficult times, but these are fortunately behind us. We have done everything for Twenty and will continue to do so,” she said.

“Bryan and I are still in the Paris region with her. Our only objective is that she can enjoy the retirement she deserves after having given so much for us and had such a great and great sporting career.

“We were very touched by the many tokens of support we received. We would like to thank the veterinary teams on site in Paris as well as at the Clinique de Grosbois, as well as the Paris CSI organising committee for what they have done for Twenty and for us”.

Swiss team manager Michel Sorg said the accident is a “huge shock for the Swiss team”.

“We [supported] Christiana Brechtbühl, Bryan Balsiger, Mélusine Guiblin-Miché and all their team as best we could on site and also after that. And of course we continue to do so,” he said.

“It is a great relief to know that the operation went well. We all have only one wish, that Twenty can enjoy a nice retirement in the meadow after such a great career during which she gave so much to our Swiss team.

“Once again, we send our full support and thoughts to the entire Twentytwo team.”

Pelvic fractures in horses: all you need to know

Andrea Oakes — Fri, 13 Aug 2021 18:32:29 +0000

BEFORE discussing pelvic fractures in horses, you need to understand the anatomy of horse’s pelvis, which connects the spine to the hindlimbs. Many powerful muscles attach to this structure; during locomotion, massive forces generated by the hindlimb musculature are transmitted through the pelvis into the spine, propelling the horse forward.

The equine pelvis is formed of three zones: the ilium, pubis and ischium, with the left- and right-hand sides forming a mirror image of one another. The ilium extends upwards and in front of the hip joints on either side, to form broad, curved surfaces called the ilial wings – which end at the obvious bony prominences called the tuber coxae. The pubis and ischium extend behind the hip joint and form the floor of the pelvis, connecting left and right sides at the rigid central joint called the pubic symphysis. The ischium ends with the tuber ischii, the bony prominences positioned either side of the tail.

(Image credit: creditUnknown)

Types of pelvic fracture in horses

THE most common type of pelvic fracture seen in horses outside racing is of the tuber coxae. Due to its superficial position on the side of the pelvis, this bony prominence takes the majority of collisions with stable doors or fences, or if a horse slips and lands on concrete, for example. These fractures may be seen with skin wounds or contusions, and the fracture severity depends on the force and angle of the collision.

Similar to these are fractures of the tuber ischii, which forms the point of the buttock. Damage is typically sustained when the horse backs into a wall, or slips with his hindlimbs beneath him to land in a sitting position.

Stress fractures commonly occur within the pelvis, due to the repetitive stress of exercise. These are typically seen in racehorses, due to the repeated demands of the work performed, but also in equine athletes in other disciplines where high-intensity training is regularly undertaken.

Bone is constantly adapting, or remodelling, to ensure that it is strong enough to cope with the forces experienced during exercise. The way this material adapts without becoming too heavy is by a coupled process, where new bone production and resorption – the natural breaking down of old bone – work hand in hand.

Excessive repetitive stress can result in this balance being lost, however, which in turn can lead to a stress fracture. Stress fractures in the pelvis, like those of other bones, develop in predictable locations, the most common of which is within the ilial wing.

Signs of pelvic fractures in horses

SIGNS that a horse may have fractured his pelvis include moderate to severe lameness, usually evident at a walk. Some types of pelvic fracture may also lead to more specific changes in how the horse walks. If the tuber ischii is fractured, for example, the horse may be reluctant to bring the affected hindleg forward as this will tighten the muscles running over this area.

Swelling of the affected region may also be seen. This can range from obvious bleeding and distortion to more subtle signs of asymmetry. A crunching feeling, termed crepitus, is sometimes evident upon examination as the bone fragments rub against each other. Most often, any associated bleeding is self-limiting, but if one of the major vessels – for example, those running across the shaft of the ilium – is damaged, a fatal internal bleed can occur.

Diagnosis can often be made from the clinical features described. Sometimes, more information is gained by internal examination via the rectum. Attempts at diagnosing pelvic fractures with X-rays are often unrewarding, because the huge muscles surrounding most of the pelvis reduce what can be seen.

Ultrasound, while not often used to diagnose fractures, is very useful for pelvic fractures in the horse. Only the surface of the bone is visible, but any displacement of the fracture fragments or significant bleeding into the muscle can typically be seen.

Stress fractures, in particular, are difficult to identify, and can easily be missed or misdiagnosed as a “pulled muscle”. But it is important to diagnose a stress fracture as continued exercise may result in a much more severe or even life-threatening fracture.

Diagnosis often requires advanced imaging with nuclear scintigraphy (bone scan), which is a sensitive method of pinpointing the site of injury. A radioactive element called technetium-99m is injected into the area and binds to a molecule, which then attaches to the calcium-containing crystals where new bone is being formed. Radiation is emitted from this compound and an image of the bone activity can be seen with a special detector.

During a bone scan at the clinic, the camera is angled to get the best view of the ilial wing. (Image credit: creditUnknown)

Treatment of pelvic fractures in horses

IN the majority of cases, treatment of pelvic fractures in horses involves conservative management. Depending on the severity and location of the fracture, and the horse’s comfort level, he will typically be given a period of stable rest ranging from six weeks to three months, before walking exercise can be re-introduced.

When there is significant risk of the fracture displacing further and causing injury to important vessels, cross-ties are often used. This involves keeping the horse tied up in the stable, wearing a padded headcollar, to prevent him from lying down and incurring further injury. If this is necessary, the horse will need close monitoring and pain management. He must be allowed regular breaks to lower his head so that mucus can drain from his nostrils, to prevent lung infection.

Surgery is rarely used to treat pelvic fracture. The requirement for a lengthy period of general anaesthesia usually rules out surgical repair in adult horses, but this has been successful in foals.

Surgical intervention is usually only required to remove problematic fragments of bone that are painful or infected, or those involved with an open wound. Ilial wing fractures, for example, often produce a spike of bone that presses against the skin and requires removal.

The severity of a fracture often relates to whether or not the horse can bear weight, despite the injury. Involvement of the hip joint or disruption of the overall stability of the pelvis are key determinants in the prognosis. The pelvis is also close to several large and important vessels, which can be damaged during fracture.

Injuries to areas that are important for muscle attachment may not impact as much on weight-bearing, and are generally less severe. A common example of this is fracture of the tuber coxae. A horse with this injury is typically very lame for one to two days, before displaying a rapid improvement in comfort levels.

This injury is often referred to as a “knocked-down hip”, as the fractured tuber coxae ends up lower than normal on the affected side. Horses who sustain this fracture generally make a full return to athletic function, despite a permanent change to the shape of the pelvis.

Meet the vets

MATT SMITH MRCVS, a Royal College of Veterinary Surgeons (RCVS) specialist in equine surgery, is a surgeon and partner at Newmarket Equine Hospital (NEH). Matt Chesworth MRCVS, also based at NEH, is a European specialist in equine surgery. This referral hospital is one of the largest in Europe, treating a wide range of leisure and sport horses from throughout the UK. Contact: 01638 782020, newmarketequinehospital.com

New rule for horses to have scans before major race raises questions H&H Plus

Lucy Elder — Sun, 16 May 2021 10:03:32 +0000

The rules also ban any international horse who has ever had a previous major fracture or orthopedic surgery from racing, and limits international Melbourne Cup contenders to one start in Australia prior to the big race. H&H finds out more, and gathers the views of British vets and racing authorities

NEW requirements for horses to undergo extensive body and limb scans ahead of the Melbourne Cup have raised a plethora of questions surrounding the knock-on effects of the stringent new regulations.

Racing Victoria and the Victoria Racing Club announced a raft of new requirements for horses competing in the Spring Racing Carnival, with even more measures for international horses and those competing in the Melbourne Cup.

These include a full body scintigraphy (bone) scan of international horses plus CT/MRI leg scans before travelling to Australia, paid for by connections, plus further CT scans before racing.

Scintigraphy uses radioactive tracers to highlight abnormalities of the skeleton, such as hairline fractures, and the dose used is harmless to the horse’s general health. The horse remains radioactive for a short time afterwards, which means spending a night or two at a veterinary practice so others are not exposed to radiation.

The rules also ban any international horse who has ever had a previous major fracture or orthopedic surgery from racing, regardless of current health and soundness, and limits international Melbourne Cup contenders to one start in Australia prior to the big race. The regulations also reduce the number of international horses allowed to take part at the Spring Carnival, while all Melbourne Cup runners — national or international — must have pre-race leg CT scans. A recommendation suggesting altering the firmness of the going for the Melbourne Cup was not approved.

“The review ultimately found that injuries in international horses, including in the Melbourne Cup, result from a variety of factors and that a combination of changes is required to reduce the risk of injury rather than one single initiative,” said Racing Victoria chairman Brian Kruger.

“We know some of these initiatives will be onerous on connections, but we make no apology for making the safety of horses our priority. Our sole focus is on ensuring that horses and riders compete safely, and we are committed to delivering these important enhancements in 2021 and beyond.”

But it has also raised larger, ethical and scientific questions over what sort of precedent this sets for global racing and whether the recommendations are the solution. These areas, any positives plus the possible unintended knock-on effects, are likely to be watched by stakeholders across the world.

British Equine Veterinary Association president Lucy Grieve told H&H: “This new rule raises many questions; undoubtedly we should all do whatever we can to avoid catastrophic injuries but it’s important that the tools we use are accurate and specific predictors.

“Where we decide to subject these animals to rounds of sedation, injection with a radioactive marker and exposure to ionising radiation we should also be sure that the end justifies the means.”

A British Horseracing Authority spokesman told H&H the organisation “notes” the publication of the review and the resulting recommendations.

“We are in contact with Racing Victoria and will be speaking to them to ascertain further details regarding this announcement, in order that we can assist British owners and trainers,” he said.

“Where a horse has been refused the opportunity to race in Melbourne as a result of these measures, we would seek to ensure there is a process to assess that horse upon its return to Britain so that it’s suitability to return to racing safely is appropriately managed.”

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New findings revolutionise how bone fractures in horses heal and can be prevented H&H Plus

Horse & Hound — Sat, 23 Jan 2021 09:00:47 +0000

New insights into how bone forms, adapts and heals are revolutionising fracture prevention and repair, explains Patrick Pollock FRCVS

The ability to repair and prevent bone fractures in horses, which can come about as a result of a single trauma or as a result of ongoing microtrauma through inappropriate training, is a topic of great interest among the veternary community and horse owners alike, with exciting new insights available.

Bone is a substance that changes throughout life, in a process called remodelling. This allows the bones of foals and young horses to grow and change shape, and in adult horses enables the repair of damage and prevents bones from becoming brittle.

The amount of remodelling is affected by the horse’s age, the type of exercise he does and the surface on which he works. Research in thoroughbreds discovered that if horses undergo controlled exercise early in life, the bone “learns” to model in a way that protects it from injury in later life.

Interval training with short bursts of high-intensity exercise is more likely to result in healthy, strong bone, than low-intensity, endurance-type work. Exercise causes tiny areas of damage, leading to “stress remodelling”, where the bone adapts to the forces placed on it. This process, called an adaptive response, is critical to bone health.

Why bone fractures occur in horses

We now know that the die is cast for a fracture long before the bone actually fails. Inappropriate training before the adaptive bone response is complete leads to too much strain on the bone. This results in “fatigue injury”, microscopic damage to the bone.

If training continues, the osteoblasts lay down too much new bone, causing the bone in those parts of the skeleton placed under excessive strain to become more dense than normal. In horses, extra new bone tends to be laid down at the joints, such as around the condyles (rounded ends) of the fetlock and in the front part of the limb bones. This dense bone, called sclerotic bone, is actually quite brittle.

The advent of magnetic resonance imaging (MRI) has enabled us to see the true extent of pathological changes within the bone prior to fracture. Abnormally modelled bone with fatigue injury appears inflamed and contains excessive amounts of oedema (fluid). Stress fractures may even be visible before the horse is lame and before radiographs (X-rays) can detect the injury.

It appears certain humans may be predisposed to the development of stress fractures; genetic markers exist to identify these people, allowing them to be monitored. Recent work at the University of Edinburgh suggests this may also be the case in horses. And it would be exciting to be able to identify horses at risk of developing stress fractures through something as simple as a blood test.

We do still see fractures that come about as a result of trauma, such as a kick or a fall, and some performance horses do slip through the net and present with a fracture. Thanks to a better understanding of how to train horses to encourage the adaptive response, however, along with our ability to detect signs of bone microdamage before a fracture occurs, the number of sport horses suffering fractures is at an all-time low.

How healing occurs in bones

In contrast to soft tissues, such as tendon, ligament or skin, bone is one of the few body tissues able to heal without a fibrous scar.

Unlike the scar left after a skin wound heals, which never gains the same degree of strength and can be thought of as a fibrous “patch”, new bone laid down during fracture healing is just as strong as the original. Healing is so effective that it is often impossible to determine where the previous fracture was.

Bone healing is affected by two main factors: the size of the gap between the fractured ends of the bone and the strain across the fracture site. Strain relates to stability: a certain amount is good, keeping bone ends together, but too much interferes with healing.

