Managing Fractured Ribs in Foals

Surgically repairing or stabilizing fractured ribs in a newborn foal can reduce the risk of further complications such as puncturing a vital organ, said Robert Hunt, DVM, MS, Dipl. ACVS, and Fairfield Bain DVM, MBA, Dipl. ACVIM, ACVP, ACVECC. The practitioners explained two methods of repair on Oct. 20 at the Hagyard Bluegrass Equine Symposium 2005 held in Lexington, Ky.

Hunt said foals often sustain greenstick fractures (a fracture that is held in place by connective tissue) while traveling through the birth canal. A foal's ribcage folds in on itself during birthing to allow passage through the birth canal. Once through the canal the ribcage reverts to its normal position. During this period, the foal might sustain a greenstick fracture. "These typically involve the left side and involve the third through sixth ribs," Hunt said.

"In many cases following a dystocia (difficult birth), the foal's ribs sustain a greenstick fracture, but they are initially not displaced," Bain explained. Additionally, over-aggressiveness by a veterinarian or caretaker who rushes to pull a foal before the birth canal is properly dilated can cause greenstick fractures. Ribs are then displaced while the foal is stumbling to get to his feet.

Palpating the fractured rib can be difficult for veterinarians. Many times the fracture is not evident on first exam because it might not be displaced yet. Ultrasound machines are utilized to detect fractures and small fragments of the bone in the chest cavity.

After Bain identifies the fracture using an ultrasound machine, he determines the appropriate course of treatment. If the rib appears stable (non-detached), Bain recommends a conservative treatment of stall rest while monitoring the rib with an ultrasound. For ribs that are displaced, Hunt uses a relatively non-invasive surgical technique to reattach the displaced portion of the rib. "A 2.7 mm reconstruction plate is contoured and secured to the rib with self-tapping cortical screws," Hunt explained. "Orthopedic wire is placed around the rib and the plate above and below the fracture line to offer further stability." Veterinarians place a chest tube in the foal to reduce the risk of developing a pneumothorax (the presence of air surrounding the lungs) as a result of the procedure, and they administer anti-inflammatory drugs.

Another method of stabilizing the fractured rib is suturing the rib fragments to an external splint on the outside of the foal's chest cavity. "This method takes about five to 10 minutes and can be done on the farm," Hunt said. An ultrasound machine is used to locate the rib fragment, then the fragment is sutured to the splint through the skin.

Both methods of repair require the foal to be confined to a stall for a minimum of three weeks, Hunt said. He explained that any type of procedure to stabilize a foal's ribs has an associated risk involved, but when the foal is facing death due to possible puncture of internal organs from the fractured rib, it is worth taking the chance.

About the Author

Chad Mendell

Chad Mendell is the former Managing Editor for .

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