To understand the healing processes, it can help to think about skin wounds. Where possible, we will close the wound and realign the edges of the skin to enable primary intention healing. Where the skin is lost, secondary intention healing occurs – the wound fills with a blood clot and then granulation tissue (proud flesh) and is eventually covered with new skin cells resulting in a larger scar.

When the gap between fractured bone ends is less than 0.01mm and the strain across the site is less than 2%, structures (cutting cones) develop across the fracture. These generate cavities that fill with bone produced by osteoblasts. This re-establishes bridges of osteons across the fracture line, which then remodel into normal lamellar bone.

As a result of this primary healing, there is no formation of a periosteal callus (lump) at the site. This is important in articular fractures, involving joints, which are common in horses, as the presence of a fracture gap then callus formation can potentiate the development of osteoarthritis.

Secondary bone healing occurs when the ends of the fractured bones are near enough to heal but not perfectly opposed, or when there is motion at the fracture site. This process involves the classical stages of injury: haemorrhage, inflammation and scar formation.

In bone, the “scar” is a soft callus made of cartilage; this then undergoes mineralisation and remodelling so that, unlike skin, the tissue becomes normal without any permanent scarring. Secondary bone healing is less of an issue in certain situations, such as fractures of the non-weight-bearing splint bones on either side of the cannons in the lower limb.

Because we now understand how bone is formed, how it adapts and responds to stress and activity and how it heals, we have never been so well prepared to identify and treat potential fractures before they occur – or to repair the damage when they do.

Understanding how bone forms

From the huge bones of the pelvis and femur to the tiny structures within the ear, each of the horse’s 205 bones performs a critical role – and each adapts in direct response to the forces and strains applied to it.

How does this remarkable, adaptable material form?

● Bone largely consists of a protein called collagen, which forms a framework for the mineral calcium phosphate. This combination makes bone strong yet flexible enough to withstand stress.

● Three types of cell are constantly at work within the bone: osteoclasts, which break down old bone through a process called resorption; osteoblasts, which make new bone, and mature bone cells called osteocytes, which basically tell the other two what to do.

● These groups of cells work together to form osteons, cylindrical structures surrounding a central canal that contains the bone’s blood supply. Osteons are aligned parallel to the long axis of the bone.

● The long bones of the skeleton have an outer layer of compact bone called the cortex. This is covered by the periosteum, a dense layer of vascular tissue which carries both nerves and the blood supply, and is important in bone healing. The medullary cavity in the centre of these bones stores the spongy marrow, where stem cells are produced.

Ref: 21 January 2021

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Record FEI ban for rider of ‘nerve-blocked’ horse who suffered horrific fracture

Eleanor Jones — Wed, 10 Jun 2020 17:02:56 +0000

The FEI Tribunal found the rider guilty of horse abuse as well as breaching anti-doping rules resulting in a record fine and ban from competition. H&H explains the case and shares reaction to the outcome from campaigners Clean Endurance and representatives of Endurance GB...

The rider of a horse thought to have been nerve-blocked who suffered a catastrophic open fracture in competition has been hit with a record fine and ban.

The 10-year-old gelding Castlebar Contraband had to be put down at a one-star endurance ride at Fontainebleau, France, in October 2016, after he sustained what the event organiser described as “the worst fracture I have ever seen” to his right foreleg. Castlebar’s leg, the attending vet said, was “only hanging from the skin and ready to fall off”.

UAE rider Abdul Aziz Bin Faisal Al Qasimi had left the scene, witnesses said, and the horse was put down immediately. A post-mortem examination found the presence of xylazine, which is used as a sedative, analgesic and muscle relaxant and is prohibited in competition.

After “multiple delays”, the FEI Tribunal ruled on the charges, of horse abuse as well as breaching anti-doping rules, this month.

The Tribunal heard Al Qasimi, the person responsible (PR), claimed the vet who put the horse down must have administered the substance. Al Qasmi also claimed there were mistakes in some of the FEI’s documents, while his expert witness, a lecturer in veterinary pathology, thought it likely the vet who put the horse down had administered the substance, arguing that the concentration of xylazine in the sample was too large for it to have been given before the accident. He added that he did not agree with some of the statements and interpretations in the post-mortem and histopathology (tissue examination) reports.

The post-mortem showed fragmentation of bone, rounded bone ends and contamination at the injury site, suggesting contact between the bone fragments before the horse was immobilised.

Examination also found osteoarthritic lesions, especially on the right front fetlock, and both old and recent lesions on the nerve tracts of the limbs, especially the front legs.

“The FEI stated one of the many conclusions to be drawn from the post-mortem report was that it was highly likely Castlebar had been nerve-blocked with local and regional anaesthetics/sedatives both before and during competition,” the Tribunal report states. The FEI also concluded that haemorrhage of the tissues surrounding the ulnar nerve in the front leg shows the horse was injected there two to four hours before his death, so during the competition.

The FEI’s experts stated that the bone ends’ condition indicate that the horse was bearing weight on the limb after it was fractured, and that the signs of injection result from treatment that would have changed Castlebar’s sense of his own movement and position, and so “favoured the occurrence” of the catastrophic fracture.

FEI veterinary director Göran Åkerström told the Tribunal: “It is a well-known fact that removing the very fundamental protective function of sensitivity by practices such as local or regional injections of anaesthetic substances will increase the risk of catastrophic injury. This is especially relevant for fractures that are due to bone fatigue (stress fractures), where Castlebar will not show any signs of pain such as lameness while under influence of the injected substance.

“At an endurance ride, this means FEI veterinary delegates will not be able to identify Castlebar as lame and he will continue the competition. The continuous loading of the fatigued bone tissue will then with high certainty lead to a severe fracture.

“Comminuted (multi-fractured) fractures are typical results of bone fatigue.

“The post-mortem report gives very clear information that Castlebar Contraband was injected on several occasions before and also during the competition before the leg fractured.”

The FEI’s witnesses said when they saw the horse, after the accident, he did not seem to be in pain; he tried to take weight on the broken leg, despite the “horrible” fracture, and after his death fell on this side, which is very rare.

The rider and his witnesses all denied this, saying the horse was clearly in pain and distressed. But the Tribunal found these statements were “scripted in a similar manner”, that there were inconsistencies, such as the fact the rider first said he signed a form consenting to have the horse put down, but then admitted a member of his team had signed it. These “make the Tribunal question” what other details in the first statement may not have been accurate; they stated that one member of the team’s “memory of the euthanasia appears to have changed between May 2017 and May 2019”.

“The Tribunal’s view is that the PR was trying to absolve himself of any responsibility,” the report stated, adding that the fact two of his witnesses worked for him “could have had an influence on their recollections of the event”.

The panel found no convincing evidence that the attending vet had administered the xylazine, adding that in a previous doping case, Al Qasimi had also argued that the substance was given by a third party, but this was “unsubstantiated speculation”.

“The Tribunal is comfortably satisfied that Castlebar received nerve-blocking injections during the event,” the report states. “By abnormally desensitising Castlebar’s limbs, this caused or likely caused pain and unnecessary discomfort to [him].”

The panel said the rider “did not seem to be particularly concerned about Castlebar’s wellbeing”.

“But what the Tribunal finds most troubling is that the PR apparently left the accident site after Castlebar’s catastrophic injury, demonstrating a remarkable lack of compassion for a horse he claimed to have loved and treated like a member of his own family,” the report states.

“This Tribunal has never before adjudicated on a horse abuse case of this magnitude.”

Al Qasimi was suspended for 20 years, fined 17,500 Swiss francs (£14,500) and ordered to pay 15,000 francs (£12,400) in costs.

“This was a tragic case of a horse losing its life due to desensitisation and micro-dosing and, while we have had concerns that this has been ongoing for some time, this was the first solid evidence we have had of nerve-blocking during rides as well as micro-dosing,” said Dr Åkerström said. “This has resulted in a change in our post mortem procedures to make them more forensic and also allowed us to prioritise the research and development of the hyposensitivity control system, which is now in place.”

A spokesman for campaigners Clean Endurance told H&H: “While assisting the FEI in the investigation prior to bringing this complex case in front of the Tribunal, Clean Endurance has witnessed first-hand the determined efforts of the FEI legal and veterinary departments, as well as those of the many excellent vets involved.

“Clean Endurance is heartened by the fact these efforts have resulted in an unprecedented sanction for abuse. The extensive information in the FEI Tribunal decision notice should become required reading for any endurance stakeholder as it provides a rare public insight into the very common and abusive training, competing and medication protocols Clean Endurance exists to fight against.”

Endurance GB chairman Phil Nunnerley said: “There was clearly a shocking case of abuse involving this horse and Endurance GB applauds the efforts of the FEI legal and veterinary teams in bringing the athlete concerned to justice.

“It sends out a clear message that the FEI has strong investigative powers and even though this case has taken nearly four years to bring together, the appropriate severity of the sentence shows the determination to clean up the sport internationally to safeguard horse welfare and provide clean competition. The message from the UK is that the wider endurance community at all levels is sickened by this case and will not tolerate such abuse.”

Castlebar Contraband had competed in the UK twice the summer before the fatal run at Fontainebleau, at an FEI ride at Euston Park and a ride in South Wales.

Antonia Milner-Matthews, MRCVS, director of welfare for Endurance GB added: “This sanction is welcomed by us all and it reflects a growing mood of impatience for change in rooting out the minority who bring our sport into disrepute with such devastating results.

“Judging by the FEI findings, they clearly think that the nerve-blocking which ultimately led to the death of Castlebar Contraband had been going on some time. In the UK we place welfare at the heart of everything we do and from this year Endurance GB has mirrored the FEI limb sensitivity wording in our rules, which allows us to eliminate those which are showing hyper or hyposensitive limbs.”

Pedal bone fractures – a broken bone that doesn’t have to signal the end

Carol Phillips — Thu, 27 Feb 2020 16:00:00 +0000

This article has been edited and approved by Karen Coumbe MRCVS, H&H’s veterinary advisor since 1991.

(Image credit: creditUnknown)

Inside the hoof, the horse’s foot contains a single large bone (the pedal bone), with a smaller bone just behind it at the back of the foot (the navicular bone), and the bottom part of the short pastern bone, which forms the distal interphalangeal or coffin joint with the pedal bone.

While improvements have been made in the treatment of bone fractures in horses in recent years, they typically remain difficult and expensive to repair, but pedal bone fractures are an exception to this. When the injury is diagnosed promptly, and treated correctly, the prognosis for full recovery can be excellent.

Causes of pedal bone fractures

Pedal bone fractures often occur as a result of a sudden traumatic injury to a horse’s foot. Such injuries can happen as a result of horses kicking out against solid objects, such as walls or cross-country fences, or during normal ridden exercise if the foot lands awkwardly on an uneven surface. Occasionally, horses may fracture their pedal bones as a result of a severe penetration of the hoof capsule by a nail or sharp stone.

Pedal bone fracture signs

Following a pedal bone fracture, the horse is often noticed to suddenly go extremely lame and may be unable to bear any weight on the affected leg. The hoof may feel hot as a result of inflammation and any pressure or percussion (i.e. tapping) of the foot resented by the injured horse. These signs can also show when a horse has an abscesses or severe bruising of the sole, which can lead an owner to assume the injury is less serious than it is. A vet should be called as a matter of urgency to any horse that is non-weight bearing on one leg.

Diagnosing a pedal bone fracture

The vet usually diagnoses a pedal bone fracture by taking an X-ray of the affected hoof, especially if or when the other likely diagnosis for foot lameness, namely a bruised foot or sub solar abscess have not been detected. Unfortunately, these fractures can be difficult to identify in the first few days after it occurs. Initially, the fracture appears as a hairline crack on an X-ray film. Consequently, it may not be spotted despite the vet taking several X-rays at different angles.

If your vet is suspects a pedal bone fracture, but is unable to locate it, it is normal to box rest the horse for 7-10 days before repeating the X-rays. By this stage, the fracture is often much clearer on the film because the bone usually dissolves close to the fracture as part of the healing process.

Occasionally, pedal bone fractures are suspected, but, despite taking numerous X-rays, the vet is unable to make a definitive diagnosis. The vet may then perform nerve blocks to confirm that the pain is definitely coming from the foot, but there are inherent risks in numbing a foot with a suspected fracture, so other investigations may be considered.

A bone scan (gamma scintigraphy) is another diagnostic option, although X-rays are usually sufficient. Occasionally MRI might be considered to rule out other pathology, such as collateral ligament injuries.

Treating a pedal bone fracture

The most appropriate treatment for a pedal bone fracture depends on the age of the horse, the type of fracture and the preference of your vet. But box rest is the most important part of the treatment and anti-inflammatory drugs are typically given.

The duration of rest is variable, though 2-3 months of total box rest, followed by 2-3 months of controlled exercise from the box, is typically required to allow the bone to heal.

It can help if the foot is immobilised during this period to prevent movement of the bone. Every time a horse bears weight on its foot, the hoof wall expands slightly, which allows movement of the pedal bone and leads to a delay in healing. The simplest way to immobilise a hoof is to shoe the horse with a bar shoe with quarter clips, which will minimise this expansion.

Occasionally, a rim shoe may be used for the same reason. A piece of sheet metal is welded around the foot so the foot sits within the rim. Applying acrylic materials between the foot and the rim shoe will further prevent expansion of the foot.

One option to prevent foot expansion is to apply a cast to the limb. Various types of cast can be used, such as enclosing the hoof alone, enclosing the hoof and pastern or enclosing the whole limb below the hock or the knee. However, casts can cause complications, so many cases are managed by using a bar shoe alone.

Surgery for pedal bone fractures

Sometimes, surgery is necessary. When the pedal bone is cracked straight down the middle, placing a screw across the joint to compress the two pieces of bone back together can be an excellent technique to speed its healing and allow a quicker return to soundness and work. However, placing the screw into the bone in the hoof has risks of serious complications, such as infection.

Surgery is most frequently required when there has been a penetrating wound to the foot, fracturing part of the bone that subsequently becomes infected. In such cases, the fractured piece of bone often loses its blood supply and dies off. The horse’s body then recognises the piece of bone as foreign material, which causes a persistent infection of the foot. The only cure for this is to remove the dead piece of bone surgically. It can be difficult to effectively remove the infected and damaged bone, whilst leaving sufficient healthy tissue for the horse to recover and weight bear fully.

Pedal bone fracture prognosis

The prognosis for pedal bone fractures is generally good, but this depends on whether the fracture enters the coffin joint (the joint between the pedal bone and the short pastern bone). Some horses with such fractures end up with severe osteoarthritis of the joint, for which there is little successful treatment available.

One of the most difficult decisions for vets dealing with pedal bone fractures is when the horse can restart exercise. This decision is made more difficult as X-rays can be of little assistance – often, the fracture line is still clearly visible on X-rays many years after the horse has become sound and is back in full work.

In many instances, the decision of when to return a horse to work is made purely on the clinical progress of the horse and its degree of soundness, with follow-up X-rays providing little, and often conflicting, information.

Further reading

Pedal bone fractures – May 2011

Splints in horses: what all owners need to know

Carol Phillips — Wed, 13 Nov 2019 14:40:49 +0000

This article has been edited and approved by Karen Coumbe MRCVS, H&H’s veterinary advisor since 1991.

(Image credit: creditUnknown)

Splints in horses are hard lumps, which are actually bony enlargements found on the side of the horse’s leg between the knee and the fetlock joint, located where the splint bone runs down on either side of the cannon bone.

What are the splint bones?

The medial and lateral splint bones are the remains of the second and fourth digit of the horse’s five-toed prehistoric ancestor. Digits one and five disappeared during evolution, while two and four become splint bones, with the middle digit forming the weight-bearing cannon bone.

The upper two thirds of each splint bone is attached to the cannon bone by dense fibrous tissue called the interosseous ligament. The lower section flares away from the cannon bone slightly and is connected to the surrounding structures by soft tissue. The lower end of the splint bone has a small pea-like “button” which can be felt through the horse’s skin.

In most horses the interosseous ligament gradually changes with age as the splint bones fuse to the cannon bone at around three to four years. This process is normal and has no clinical signs.

Splints in horses: Causes | False splints | Diagnosis and treatment | Complications

What causes splints in horses?

A true splint occurs when the interosseous ligament becomes damaged, leading to soft tissue inflammation and lameness with heat, pain and swelling in the area between the splint bone and cannon bones. As the acute inflammation settles and healing proceeds, new bone is laid down in this area, eventually forming a hard, non-painful lump, the size of which depends on the degree of original damage. This is the splint, which will reduce in size over time, but is unlikely to disappear. The new bone stabilises the source of irritation by forming a bridge between the digits.

These splints occur most typically on the inside of the forelimb, or on the outside of the hind limb in young, immature horses in work.

Poor conformation, mineral imbalance in the diet, excessive weight of horse or rider, concussion associated with work on hard and uneven going, and unbalanced hooves can all lead to splints forming.

False splints in horses

False splints occur as a result of direct external trauma to the splint bone itself, such as the striking of the inside forelimb with the opposite leg, or kicks to the outside splint bone during field trauma or injuries. A bony lump forms where there has been bruising and damage to the periosteum covering the bone.

Fractures of the splint bone, which are most common in young horses, can also lead to the formation of a splint. Kicks and infected wounds can also cause fractures along the splint bone. There are also some fractures of the distal or thinner lower end of the splint bone that are associated with excess bending of the fetlock, due to weakening of the suspensory ligament caused by desmitis.

Diagnosis and treatment of splints in horses

The diagnosis of a simple splint is usually achieved on clinical signs, but your vet may wish to X-ray, or much less commonly, use other imaging techniques, if complications, such as a fracture, are suspected.

A fractured splint should be suspected, if a horse has an open wound, often from a kick injury, on the side of the cannon bone , which is slow to heal.

In the majority of cases the main forms of treatment are rest and anti-inflammatory therapy, with hydrotherapy used in some chronic cases. Prolonged peroids of rest may be needed.

Once the splint has finished forming, most horses are able to return to work and suffer no on-going problems from a splint, although they can be unsightly and may be considered a significant blemish, particularly in show horses. If the swelling is reduced surgically, there is a high chance of recurrence in operated horses.

Complications

The main concern associated with fully formed splints is cosmetic, although a splint positioned close to the knee joints could lead to carpal arthritis or it has the potential to interfere with the soft tissues, although this would be unusual.

The usual complication with almost any splint is the amount of time off required, which can stretch into months and be particularly problematic in older competition horses.

With this in mind, it is worth following these simple steps to lessen the risk of a splint forming in the first place:

Exercise: don’t do too much too soon, especially on hard ground
Maintain proper foot trimming and shoeing
Use exercise boots or bandages to reduce interference injuries
Manage horses kept together to minimise kick injuries, as much as possible

Knee joint injuries in horses H&H VIP

Horse & Hound — Tue, 21 May 2019 08:00:22 +0000

Colloquially referred to as the knee, the equine “carpus” would be more accurately termed the wrist — as this is its equivalent structure in the human body. The horse’s fetlock then relates to our knuckle, his hoof to our fingernail and his pedal bone to the bone in the very tip of our finger.

The carpus consists of two rows of bones: the radial, intermediate and ulnar carpal bones at the top, and the second, third and fourth carpal bones beneath (some horses, but not all, have an additional first carpal bone). The pointy bit you can feel sticking out at the back is the accessory carpal bone.

These rows form two joints, the radiocarpal joint and the intercarpal joint. There is, in fact, another joint between the bottom row and the cannon bone, known as the carpometacarpal joint. Having no movement, however, this joint suffers from very few problems.

Two extensor tendons run over the front of the carpus, and two palmar carpal ligaments at the rear attach the rows of carpal bones.

Floating fragments

Injuries to the carpus fall into two categories: bone chips within the knee, or a combination of fracture, swelling and laceration as a direct result of trauma.

Chips to the bones inside the knee are most often seen in racehorses, forming a big part of the surgery list every week as the Flat season gets underway.

These fragments may be developmental in origin and part of the osteochondrosis dessicans (OCD) disease process, but more commonly occur as a result of overloading. Uneven distribution of weight could be a one-off, high-load impact, causing a small piece of bone to fracture and form a chip, or more repetitive in nature.

As bone adapts to race training, it can become harder and more brittle, making it more susceptible to fracture. Chips can vary in size and occur on the edges of the knobbly carpal bones, typically where the force of the weight comes through the joint.

While most of the horse’s weight is distributed down the inside of the leg, there is also a lot of pressure on the front of the leg at full gallop. If you imagine a photograph of a racehorse in action, the carpus of the foreleg on the ground can appear hyperextended — almost bending slightly backwards. This often leads to an associated stretch of the palmar carpal ligaments at the back of the knee, so we commonly find damage to these in the presence of bone chips.

Less frequently, the fracture can be much larger. Diagnosis of a “slab” fracture is made because the horse is lame, with a joint that is swollen and painful when flexed, and can be confirmed by radiographs.

Treatment is aimed at removing the chip, via arthroscopy (keyhole surgery). If the fractured piece of bone is big enough, repair with screws may be possible — a procedure that can be carried out via arthroscopy under general anaesthesia. As long as the damage to the joint and the articular cartilage is not too severe, the prognosis is good. Around 80% of these cases return to their athletic career.

Trauma to the carpus is common and can occur from a kick, for example, or repeated banging of the joint against a hard object such as a stable door.

A swelling known as a carpal hygroma can form over the carpus, as fluid pools under the skin. A hygroma is a cosmetic blemish and lameness is not usually present, although infection can develop after drainage or injection.

An injection of contrast material and subsequent radiographic examination will outline the extent of the hygroma, while fluid injection into the carpal joints will establish whether or not there is any communication between the joint and the hygroma.

Treatment in the early stages involves drainage, steroid injections and bandaging. If infection is present, surgical resection (removal) of the infected tissue is recommended.

Any swelling over the carpus should be carefully evaluated. If there is a wound — even a pinprick from a thorn — infection can occur in the inter- and radiocarpal joints, as well as the tendon sheaths that lie over the front of the carpus.

In these instances, infection must be ruled out or appropriate treatment started immediately if it is discovered. Surgery may be necessary, involving high-volume lavage (flushing out) of the tendon sheath or joint.

Any lump or bump as a result of suspected trauma that causes lameness will require further diagnostics, such as an ultrasound scan or radiography.

Open wounds

The term “broken knees” refers to the often horrific-looking cuts and grazes a horse sustains when falling on to his knees on a rough, hard surface.

The carpi are particularly susceptible to damage as they lack padding from muscle or soft tissue and will be flexed when the horse falls, meaning that the skin is taut and more easily cut. Injuries are likely to be full-thickness and abrasive in nature, resulting in significant tissue deficit and bruising.

Additionally, these wounds tend to be heavily contaminated. It may be impossible to suture the skin, so wounds are often managed as second-intention healing where the edges are left to close naturally. The carpus goes through a large range of motion, however, which places the area under tension and reduces the chances of satisfactory healing.

Knee lacerations often need careful dissection to debride (remove) any dead tissue and contamination, a procedure that may require general anaesthesia. When sufficiently clean, the wounds should be repaired as well as possible and the leg immobilised either with a heavy bandage or bandage cast.

Broken knees should always be evaluated for evidence of joint penetration, although the two extensor tendons running over the front of the carpus will offer some protection.

Ref Horse & Hound; 16 May 2019

First win for racehorse who underwent remarkable surgery on fractured leg

Lucy Elder — Sat, 30 Mar 2019 16:52:31 +0000

A racehorse who made a comeback from a broken leg has scored his first win.

Prince Dundee, trained by Lucinda Russell, was diagnosed with a micro-fracture in June last year and underwent standing surgery on his cannon bone at The Royal (Dick) School of Veterinary studies.

The procedure went so well that he was able to return to his job months later and has raced five times this season, winning over fences by five lengths on his last outing at Hexham (26 March) with jockey Blair Campbell.

Posted by Lucinda Russell Racing on Wednesday, March 27, 2019

Lucinda told H&H the outcome has been “absolutely fantastic”.

“The surgery was amazing,” Lucinda said, adding the standing operation came without the risks associated with general anesthesia.

“His recovery was great, when horses have had a major issue [there is always the concern] they might not fully recover within themselves, especially when we are talking about athletes.

“He has not only come back to race, but has now won as well.”

Broken bone? No problem, we'll repair it standingIts been a record year at the Dick Vet Equine Hospital for fractures, with a greater number and range than we've had before, perhaps its due to the hard ground after our wonderful summer? So far we've generally had great success, and we thought you might like to see whats involved, so here's a wee treat for you. In this video Dick Vet Equine Surgeon Dr Eugenio Cillan-Garcia fixes a fracture with the horse standing and sedated. We do this because it reduces the risks for the horse. We've speeded it up so you can see the whole process…enjoyPosted by Dick Vet Equine on Thursday, August 23, 2018

The fracture did not show up on X-rays and was diagnosed through bone scans and MRI.

Vet Eugenio Cillán-Garcia performed the surgery (news, 6 September 2018), which involved inserting two screws into the leg.

He explained this type of diagnosis and surgery is to prevent a small fracture such as this from worsening to become a catastrophic fracture, from which horses cannot survive.

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He added the horse had a slight lameness last year, so they started investigating.

“The X-ray didn’t show anything, no sign of a fracture, but I was still quite suspicious so we decided to do a bone scan,” said Mr Cillán-Garcia.

This showed a very hot area, which led to the diagnosis of a fracture and surgery 10 days later.

Mr Cillán-Garcia was full of praise for the veterinary team, Lucinda and the horse’s owners for allowing him to “go the extra mile”.

“You have to have a really good team together, not just on the veterinary side, but the trainers and owners,” he said.

“I’m tremendously lucky working with some of the clients I do, especially Lucinda who is so forward thinking and cares for her horses so well.

“We did the video because this is something we are doing often and I think it is good for people to know [how it works].”

For all the latest news analysis, competition reports, interviews, features and much more, don’t miss Horse & Hound magazine, on sale every Thursday

Racehorse returns from broken leg to win first race

Caroline Bankes — Sun, 10 Dec 2017 16:09:42 +0000

A National Hunt racehorse who suffered a serious fracture to a hind cannon bone has made a miraculous recovery winning her first race after a year off.

Miss Tiggy, who is in the care of Grand National-winning trainer Lucinda Russell (One For Arthur), had her winning run at Ayr on 4 November.

“To win was just fantastic. The owner of the horse John Adams was totally supportive at every stage. The happiness and joy on his face in the winner’s enclosure made my day,” said Lucinda.

The seven-year-old mare was given a life-saving operation at the Royal (Dick) School of Veterinary Studies equine hospital in Edinburgh in November 2016.

She had come in lame after the gallops, but nothing showed up on the first X-ray.

A follow-up bone scan at the Royal (Dick) revealed she had a serious fracture at the top of her hind cannon bone just under her hock.

Orthopaedic vet Eugenio Cillan Garcia from the Dick Vet Equine Practice said the only way to repair the break was to put three screws into the cannon bone.

The surgery was conducted with the mare conscious and standing, but heavily sedated to give the best possible chance of recovery.

A few days later Miss Tiggy was back in Lucinda Russell’s Kinross yard on three months box rest.

Continued below…

(Image credit: Dick Vet Equine Practice)

‘One For Arthur’s done Scotland proud’: Lucinda Russell becomes fourth female trainer to win the Grand National

The winning connections of Grand National hero One For Arthur reflect on a day they will never forget

(Image credit: Dick Vet Equine Practice)

Grand National hero out for the season with injury

Trainer Lucinda Russell said the horse’s welfare “comes first” and his owners have taken “triumph and disaster in an impeccable

“When they come back after an injury like that you’re just grateful at every stage, first that they are alive, then they can be turned out. Just to start riding again was an achievement,” said Mrs Russell.

Before the injury Miss Tiggy had run five times, being placed on three outings but never had a win.

“We were hopeful we could save her, but never imagined she would go on and win races,” said Tess Fordham, the vet who oversaw her rehabilitation.

Miss Tiggy’s next outing is at Hexham on 13 December.

For all the latest news analysis, competition reports, interviews, features and much more, don’t miss Horse & Hound magazine, on sale every Thursday

Complex fractures in horses: what’s the prognosis? H&H VIP

Horse & Hound — Sun, 02 Oct 2016 07:55:08 +0000

As the X-ray images appeared on screen, Leila Loveday didn’t need her veterinary training to see that the outlook was bleak for her Irish sport horse Bambi.

The mare had been kicked in the elbow by one of Leila’s geldings after escaping from her own paddock to join them. The impact had smashed the bone to pieces.

“Her elbow was shattered,” recalls Leila, an equine vet, who co-owns Bambi with Sue Cross. “I feared the worst when she came in hopping lame with a nasty wound, unable to bear weight on the leg. The prognosis was dire — we were close to putting her to sleep.”

Bambi was taken to Rossdales Equine Hospital, where surgeon Tim Barnett discussed the options with her owners. While surgical repair of the fracture was a possibility, there was a significant risk that the site would fall apart after surgery or fail to heal. The greatest challenge would be returning Bambi safely to her feet after her anaesthetic and nursing her through the critical early weeks.

“She’s a very amenable mare, so I knew that the aftercare would be easy if she could just get through the operation,” says Leila. “We decided to go for it.”

The location of the injury made the 13-year-old mare a good candidate for surgery.

A radiograph of the fractured ulna before surgery (Image credit: creditUnknown)

“She had suffered a comminuted fracture of the ulna,” says Tim, explaining that this term is applied when a bone breaks into two or more pieces. “There were a lot of free fragments of bone, with fracture lines opening up into the joint. These injuries can heal well, however, with the use of plates and screws to keep the bone together — providing that the horse gets up after surgery and keeps as still as possible for a few weeks.

“We are able to make the horse comfortable and to bear weight on the injured limb immediately following the repair of an elbow fracture,” continues Tim. “With fractures of long bones, such as the radius or femur, it can be extremely difficult to make the horse comfortable enough to weight-bear. Laminitis can develop very quickly if the opposing leg is overloaded, often proving fatal.”

Inserting metalwork

With Bambi fully anaesthetised, the team at Rossdales could start the lengthy and complicated process of fixing the splintered pieces of bone back together.

“Infection is always a risk because injuries to this area are usually associated with a wound,” explains Tim, who operated on Bambi with senior surgeon Tim Greet.

“There is very little muscle cover over the elbow, so the wound typically reaches down to the surface of the bone. It’s important to remove any foreign material from these ‘open fractures’, making sure they’re as clean as possible, because any infection will cause repairs to loosen and fail.

“When we opened up the region we found lots of damaged bone that could not be pieced back together,” adds Tim. “We had to remove some of these fragments and use an artificial bone cement to fill the gaps, to allow the plate to fit neatly.”

A plate being held in place on a cadaver model of a similar ulna fracture to Bambi’s (Image credit: creditUnknown)

Tim explains that plates are used to counteract forces that might cause instability of the break and prevent proper alignment of the edges of the bone.

“It’s vital to place the broken pieces in the correct anatomical place, or as close as you can get them,” he says. “We shaped a plate to fit the bone contours, bending the metal with instruments. We then lined up the holes in the plate with areas of bone that were suitable to be drilled into, filling every hole with a screw. This gave the best chance that Bambi’s repair would hold.”

The critical moment was approaching, as Bambi regained consciousness after surgery. Any sudden or awkward movement could pull the metalwork clean out.

Her owners endured the long, anxious wait for news.

“We were on tenterhooks all day,” recalls Leila, of the nail-biting episode in September 2015. “The operation took a few hours, but eventually Tim rang to say that she was up.”

Bambi’s placid nature proved a bonus during recovery. The mare stood quietly during several weeks of nursing at the hospital, before returning home for three months of box rest.

“Provided the fracture is brought close together and stabilised, with no infection, the prognosis for initial healing is good,” says Tim. “The bone reacts, growing across the fracture line to form a scar.

“After around two months, the site may well be strong enough for the metalwork to be taken out. If the horse is comfortable, however, plates and screws are usually left in place with repairs such as this one. The callus [the bony healing tissue] will often wrap itself around or alongside the plate with time, making removal difficult.”

Long-term prognosis

Just five months after the accident, Bambi was back in light ridden work. Leila then gave the mare a further two months’ rest before starting a gradual rehab programme and stepping up the schooling.

Remarkably, Bambi won both novice classes on her return to affiliated dressage in July.

“The more work she does, the better she moves,” says Leila. “There’s very little scarring around the elbow and you can’t really feel the plate. She has even popped over a few logs in the forest.

Bambi back in action (Image credit: Sue Cross)

“The plan was that she would be a hack, or, failing that, a broodmare,” adds Leila, who recently qualified the mare for the Petplan Area Festival finals at elementary. “Her recovery has surpassed all our expectations. We’re forever in Tim’s debt, and extremely grateful to the whole team at Rossdales.”

As for the long-term prognosis, Tim is cautiously optimistic.

“With any fracture line that leads into a joint, there’s always the chance that arthritis will develop with age,” he says. “But the elbow tends to cope well with this — it’s a very forgiving joint.

“Of all the fracture locations, the elbow has the best potential for a positive outcome,” adds Tim. “It’s challenging surgery, however, and each case must be assessed on an individual basis.

“Sadly, repair is not always an option. As a surgeon, it’s important to recognise the limits of the fracture you’re presented with.”

Mending breaks — fast facts

• Bone is one of the fastest-healing tissues in the body, able to regain full strength after successful healing.Outside of racing, devastating fractures are rare. The most common cause is a one-off traumatic injury — typically a kick from another horse, a road accident or collision with a solid object such as a fence post.

• Fracture repair plates are made of steel alloy, with the same type used for many species. Very few are equine-specific.

• Modern equipment and techniques now allow the repair of many distal (lower) limb fractures under standing sedation, without the need for general anaesthetic.

• A successful outcome depends upon accurate diagnosis of the fracture and careful planning of the surgical repair.

• Tim Barnett is one of the relatively few European and RCVS specialists in equine fracture surgery — and one of six such surgeons based at Rossdales Equine Hospital. “Those of us who train as surgeons attend specific fracture repair courses,” he says. “We practise on artificial cadavers and models.”

Ref: Horse & Hound; 29 September 2016

Neck fractures: what’s the outlook? [H&H VIP]

Horse & Hound — Wed, 02 Jul 2014 08:00:50 +0000

Fractures of the neck are mercifully rare. To understand the nature of these fractures, it helps to know a little about the basic anatomy of the equine neck.

The spinal column in the horse’s neck area is made up of 7 separate vertebrae. A tube runs down the middle of them, called the vertebral canal, which encases the spinal cord. The vertebrae are held together by facet joints, one on either side, above the spinal cord. Beneath the cord, the vertebrae are cushioned by discs.

The critical structure in all this is the spinal cord, which carries nerve impulses between the brain and the body. Damage to the spinal cord is serious, with limited chance of repair. Spinal cord damage can result in a range of findings, from mild unco-ordination of the

hindlimbs through to sudden death due to paralysis of the respiratory muscles.

Research into spinal cord injury is a huge priority in healthcare, with cutting-edge research being carried out in the veterinary field. This includes the promising use of “ensheathing cells,” a specialised stem cell which originates from the link between the brain and the nose.

Reflex action

The challenge for any vet called to a horse who is down is to ascertain whether there is damage to the spinal cord.

In a competition situation, it can be difficult to establish if the horse has a serious spinal injury or is simply winded. It is normal to allow a horse at least half an hour after a severe fall to get back up.

Damage to the spinal cord is not visible on an X-ray, as the cord is of the same density as muscle and ligament. However, on occasion it can be inferred from the damage to the bony column, the cervical vertebrae.

If a horse has a smashed neck, an X-ray will tell us that the outlook is hopeless. Fortunately, this situation is very unusual.

We can usually only take X-rays in one plane, from side to side, yet many fractures are only visible in the up-to-down plane. More often than not X-rays are inconclusive, so a bone scan is necessary for diagnosis.

A veterinary surgeon on duty at an event or called to a riding accident where the horse is down will assess the recumbent horse. If there are no reflexes of the hind limbs and no sign of improvement over a limited timescale, then the horse will need to be euthanased to prevent any further suffering.

Sudden death or total paralysis are much more unusual presentations with an equine neck fracture. As always, the difficulty is the grey area. There may be nothing horrendous on the X-rays, but the horse is either unable to rise or is ataxic — he appears unaware of where his legs are.

The horse has a very large vertebral canal, relative to the size of his spinal column. The diameter of the canal varies with the position along the neck or back.

While upper neck fractures can be catastrophic for a human, resulting in lifelong dependency on a ventilator to breathe, horses that survive an upper neck fracture to diagnosis will often return to ridden exercise. The fractures can be radiographically dramatic, but the large diameter of the canal allows considerable disruption before there is any pressure on the spinal cord.

The equine neck is narrowest at its base, underneath the shoulders, at the junction with the thoracic spine. Fracture here often results in severe ataxia. It is also where it is hardest to X-ray, due to the massive soft tissue musculature of the horse’s shoulder.

Time will tell

Realistically, there is no effective treatment for neck fractures other than rest. The musculature of the horse provides remarkable stability and, given time, many of these fractures will heal very well.

While displacement of the fracture can occur days or weeks after the trauma, this is not common. Pelvic fractures are much more prone to displacement.

There is a surgical procedure to stabilise 2 vertebrae, either with bone plates or a stainless steel basket. The risks of general anaesthesia in a horse with an unstable neck fracture, however, are substantial.

This surgery is usually reserved for “wobblers”, a related condition where the vertebrae are malformed either through abnormal growth or through disease such as arthritis. This malformation creates pressure on the spinal cord and results in ataxia. Fusing 2 vertebrae together reduces pressure on the spinal cord during movement.

The hardest question with neck fractures is “will the horse get better”? No one wants to go through a prolonged rest regime only to find a year later that the horse is still wobbly and is a danger to himself and to everyone around him.

Predicting the degree of improvement — or indeed if there will be any improvement at all — remains very difficult.

Within a few hours of injury, the fracture haematoma (the blood clot surrounding the break) will exert pressure on the spinal cord. Over the next week or so, this is absorbed and replaced with granulation tissue — the soft, pink tissue sometimes seen filling the defect in a skin wound.

Granulation tissue then changes into scar tissue. On occasion the scar tissue enlarges, resulting in greater pressure on the cord and a marked deterioration in the horse’s condition. Most horses improve over the first 3 months, with some further improvement over the next 9 months.

Broken necks in horses are potentially devastating but rare. A crashing fall more often results in fracture of the limbs or of the thoracic spine.

When neck fractures do occur, the outcome may be sudden death or euthanasia a short while later due to paralysis. Often, however, the horse is able to rise after a while. Provided that the spinal cord is not permanently damaged or compressed and that healing is satisfactory, the horse can return to exercise.

Case study: a dramatic fracture

Racehorse Fred (name changed) broke his neck during a fall at Newbury races. X-rays showed a moderately displaced but still incomplete fracture of his 2nd cervical vertebra. As a result of muscle contraction, his 3rd vertebra was displaced forwards into the gap left by his 2nd vertebra.

Despite this dramatic fracture, Fred’s primary clinical signs were swelling of his neck and associated pain. He was ataxic — a bit wobbly —but less than you might have guessed on seeing these X-rays.

Fred was managed conservatively with painkillers and strict box rest. He later returned to training. Sadly, hopes of a happy ending for this story were shattered when, a couple of weeks before his next race, Fred fell again and broke his pelvis.

Radioactive risks

While bone scans can be very useful in the investigation of spinal trauma, there are problems with this diagnostic method.

The horse is injected with a radioactive material, combined with an agent which binds to bone. The material is carried in the bloodstream and binds whenever it reaches a bone crystal.

The horse is then scanned with a camera that can detect radiation and highlight any “hot spots” where there is increased blood supply to the bone. Typically these are areas of inflammation associated with fractures, but could also be tumours.

Because bone scans involve radiation, they are regulated by law and can only be carried out in legally-defined “controlled areas” — which are all in veterinary practices. The procedure cannot take place in a stable at a horse’s own yard. The horse must therefore be fit for transport before a scan can be considered, which can be several weeks after the injury.

Additionally, it takes a minute or two to obtain the image. A horse that is wobbly and swaying around can be very difficult to scan.

This veterinary feature was first published in Horse & Hound (26 June, 2014)

Can split pasterns in horses be predicted? [H&H VIP]

Horse & Hound — Sun, 01 Dec 2013 17:26:27 +0000

A split pastern, where the first pastern bone cracks down the middle, is a common training and racing injury in thoroughbreds.

At the top of the first pastern bone is a central groove. A central ridge at the bottom of the cannon bone fits into this groove, inside the fetlock joint. The crack usually starts at the bottom of the groove and continues down the length of the pastern bone.

In severe cases, the whole bone can fall apart, requiring surgical repair with screws. Milder cases, in which the crack reaches part way before petering out, can heal with rest.

2 highly respected equine surgeons, writing in the Equine Veterinary Journal (EVJ), reported on 110 cases of split pastern. They speculated whether it might be possible to predict incipient fractures by measuring various features of the bone.

Most notably, they showed that the plate of bone beneath the joint cartilage seems to get thicker before it cracks. They compared the thickness of this bone plate with the total length of the bone, so that variations in the size of the horses were not confusing the measurements.

In pastern bones that had sustained fractures, the bone plate thickness was on average more than 4% of the total bone length. In the other non-fractured leg, it represented on average less than 4%.

The reason for this increased bone thickness before cracking is not certain. The most likely explanation is that, although the bone may be adapting to the stresses of training and racing, the bone plate does not develop sufficient strength in time to prevent a split occurring.

Laura Collett’s Noble Bestman operated on to repair broken pastern

Horse & Hound — Mon, 14 Oct 2013 11:52:43 +0000

Noble Bestman, the popular 4-star eventer ridden by Laura Collett and owned by Philip Walker, is recovering from an operation after fracturing his off-fore pastern during the cross-country at Boekelo on Saturday (12 October).

He will have to remain in the Netherlands until he is fit to travel, but vets hope he will make a full recovery.

Laura said: “He landed over a straightforward fence and went lame, so I pulled him up. The vets were brilliant and he was taken straight off to the clinic 10min down the road in a horse ambulance, where they X-rayed him and discovered he had fractured his off-fore pastern.

“We had to make the decision whether or not to operate, so I took the X-rays to [team vet] Liz Brown and talked to his owner [Philip Walker], and we decided to operate, which they did at 9am the following morning.

“The operation was successful — it was a clean, straight fracture and they put 3 screws in to hold it together. We were able to see him once he had come round, but he can’t travel for a couple of weeks.

“He’s a sensible horse so hopefully he won’t mess around too much on it, and the vets were quite positive and said that he should be able to come back to full work if he recovers well.”

Noble Bestman has his own twitter account — follow his recovery at @SuperSteveNo1 or through rider Laura Collett (@CollettEventing) or her headgirl Felicity Roberts (@flickrobertsno2).

Full report of Boekelo in H&H this Thursday (17 October).

Survey links racing surfaces with stress fractures

Horse & Hound — Fri, 22 Feb 2013 14:48:36 +0000

Vets have long suspected that the incidence of certain injuries in racing varied according to the type of surface on the track.

Horses racing on American dirt tracks appeared to suffer a different spectrum of injuries from those on England’s turf courses.

But such hunches have been difficult to measure objectively because there are so many other possible factors.

Now vets in California have had the perfect opportunity to test their theories on three courses that switched from dirt to synthetic surfaces in 2006-07.

The study concentrated on one specific injury, the stress injury and fracture of the humerus (the chunky bone between the shoulder and the elbow).

Vets studied the cases of 841 racehorses who had sustained such injuries in the two years before and after the track surface switchover.

With bone scans, radiographs and post-mortem findings on record, they could see if surface changes had altered the nature of the stress on the bone.

They already knew that the bone could be stressed and fracture either near the top beside the shoulder, or near the bottom beside the elbow.

Stress changes near the top were more likely to give rise to catastrophic fractures and the loss of the horse. Those near the bottom more commonly caused lameness that resolved with rest.

The study results revealed a clear trend. Horses that raced on the dirt tracks were far more prone to stress problems near the top of the bone and therefore to disastrous fractures.

Horses that raced on the synthetic tracks suffered a higher incidence of injury at the bottom of the bone, but fewer life-ending factures.

The softer and more forgiving synthetic surfaces do cause stress effects on the humerus of young racing thoroughbreds. Stresses are less severe and with less drastic effects, however, than when dirt tracks were used.

To read all the latest veterinary research and developments see 21 February 2013 issue of H&H

Read all the latest articles about fractures

Could fractures in horses ever be predicted?

Horse & Hound — Tue, 20 Nov 2012 15:43:14 +0000

Fractures to the bottom of the cannon bone within the fetlock joint are unfortunately common in racehorses.

They may be simple and non-displaced, in which case they can usually be repaired with bone screws, or they may be very serious and leave vets with no option but to euthanase.

All these fractures appear to start in roughly the same place on the joint surface of the cannon bone and may go undetected in the early stages.

During strenuous exercise, like racing, the break splits upwards through the bone and then out of the side of the bone shaft.

Between 1999 and 2005 there were 47 catastrophic fractures of this kind on UK racecourses.

Vets and researchers at Newmarket’s Animal Health Trust looked carefully at the fractured legs and the non-fractured fetlocks from the same horses before comparing them with the fetlocks of horses put down on racecourses for other reasons.

The fetlocks were all MRI scanned and those with apparent changes were X-rayed.

The horses that had sustained fetlock fractures of this kind showed distinctive MRI changes in the bone pattern in the area of the fractures.

Some 11% of these horses had early, previously undetected fractures in the other leg as well, while pre-fracture MRI signs were seen in the lower cannon bones of 12% of the horses that had been lost because of injuries unrelated to the fetlocks.

This research shows that it might be possible to predict fractures of this kind in the future using MRI.

At present this would be expensive and impracticable, but who knows what might be possible in the future?

Read all the latest veterinary research and developments in this week’s issue of H&H (22 November)

Find out more about fractures

Find an equine vet

Putting a plaster cast on a horse’s broken leg

Horse & Hound — Wed, 18 Jan 2012 11:05:18 +0000

Do you need an equine vet?

Like people with broken legs or arms, sometimes horses have to have their limbs put in casts.

These days, casts are made from synthetic resin and fibre, rather than plaster of Paris, but the principle of their function remains the same – to ensure complete immobilisation.

Occasionally, a cast might be put on to repair a fracture, but more commonly they are applied after complex orthopaedic surgery or after severe lower limb injury.

The casts work a treat on the affected limb, but vets know that a potential complication is always lurking in the wings – laminitis in the other foot.

It seems that prolonged weight bearing on just one limb can disrupt the normal internal function of the foot so much that it suffers laminitis.

The horse may then be lost, not because of the original injury, but because of the secondary laminitis.

Vets in Colorado reviewed records of 113 horses requiring casts to support or repair a limb. Some were full length, some were half length, some were for forelimb and some hindlimb. They were all left on for at least a week.

All were hospitalised and treated with every possible nursing attention. Despite this, 12% still suffered weight-bearing laminitis.

Vets found that several factors appeared to increase the risk of developing laminitis in the healthy limb: the weight of the horse, the length of time the cast was left on and the type of injury.

It seems that, even though heavier horses may have bigger hooves, it is the actual weight on the healthy leg that causes the problems.

The longer the cast is in place, the greater the risk of developing laminitis. And horses with fractures were at greater risk in this study compared with those with other injuries.

The type of cast made no difference and, surprisingly, horses with casts on hindlimbs were just as likely to develop laminitis in the other hindlimb as horses with forelimb casts – despite the front legs bearing so much more of the weight.

This veterinary article was first published in the current issue of H&H (19 January 2012)

Find an equine vet

Broken jaws: surgery

Horse & Hound — Tue, 30 Aug 2011 15:50:15 +0000

Surgery — the options

Horses that have displaced fractures or bilateral fractures will need surgery.

Depending on the nature of the patient and the type of fracture, this can be performed in the standing horse using sedation and local anaesthetic.

Sometimes a short general anaesthetic is needed, but this adds its own extra risks.

For fractures of the part of the jaw to the front of the cheek teeth — the incisors, incisive bone, mandible and premaxilla — repair can be performed with intra-oral wiring.

This involves thoroughly cleaning the fracture site and manually reducing the fracture.

Stainless steel wire is then inserted around the teeth on either side of the fracture to anchor it in place.

In cases where the canine teeth are present and the fracture is located in front of them, a notch can be cut into the canine teeth and a wire passed around them to hold the incisors in place.

A wire can be passed back around the second cheek tooth to provide further support, especially if the fracture is located behind the incisors and canine teeth.

An acrylic can be added to provide more security and to cover the sharp cut ends of the wire.

With a little creativity, intra-oral wiring can be used to stabilise any type of fracture in this area.

The goals of any fixation are anatomic alignment and stability to allow the horse to eat and drink.

There are occasions when more involved methods of fixation are required, such as internal fixation with screws and plates, plus intra-oral wiring.

For example, when a horse is kicked on the chin and the mandible is fractured with the incisors pushed back into the mouth, intra-oral wiring is used alongside an external fixator and/or a bone plate and screws to maintain stability.

For the full veterinary article on broken jaws, see the current issue of Horse & Hound (1 September, 2011)

Learn more about fractures in horses

Is surgery ever an option for broken ribs?

Horse & Hound — Tue, 07 Jun 2011 10:56:37 +0000

Anybody who has broken a rib will know how painful it can be and there is no magic cure apart from rest and time. But is the same true of horses? Can they be mended? And what is the long-term prognosis?

Surgery is only necessary for the most severe breaks, where the fractured sharp ends of the ribs are displaced inwards and have the potential to lacerate and damage the lungs.

In these cases ultrasound and X-rays should be aimed at calculating ways to stabilise the fractures so that there is no further damage to the lung.

If the lung has been damaged then a life-threatening collapsed lung (pneumothorax) may develop.

There are two methods of stabilising broken ribs.

First, anchoring support (external coaptation) can be achieved by placing stainless steel wires around the ribs and attaching them to a cast surrounding the rib cage.

Second, internal fixation can be achieved by repairing the fractured ribs individually using small bone plates, thick nylon suture or stainless steel wire fixation.

Both these techniques have good results, but self-healing is often the preferred option.

For the full veterinary article on broken ribs, see the current issue of Horse & Hound (9 June, 2011)

Treating a horse with a broken leg

Horse & Hound — Wed, 15 Sep 2010 11:27:05 +0000

Dealing with life-threatening equine fractures

Horse & Hound — Mon, 26 Mar 2007 11:32:41 +0000

While running in the Grade One Preakness Stakes in May 2006, Kentucky Derby winner Barbaro fractured his right hindleg. The decision was taken to try to save him and for a while the future was looking optimistic, despite the complication of laminitis. But then things began to deteriorate.

On 29 January, some eight months later, Dr Dean Richardson DVM, Barbaro’s vet at Pennsylvania’s George D Widener Hospital, took the decision, with owners Roy and Gretchen Jackson, to put the colt down. His pain was no longer manageable.

Would it have been kinder to end Barbaro’s life on that afternoon at Pimlico? Or is it justifiable to push against the boundaries of veterinary knowledge in the hope of securing a worthwhile quality of life for the patient?

There is clearly no definitive answer. Veterinary associations issue guidelines, but the assessment of each case can be made only by the individuals present.

Quality of life

Peter Webbon MRCVS, chief executive of the Animal Health Trust, believes long-term quality of life is the most pertinent factor.

“The mending of fractures, while technically demanding, is certainly feasible. Fractures above the knee are quite tough to deal with, but, overall, the problem isn’t the mending but the patient’s adjustment to post-operative care,” he says.

“As long as the welfare of the patient isn’t prejudiced to a significant degree and the patient isn’t distressed, it’s certainly justifiable to continue treatment. It’s only when the patient is clearly distressed, losing weight and no reasonable life expectancy will be achieved, that euthanasia is the best option.”

Barbaro’s treatment

Barbaro had a broken cannon bone, a broken sesamoid bone and a broken long pastern bone. Dr Richardson performed a fusion of the fetlock and pastern joints and implanted a stainless steel plate and 27 screws to give the leg maximum support.

Having recovered from anaesthesia, Barbaro was able to walk to his box, eat his food and put extra weight on his injured leg.

Two months later the broken bones had almost completely fused, although the signs of laminitis in Barbaro’s “good” hindleg began to cause concern. He was given a special support boot for his laminitic foot and a sling was brought into his stall to take the weight off his hooves for hours at a time.

But by the end of January, a deep abscess had developed in Barbaro’s right hind foot and, on 27 January, two steel pins were inserted into the healed bones of his right foot as part of an external fixation device to allow it to bear more weight. Later that same weekend, the previously healthy front legs displayed clear signs of laminitis. The colt could not comfortably put weight on any of his legs. The battle for his recovery had ended.

Prognosis

For every Barbaro, there are hundreds of other horses suffering traumatic injuries. Treatment of major fractures is time-consuming and expensive. Many owners can not afford to pay for surgery, unless it is covered by their insurance. But veterinary procedures are improving and fatal fractures are becoming rarer.

As Jacefk Bobkiewicz MRCVS, from Hook Norton Veterinary Surgeons, explains: “Ten years ago, the mortality rate was much higher. A better understanding of the mechanics of the bone, improved operating techniques, good quality of implant materials and the use of digital X-rays have all helped.”

This veterinary report was first published in Horse & Hound (1 March, ’07)

Diagnosing hairline fractures with scintigraphy

Horse & Hound — Mon, 12 Mar 2007 12:22:36 +0000

Modern diagnostic tools such as MRI or scintigraphy, also known as bone scanning, are sometimes preferable to the more standard imaging methods, such as X-rays (for bones) and ultrasound (for soft tissues), when diagnosing hairline fractures.

These modern tools can help pinpoint deep sites of skeletal inflammation, which are not apparent using other forms of routine clinical investigation.

With scintigraphy, a low level of a relatively safe radioactive substance attached to a “bone-seeking” agent such as (technetium) is injected into the horse’s bloodstream. In areas where there has been stress or damage, the bone has a greater uptake of this agent. This results in a higher radiation count in these specific areas, or “hot spots” which allow us to see how the bone is behaving or how it feels.

By comparison, X-rays provide an anatomical assessment of the bone, or how it looks.

The need to find the site of pain is also crucial. Many horse-owners will have made the mistake of disguising vague lameness with painkillers such as bute, which can be potentially disastrous when there is an underlying bone injury. If a horse with such an injury is returned to work prematurely, the damaged bone may fracture with catastrophic consequences.

This formed part of a veterinary feature on equine fractures in Horse & Hound (18 January, ’07)

H&H’s guide to different types of fracture

Horse & Hound — Fri, 23 Feb 2007 09:47:09 +0000

Obvious broken bones

These are mostly fractures of the long bones, across the main supporting shaft of the limb. As these bones have a vital weight-bearing role, a fracture here is usually bad news. The majority of such fractures will be impossible to repair, particularly in any horse weighing more than 300kg. If there is an open wound and a broken bone sticking out through the skin, the tissue damage and infection will be overwhelming.

Less obvious broken bones

These are mostly fractures of small bones, such as those within the hock, knee or foot. These bones suffer a range of different fractures and treatment depends on the size of fragment, angle of the fracture plane and degree of joint involvement. Some of these injuries may be treatable and the horse may return to full work.

Non-apparent fractures

These include hairline cracks and so called starburst fractures, which have not displaced. These will heal, provided the bones do not undergo further damage, transforming them into an obvious catastrophic fracture. Similarly difficult to detect are the stress or fatigue fractures most commonly found in young Thoroughbred racehorses, which can rarely be diagnosed definitively simply by looking at the horse. A problem with less obvious injuries is that the horse may only be transiently lame. Consequently, the horse may be turned out or return to work before the damage has repaired, resulting in more serious injury.

Chip fractures

These occur when a small fragment of bone chips off. The severity of the injury depends on the site of damage. For instance, if there is a bone chip within a joint, there is the potential for crippling degenerative joint disease to develop.

Other non-weight bearing lameness

Finally there is severe non-weight bearing lameness that thankfully turns out not to be a fracture at all and may be a bruise to the bone, pus in the foot, or something else entirely.

This information formed part of a veterinary feature about fractures in Horse & Hound (18 January, ’07)

Vet innovations: Prevention of racing injuries

Horse & Hound — Mon, 06 Feb 2006 12:22:10 +0000

Over the past five years, a number of veterinary research projects have focused on injuries to racehorses. In particular, the studies have identified factors that alter the risk of horses sustaining fractures of the lower leg during racing, and factors that increase the risk of horses falling during national hunt racing.

The results of these studies have been presented to representatives of the racing industry and have been published in scientific journals. If the findings are acted upon appropriately, and suitable injury-avoidance strategies devised, horses racing in the UK can expect to be safer than at any time in the past.

The study of lower leg fractures showed the importance of training horses at racing speed, not for long distances but for short “spurts” of gallop work. If the horse’s skeleton is exposed to the stresses generated at racing speed, it will adapt and strengthen appropriately.

Races at the start of a horse’s career have been identified as higher risk than races later on, when bone adaptation is more advanced. To minimise the risk associated with these races, the industry has initiated a programme of 13/4-mile national hunt flat races rather than the standard two miles.

It has also been found that horses are more likely to fall when jumping hurdles for the first time under race conditions. Some innovative racecourse “schooling races” have been introduced to give young horses experience of jumping obstacles under racing conditions, but in a less competitive environment.

Acting on the results of scientific research is just as important as conducting the research. Horses will only benefit from equine welfare research if it translates into altered management, novel diagnostic methods or treatments. Sometimes the hardest step in this process is moving from “interesting research finding” to “applied equine science”.

This formed part of a veterinary feature in Horse & Hound (12 January, ’06)

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Dealing with bone chips

Horse & Hound — Fri, 01 Jul 2005 11:37:28 +0000

Your horse sustained a small wound on the outside of the left fore cannon bone about two weeks ago. Despite cold hosing, bandaging and box rest, the wound has failed to heal. After a course of antibiotics prescribed by your vet, the discharge stops and the wound heals, only to swell up and start discharging again between five and seven days later. Frustration grows as you call for another visit. This time, the vet suggests a radiograph (X-ray) to see if a sequestrum has formed.

A sequestrum is a piece of dead bone that has lost its blood supply. The horse’s body treats this as a foreign object, rather like a splinter, and the immune system tries to reject it. That is the reason for the heat, pain, swelling, discharge and failure to heal. The immune system works hard to rid itself of this apparent foreign body, but is usually unsuccessful due to the size of bone involved.

How and why does it form?

Sequestra usually form in an area with minimal soft tissue covering the bone. Typically, this is the cannon bone region and over the splint bones, where the bone lies close to the skin; but any area with minimal soft tissue cover is at risk of a sequestrum following trauma. They include:

the inside of the forearm or gaskin
the bony prominence at the end of the stifle
the top of the head
the point of the hip
the lower jaw

The original wound associated with a sequestrum can vary from a small nick to a large laceration. Usually, the wound causes sufficient trauma to damage blood supply

to the underlying bone and may even cause a small, superficial fracture.

The size of the sequestrum will vary with the original trauma and can range from a few millimetres to a few centimetres. The most common site of sequestrum formation is one of the splint bones. The second most common site is the front of the hind limb cannon bone, following a laceration.

The damage to the bone may not be evident immediately, even on a radiograph (X-ray). It takes three to four weeks for the body to start the rejection process in earnest. Only after some of the bone surrounding the sequestrum has been reabsorbed can a definitive diagnosis be made through radiographs or ultrasound.

Is it a serious problem?

In most cases, a sequestrum can be treated successfully with surgical removal of the damaged bone. The bone is usually small and not essential. Rarely, a sequestrum poses a more serious problem. This occurs when the damaged bone is within a joint or involves a significant portion of the thick outer portion of the bone (the cortex). In the latter case, the bone may be at risk of fracture, particularly if a general anaesthetic is performed and the horse has to stand up as it recovers.

Although the sequestrum may appear easy to remove, there is often significant scar tissue around the bone that makes this task quite challenging. Radiographs taken prior to surgery can help to identify the exact location of the dead bone. As long as the delay in surgical removal of a sequestrum will not compromise the horse further, surgery can be delayed until the vet is reasonably certain that the affected bone can withstand the stress of recovery.

Occasionally, a sequestrum may be very small and can be reabsorbed by the body without the need for removal. In most cases, sequestrum formation is an inconvenience rather than a serious cause of persistent lameness. Many horses with sequestra are in fact not lame at all, and removal of the sequestrum usually results in a full return to normal function.

Following removal of the dead bone, healing is usually rapid, since the cause of the infection has been removed. In most cases, there is minimal or no lameness before surgery, which means that most cases can return to full work reasonably quickly. The speed of return to work (within a few weeks or a month) would be determined by the bone involved, the amount of bone involved, the location of the sequestrum on the bone and the healing of the original injury.

This veterinary feature was first published in Horse & Hound (16 June, ’05)

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Dealing with stifle injuries in horses

Horse & Hound — Thu, 21 Apr 2005 10:57:04 +0000

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Article below originally published online April 2005

Horses jumping fixed fences at speed are particularly prone to hitting their stifles, which can result in an injury even if the front of the hind limbs has been greased.

The degree of lameness usually, but not invariably, reflects the severity of the damage. Some degree of soft tissue swelling may develop, although the absence of detectable swelling does not preclude severe damage.

If lameness is severe the stifle should be X-rayed. This is generally not an emergency and can wait for 24-48hr until the horse can be moved to a suitable facility. If lameness is mild and improves rapidly, there is probably no serious underlying injury, merely bruising. But if lameness persists the horse should be X-rayed.

A standard X-ray of the stifle comprises views from the side and back, but this may be inadequate to detect a fracture of the inside of the patella. This area can be examined by holding the leg in a shoeing position, placing the X-ray cassette under the stifle and holding the X-ray machine above it. This results in a “skyline view” of the patella. It is crucial even if bony abnormalities have been seen in other views, because a horse can sustain a fracture of more than one bone simultaneously.

The three areas most susceptible to severe injury are the tibial crest, the trochlear ridges of the femur and the patella.

Fractures of the tibial crest vary in shape and size. Sometimes there is a crack, whereas in other cases a whole piece of bone may be fractured. Depending on the precise location of the fracture, it may be prone to becoming displaced from the parent bone by the pull of the patellar ligaments.

The treatment is dependent on the size and precise location of the fracture and whether or not it is widely displaced. The vast majority of these types of fracture heal satisfactorily with rest alone.

The healing process is monitored by serial X-rays. Initially the horse is strictly confined to box rest, but when a reasonably stable fibrous union has been achieved the horse starts daily walking exercise to promote bony union of the fracture.

In the early days it may be preferable to stop the horse from lying down, because a large non-displaced fracture could become displaced by the muscle pull as it gets up. The horse can be tied via a long rope or chain and a ring, which can slide on an overhead rope extending from one side of the stable to the other. This allows the horse to walk about, but prevents it from lying down. Most horses tolerate this well.

The majority of horses are able to return to work after 3-6 months. However, if a large fracture is substantially displaced this has to be treated surgically. This involves placing a plate over the fracture using multiple screws. This usually works very well, although severely traumatised bone may be vulnerable to splitting during or after screw insertion. The prognosis for return to competition is generally good.

Fractures of one of the trochlear ridges of the femur often results in several small pieces, which must be surgically removed. This is easily performed using keyhole surgery if the pieces are immobile. It is more of a challenge if they are mobile.

During arthroscopic surgery of the femoropatellar joint, fluid runs into the joint to keep it inflated, therefore allowing a good view of the joint. If bone pieces are highly mobile they can be difficult to find and remove. Fortunately these fractures usually occur at the lower part of the trochlear ridges, a region not subject to pressure from the patella. Joint function is therefore not compromised and the prognosis is good.

Small avulsion fractures (when a fragment is torn off) may occur from the top of the patella. These generally require no other treatment than rest. Once the horse becomes sound it is generally safe to resume work, although the fragment may still be apparent on an X-ray.

More serious are the fractures that involve the inside part of the patella. Even if non-displaced, these must be removed because they never heal satisfactorily. They almost invariably involve the joint surface of the patella, and osteoarthritis is an inevitable complication if the fracture is left in situ.

Small fractures can be removed using keyhole surgery. Larger fractures may require a bigger incision, but this can be kept as small as possible by using arthroscopy to identify the location of the fracture and free the fragment from any attachments. A small incision can then be made directly over the fragment.

During the arthroscopy procedure, the entire femoropatellar joint can be inspected to ensure that there is no other damage, and any bone debris flushed out.

Generally, surgical removal of the fracture results in a favourable prognosis for return to full function, in the absence of cartilage damage. But the initial injury is sometimes more complicated. There may be associated muscle damage, or tearing of the joint capsule, or tearing of the ligamentous attachments to the patella. All these factors make the prognosis much more guarded.

This veterinary feature was first published in Horse & Hound (24 March, ’05)

Understanding the forces behind fractures

Horse & Hound — Thu, 14 Apr 2005 14:49:46 +0000

Horses still occasionally fracture their legs while racing, although, luckily, it is a comparatively rare occurrence. It is important to understand why such fractures happen, because if there is a common reason, changes in the management of either racecourse or the racing calendar could be made.

A study performed at the University of Liverpool, funded by the Horserace Betting Levy Board, investigated whether there are common factors to explain why either a horse suffers a fracture or if certain races had specific reasons why injuries occur during them.

The first part of the study (view article here >>) identified why some horses may be at an increased risk of sustaining such a serious injury. The second part of the study investigated why features of a particular race may result in an increased risk of fracture. This identified 109 races over a two-year period in which a serious fracture to the lower limb occurred.

The same information was gathered on each of these races. It was compared with three randomly chosen races of the same type (such as hurdle, steeplechase or all-weather) run in the UK within five days of the race in which the injury occurred, as well as three randomly chosen races of the same type in the UK in the same calendar year.

Two significant findings were that longer races and races with more runners carried an increased risk of horses sustaining a serious lower limb fracture. While this was a highly statistically significant finding, it may be no more than a reflection of the fact that there were more horses at risk during a greater period of time in longer races with more runners.

Although it might be expected that shorter races would show an increased risk, since they are generally run at a faster speed, there was no evidence that this was the case. In fact, the speed of the race had no effect on serious fracture incidence.

The possibility that such injuries occurred more frequently in races with greater numbers of runners as a consequence of direct contact between runners was shown not to be the case in a previous study assessing videos of races. This showed serious injuries were not commonly associated with physical contact between horses.

An important finding was that the condition of the course had implications for the risk of the horse sustaining a serious fracture. First, the risk was altered substantially through variation in the declared going on the day of racing. Horses were 2.6 times more likely to sustain serious fractures in races run on good to firm or firm surfaces. This supports other studies that identified the going as vital to the risk of injury.

Further research has identified key relationships between the risk of fracture and the condition of the course. In particular, the going at the previous meeting was found to have a significant bearing on the risk of fracture at the next meeting at the same course. If the going was any firmer than soft during the previous raceday, the risk of serious fracture increased.

The risk was also associated with the length of the period between meetings. If the race occurred within nine days of the previous meeting, there was an increased risk of serious limb injury. The risk was greatest at one day after the previous meeting and decreased significantly up to nine days. If the period between meetings was more than nine days, there was no further decrease in risk.

It is likely that the going at the previous meeting will affect the condition of the course at the next meeting. If the surface is uneven, the balance of forces through the horse’s limb are likely to be altered, increasing the risk factor.

It appears that the maintenance of the course is vital, and the increased risk when meetings are held close together may reflect difficulties in repairing damage before the next meeting.

The ground condition, or “going”, is a potentially controversial area. The Jockey Club recommends that racecourse managers aim to provide good to firm ground for flat racing and good ground for jump racing. Most British courses have some form of irrigation that can be used to alter the going. The use of such systems can be difficult due to changeable weather and the imprecise nature of forecasts. In hot weather, it can be difficult to water sufficiently to make appreciable changes in the going.

Despite this, there is good evidence that going has a strong influence on risk of injury during racing. More research is needed to understand fully what is required to minimise the risks. The challenge now is to develop techniques that will provide a durable surface that reduces injury risk while withstanding repeated racing in a British climate.

This veterinary feature was first published in Horse & Hound (10 March, ’05)

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New racing fractures research unveiled

Horse & Hound — Thu, 25 Nov 2004 10:43:36 +0000

A lack of work at racing speed and the use of sand gallops in training have been found to increase the likelihood of a racehorse suffering a bone fracture in a race. Horses in their first year of a racing career also carry an increased risk of suffering a bone injury.

These were the findings of a major research study funded by the Horserace Betting Levy Board, which was recently published in the Equine Veterinary Journal. The research, headed by Dr Tim Parkin, was carried out at the University of Liverpool into reasons why horses may sustain serious broken lower legs (from the hock and knee to the foot) during racing.

Three major factors were identified that altered the risk substantially of the horse sustaining a fracture. A major finding was that horses that undertook no gallop work in training had an increased risk of serious injury. This risk was reduced substantially if the horse did any fast galloping work during training.

This finding supports several other studies looking at how bone adapts to exercise, in particular that the bone is able to change both its shape and structure to make it strong enough to withstand the forces required of it during galloping exercise.

There was some evidence in this study that horses which do an excessive amount of galloping exercise during training may have a slight increase in risk of fracture, although the number in which this occurred was very small. It is likely that in these horses the bone has become as strong as is possible, and that excessive exercise is leading to damage within the bone, which then increases the risk of fracture.

The conclusions of the study are that short distances of high-speed exercise are vital to allow the bone to adapt and become strong enough to withstand racing competition. This distance may be as short as the horse doing fast gallop work of between four and 10 furlongs (800-2000m) each week.

Horses trained by methods that involve no fast work during training tend to have bones that have not adapted to withstand the rigours of competition, and thus are at increased risk of serious injury.

Greater risk in first year

The second significant finding was that there was a large increase in risk of fracture in horses in their first year of racing. After the first year, there was a decrease in risk

of injury, but there was evidence of an increased risk in horses that raced for more than five years.

However, very few horses have racing careers that last for this length of time, with only 8% of the horses in this study having raced for five or more years.

This effect of racing experience was not dependant on the age of the horse, with no significant difference in the amount of risk between a horse which started racing as a two-year-old in comparison with, say, a five-year-old. Thus two-year-old racing is in itself not a risk for sustaining a serious bone injury other than it would be the horse’s first year of racing.

So changing the racing programme to reduce the emphasis on the two-year-old season is unlikely to have a significant effect on the number of horses that sustain serious bone injuries at the racecourse.

It is likely that the increase in the exercise level during the horse’s first year in competition is responsible for this increased risk. This is especially so since the bones of the novice horse may not yet have adapted sufficiently to withstand the rigours of competition, and thus are more likely to fail and fracture.

Previous studies have identified an increase risk of fracture in horses competing in national hunt flat races (bumpers), and it is likely that this increased risk is due, in part, to the effect of the experience of the horses in these types of races. In this study an individual horse in a National Hunt flat race was about five times more likely to sustain a fatal distal limb fracture than a horse in a turf flat race.

The effect of the training surface

The third significant finding of the study was the effect of the training surface on the risk of fracture. There was a significant increased risk of fracture in horses trained on sand gallops in comparison to other surfaces such as turf or woodchip. This is always going to be a complex issue, as there are a wide variety of surfaces that are considered to be sand.

However, several studies have shown that there is an altered risk of fracture during races on dirt tracks in the USA or all-weather tracks in the UK in comparison to turf racing. It is likely that the limb of the galloping horse is subject to differing forces on such surfaces. This could lead to either an increase in damage to the bone or failure of a bone to strengthen adequately, both of which would ultimately lead to an increased risk of fracture.

With the increasing emphasis on all-weather racing in the UK, as well as the use of non-turf training surfaces, further work is now required to fully understand why there is an altered risk on some surfaces.

These studies have identified a number of issues that cause racehorses to have an altered risk of fracture. With this information, it becomes possible to institute changes in management that should reduce the risk of such injury and ultimately lead to a reduction in the number of serious injuries sustained during racing.

In particular, it appears to be vital that all racehorses should receive some training, even it is for only a short distance, at racing speed. Furthermore, the increased risk of horses during their first year in racing should always be considered, and their racing and training programme should be structured to allow their bones to adapt sufficiently to the rigours of competition.

This veterinary feature was first published in Horse & Hound (4 November, 04)

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Feeding for healthy bones

Horse & Hound — Tue, 20 Apr 2004 14:38:10 +0000

As bone is largely comprised of the minerals calcium and phosphorus, is it natural to think that all bone problems would have a nutritional cause.

Problems such as developmental bone disease in fast-growing youngstock can be linked to nutrition. This normally occurs when an incorrect balance of nutrients is supplied.

Research has shown that reduced levels of starch in growth feeds can help create the right conditions for the correct formation of bone from cartilage. The correct balance of vitamins and minerals is also vital at this time.

The ideal ratio between calcium to phosphorus should be 1.5-2.1. If the calcium to phosphorus ratio is wrong, calcium is leached from the bone to compensate. In chronic cases this can result in the build-up of fibrous connective tissue, which will result in bone-related problems.

In comparison, bones problems that are associated with exercise, such as stress fractures, are far less likely to have a nutritional cause.

Stress fractures are common in all athletes, including horses in training. They occur when a greater than normal strain is put on the skeleton. Areas such as the pelvis are commonly affected and stress fractures are usually related to exercise intensity rather than nutritional insufficiency.

It appears that the key issue is bone adaptation. Bone is an active organ, fulfilling support, movement, mineral reserve and blood production functions, and it changes its strength according to the workload put upon it. Bone strength increases with exercise, but only after undergoing a period of weakness first.

In early training it is essential not to over-stress the bone, while the strengthening process is taking place. New research suggests that short sharp bursts are beneficial for developing resistance to fracture.

Care must also be taken after a horse has been on box-rest. A decreased workload results in a reduced bone mass and strength of up to 5% after a 12-week period. When the horse returns to work time must be allowed for bone strength to redevelop.

Horses that are most likely to suffer from stress fractures include:

Immature animals subjected to high levels of exercise
Horses asked to do fast work without sufficient conditioning or warm up
Horses brought back into training too quickly after a rest

Coping with fractures

Horse & Hound — Wed, 21 Jan 2004 14:11:51 +0000

The sight of a horse trying to move around on three legs after being struck down with a sudden severe lameness is every owner’s worst nightmare. Luckily, many suspected broken legs are nothing more serious than a case of pus in the foot or a nasty overreach injury.

However, a fracture should be suspected when:

A horse is suddenly totally unable to use the leg
A loud crack is heard prior to the onset of lameness
The limb is totally unstable or at an unusual angle
The horse is in extreme pain

In such circumstances, the horse will be shocked, so cover him with a rug and contact your vet immediately, requesting an emergency visit. Keep the horse still as he may panic when he realises he cannot move. Food can have a calming influence, hay and a bucket of feed are good emergency “painkillers”.

If the horse flails around attempting to bear weight on an unstable limb, this will increase the soft tissue damage, reducing the likelihood of a successful repair. Good first aid at the time of the accident will play a major role in the eventual outcome.

Fractures of the equine limb bones can be split in to the following categories:

Obvious broken bones are most commonly complete fractures of the weight bearing long bones, and usually are very bad news. These are normally impossible to repair in any equine larger than a small pony, although fractures of the point around the elbow can in some cases be treated, even in big horses. Any injury where a major broken bone is sticking out through the skin is untreatable due to overwhelming tissue damage and infection.

Less obvious broken bones are mostly fractures of the small bones, such as within the hock, knee or foot. These bones suffer a range of fracture types and treatment depends on the size of the fragment, the angle of the fracture plane and the degree of joint involved. Some of these injuries may be treatable and a full return to work possible. The prognosis with splint bone fractures is often good.

Fractures that are not obvious include non-displaced hairline cracks, which will heal provided the bones do not undergo any further damage. Also rarely diagnosed are stress or fatigue fractures, most commonly found in young racehorses. Less obvious injuries of this nature may develop into more serious injuries if they are not recognised and treated.

Chip fractures occur when a small fragment of bones separates off, with the severity of the injury depending on the site of damage. If a bone chip is within a joint, degenerative joint disease may develop.

Fractures requiring immediate euthanasia include:

Fractures involving multiple long bones
Complete upper hindlimb or forelimb fractures, expect in small ponies
Complete fractures of bones above the knee in horses weighing more than 350kg
Compound fractures with open wounds
Severe long-standing infected joints, synovial sheath or bursa
Severe loss or damage to soft tissues

Proper diagnosis, which can be difficult even in the extremely lame horse, is essential to determined how to proceed. If the injury occurs in the field, it may be necessary to move the horse to an equine hospital to take good quality X-ray pictures of the injury.

Your vet will advise whether or not transport is possible. Without moving the horse, it may be impossible to make a diagnosis, leading to euthanasia on humane grounds.

Regrettably many equine fractures are untreatable. Others may be potentially repairable, but incur a long, costly course of surgical treatment. Some more straightforward fractures are technically fairly routine to repair, given a skilled surgeon and proper facilities, but knowing where to draw the line can be hard.

The ultimate aim of most equine fracture repair is a return to work and a horse that is only able to hobble across a paddock is an unsatisfactory conclusion.

Dealing with kick injuries

Horse & Hound — Wed, 28 May 2003 00:00:00 +0000

Types of injury

Bruising and haematomas

These are very common following kicks over muscular regions such as the rump (gluteal muscles), thigh muscles (quadriceps), or forearms. The overlying skin is often undamaged, but blood vessels are ruptured by the hoof’s impact.

Bleeding into the surrounding tissue may be mild, forming bruises, or in some cases more severe, resulting in large fluid swellings under the skin called haematomas. Mild bruising can be treated with cold hosing and compresses, but large haematomas deserve veterinary attention.

Skin lacerations

Trauma from kicks often only causes small skin wounds. However, these should be carefully examined as they often lead to pockets under the skin where the connective tissue has been separated by the blow, leaving atunnel into deeper tissue for bacteria to travel along.

Small superficial wounds away from joints, which do not appear to be causing marked lameness, can be treated by poulticing, followed by twice-daily cleaning and application of a suitable wound ointment.

Deeper puncture-type wounds require veterinary attention, as the skin has been broken and bruised tissue is prone to infection. The wound will need flushing and the horse will require antibiotics and tetanus prophylaxis.

Large skin wounds may need stitching, and these must be seen straight away, as bacteria multiply rapidly and, after six hours, most wounds will be too infected to close.

Wounds that need stitching should be cleaned with saltwater (half a teaspoon of table salt into a litre of water) and bandaged to prevent contamination while waiting for the vet.

Infected or heavily contaminated wounds should not be stitched. Instead, they should be managed with antibiotics, bandaging and water-soluble wound ointments.

Kicks onto joints

Joints are particularly dangerous sites for a horse to sustain a kick. If the skin is broken there is a serious risk of joint-capsule penetration. Any puncture-type skin wound over a joint should receive veterinary care.

If infection gets into a joint, it will rapidly become septic. This is extremely serious and can lead to permanent lameness or even necessitate euthanasia.

Kicks onto bone

In many cases, the bone will just be bruised and will heal quickly, leaving only a splint-type bony swelling. These cases respond well to a week’s cold hosing and kaolin poulticing, combined with box rest.

Sometimes, however, the kick wound is deep or traumatic enough toaffect underlying bone, resulting in a ‘sequestrum’, a fragment of bone that has broken off with the initial impact or has become devitalized due to reduced blood supply as a result of infection.

The wound may heal initially, only to break open again. A chronic drainage tract will persist until the sequestrum is surgically removed.

Any kick wound which refuses to heal should be X-rayed to rule out bone chips, fractures or sequestra. Some kicks onto bone are so powerful they fracture the bone.

Many fractures can be repaired, though sadly some cannot, necessitating euthanasia.

Recognition of non-displaced ‘hairline’ fractures is essential for, as the horse gets sounder and starts to bear weight, the bone may suddenlygive way.

Any kick wound resulting in severe lameness deserves urgent veterinary attention.

Call the vet if:

the wound is pouring or pumping blood
the skin over a joint or tendon sheath has been penetrated
the horse is lame
a large haematoma has developed
the wound is infected, highly contaminated or doesn’t show signs of healing
your horse’s tetanus jab isn’t up-to-date
the wound is deep or large enough to require stitching.

Alternative treatments

There are a number of alternative therapies that can be helpful with kick injuries and worth keeping in your first aid kit. Before using them, check with your vet that they won’t interfere with any other treatment your horse is receiving.

Arnica: useful for treating bruises.
Calendula lotion: used to flush out wounds, Calendula has antiseptic qualities and stimulates healing.
Hypericum: eases pain – useful when an area is very painful but there’s not much damage.
Hepar sulph: if a wound is infected and oozing pus, Hepar sulph will help stimulate healing.

First aid for fractures

Horse & Hound — Wed, 19 Feb 2003 00:00:00 +0000

Suspected fractures

If your horse suddenly goes very lame, first look carefully at the foot, as most lameness is due to something in the foot rather than a fracture.

A broken leg should be suspected when:

a horse is suddenly unable to bear any weight on the limb
a loud crack is heard prior to the onset of lameness
the limb is totally unstable and possibly bent at an unusual angle.
the horse is in extreme pain.

Action plan

Contact your vet immediately requesting emergency veterinary attention. Ensure he knows the potential seriousness of the situation.

While you are waiting, you should cover the injured horse with a coat or rug as a horse that is in shock will feel cold.

Keep him quiet and still. If you find a horse in this state in the field, do not move him.

Put on his headcollar and make sure he does not try to move on his injured limb.

Food is often a good way of calming them, so keep hay and a bucket of feed handy.

Organise transport in advance, so everything is ready if the horse has to be moved.

Horses with a leg injury may find it easier to walk up a gentle trailer ramp than a steeper one into a horsebox.

Regrettably, many fractures in the horse are untreatable, particularly when there is an open wound with the bonevisible through the skin. In these cases, the tissue damage and infection will be overwhelming.

The majority of broken long bones of the upper hind and fore limb will also be impossible to repair.

Other lower limb fractures are potentiallyrepairable, but your horse will be facing a long course of surgical treatment.

In many cases, euthanasia is the kindest course of action.

However, many suspected fractures are relatively easy-to-repair bone chips rather than complete fractures, or maybe other causes of sudden severe lameness such as a locking patella.

So, don’t despair. Obtain immediate veterinary help and a diagnosis as soon as possible.

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Q&A: Coping with fractures

Horse & Hound — Wed, 18 Dec 2002 00:00:00 +0000

Q: My horse has recently been diagnosed with a fractured pedal bone and my vet has prescribed a period of box rest until the fracture has healed significantly. Can you suggest any alternative therapies which might aid the healing and help my horse cope with the enforced rest?

Tim Couzens MRCVS replies: Bone, along with ligaments, tendons and cartilage, is a type of connective tissue.

It is the major rigid component of the skeleton and basically consists of cells and a type of matrix, which is composed of collagen and inorganic salts.

It is these salts which are responsible for most of the weight of bone, while the collagenous fibres give bone its strength and resilience.

Successful healing of fractures is dependent on several factors:

A diet which will supply the necessary nutrients for bone healing.
A good supply of blood to the site of the fracture. This will deliver building blocks for new bone to form to aid healing.
Absence of infection and stabilisation which are vital to allow the ends of the fracture to unite properly.

Remedies to aid bone healing

The best known natural remedy for treating fractures is the herb comfrey, whose common countryside name is “knitbone”.

This plant is a familiar sight in many fields and has been used traditionally to hasten the healing of fractures.

This action is thought to be due to one of its constituents, allantoin, which speeds up healing.

In summer, the fresh plant is easy to find and most horses find it palatable.

Simply feed your horse a handful of the leaves each day. Be careful not to mistake the plant with foxglove which looks similar.

If in doubt, or when the plant is out of season, use dried leaves or liquid tincture. These are both available from proprietary sources.

Comfrey is also used homoeopathically, with the same effect, although the remedy is known under its Latin name ‘symphytum officinalis’. Ideally, use symphytum 6c twice daily until the fracture is fully healed.
Ruta grav is useful where fracture healing is slow or where there has been extensive damage to the periosteum at the time of the fracture. Ruta is also good for non-union fractures (where the ends of the bone fail to unite). As above, use the 6c potency twice daily.
Calc phos and calc carb also help with the healing of fractures, with the former best suited to leaner horses and the latter to heavier builds. Both are constituents of bone and I’d recommend you use the 30c potency once a day.Beating infectionWhere there is a problem with infection in the bone (osteomyelitis), one of the best remedies is silica 30c. This is given three times daily in this situation, though it should not to be used if there has been orthopaedic fixation of the fracture as it may cause metal implants to work loose.Sometimes, a healed fracture will result in unwanted excess bone – often bony spurs which are normally reabsorbed naturally. Calcium fluoride and heckla lava are two remedies which will encourage these to disappear. These are best given in the 6c potency once daily for about eight weeks.Box rest stressWhile the fracture is healing, your horse will have to be confined to box rest to help with stabilisation. If this causes some degree of stress, then think about using some herbal remedies which have a calming,quietening effect such as valerian, skullcap, chamomile and vervain.These can be safely given alongside any homoeopathic treatment and are readily available either in dried form or as liquid combinations.

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“We know that there are many environmental risk factors for fracture and much has been done over the years to reduce these risks. Despite this effort, fractures sadly still occur, and we know that some horses are genetically more predisposed to fracture than others,” said Dr Guest.

“The development of a polygenic risk score for fracture will allow us to identify horses that are at high genetic risk, to allow the targeted use of diagnostic imaging and close monitoring of their bone health.

H&H asked Dr Guest what options there could be for mitigating risk for horses with lower levels of collagen type III.

“We think that collagen type III is only a small piece of the puzzle and that there are going to be lots of different genes which are affected in genetically high-risk horses,” she said.

“The effect of each individual gene is likely to be small and so we do not anticipate developing an intervention based on collagen III alone.

Dr Guest also told H&H that identifying horses at genetically high risk “would allow owners to make “informed breeding decisions”, such as crossing them with a low-risk horse.

“Over time this would help to reduce the genetic risk in the population, while still maintaining genetic diversity in the breed,” she said.

The study was funded by the Horserace Betting Levy Board, the Anne Duchess of Westminster Charitable Trust and The Alborada Trust.

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Mare defies the odds with successful return to competition after leg fracture

“Boots was fine but Ruby had scrapes everywhere and I noticed blood on her left front leg,” Abigail told H&H.

“When I took her rug off she had what looked like a puncture on her shoulder and she couldn’t move. I knew something was massively wrong and we phoned the vet.”

Abigail said a discussion was had about ending Ruby’s life on welfare grounds, but the vets felt it was worth transporting her the 30 minutes to the hospital.

“The vets were brilliant, one travelled in front of us and one followed behind. By the time Ruby walked off the trailer you wouldn’t know she’d broken something,” she Abigail.

“The vets could see lots of bone fragments and they agreed these needed to come out, but one was quite large. The plan was she would be in the hospital for around three days, but it took the three days to get the last of the fragments out.

“She was kept in for a few more days observation. Then going into the second week her whole leg blew up to about three times its normal size from her shoulder down. The vets took a swab from the wound and she was put on antibiotics for an infection.”

After three weeks in hospital Ruby was allowed to return home to continue her recovery.

“She needed 18 weeks of box rest – and she was a saint. She was never rude or stressed, we couldn’t believe how calm she was,” said Abigail.

“After this we got the go ahead to start her rehab with walking in-hand in straight lines, and slowly building it up each month.”

Ruby has since made a full recovery and the pair have enjoyed their first outing to an unaffiliated dressage competition where they scored 71.5% in the novice class. Abigail hopes to affiliate in the future.

“I took her along but I wasn’t expecting anything from her – I was just happy to have her there, but this was the best test she’s ever done,” said Abigail.

“I still can’t believe she’s still here today. It has been such a rollercoaster and I can’t thank the vets enough for how much they did for her.”

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‘His bone was in bits’: eventer who faced being put down comes back to championship win

“The pedal bone was in bits,” Tamsin told H&H. “We didn’t think he’d make it.

“I was away for the weekend, typically, and they went to get him in and he was on three legs – it as awful. As soon as you see the call, you just know, and I said ‘Get the vet out straight away’.”

At first it was thought Twink had an abscess, but his condition did not improve.

Twink spent months on box rest, being walked in hand, and there were a host of other issues to deal with – for the horse and hs owner.

By this point, Tamsin said, Twink had about a 65% chance of eventing again, which was significantly better than initial estimates. But he had some back and other issues that needed to be treated, as did the ulcers and the asthma he developed this year.

But, finally, X-rays showed the bone had healed, and “looked fantastic”, Tamsin said.

After a long process of building up the work, the combination were jumping by April, then eventing again in August, “and it was magic to be back on”, Tamsin said.

They qualified for the Brigante Cup by coming third at Shelford, then completed their Area Festival in eighth place; having been in a strong position after the dressage, they had a showjumping sat-nav error.

“I was rusty!” Tamsin said. “I got four faults for the circle and 12 for time, then time-faults across country, so the next event, I thought ‘Right, I’m riding him like I stole him’, and that was the championship!”

Tamsin, who paid tribute to her trainers Richard and Jane Carruthers and Gary Foggon, and her friend Kim Pemberton who helps her at events, also praised the team at Frickley for the championship, which was run like a long-format event with the showjumping last.

“It was really exciting, and just amazing to win,” she said.

“I never thought I’d get him back, I thought I’d lose him so many times, so this was what dreams are made of – a dream come true. After all the heartache, it was just brilliant.”

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Olympic showjumper recovering from surgery on broken bone in front leg

She underwent surgery on Monday (21 March), carried out by specialist Dr Fabrice Rossignol following consultation with Twenty’s regular vet, Thomas Wagner, and vet Anton Fürst of Zurich University.

An update from connections on Tuesday (22 March) said the surgery “went well” and the vets are “very happy with the result”.

“Recovery will obviously take time and the only goal is that Twenty can enjoy the retirement she deserves,” said the statement from her connections.

“This event is very difficult for me and I am very affected,” said Bryan. “But I am also relieved today to see that the operation went well and that Twenty is standing and can already walk.

Owner Christiana Brechtbühl added that Twenty is a “member of our family and what happened is extremely hard to live with”.

“We have lived through very difficult times, but these are fortunately behind us. We have done everything for Twenty and will continue to do so,” she said.

“Bryan and I are still in the Paris region with her. Our only objective is that she can enjoy the retirement she deserves after having given so much for us and had such a great and great sporting career.

“We were very touched by the many tokens of support we received. We would like to thank the veterinary teams on site in Paris as well as at the Clinique de Grosbois, as well as the Paris CSI organising committee for what they have done for Twenty and for us”.

Swiss team manager Michel Sorg said the accident is a “huge shock for the Swiss team”.

“We [supported] Christiana Brechtbühl, Bryan Balsiger, Mélusine Guiblin-Miché and all their team as best we could on site and also after that. And of course we continue to do so,” he said.

“It is a great relief to know that the operation went well. We all have only one wish, that Twenty can enjoy a nice retirement in the meadow after such a great career during which she gave so much to our Swiss team.

“Once again, we send our full support and thoughts to the entire Twentytwo team.”

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