Breaks At Birth

In humans you tape them. In dogs you can fix them with a cage that fits outside the chest. But in foals, cracked or fractured ribs can be hard to find, present no easy solutions, and can be life-threatening.

Each winter and spring as foals are born, a small percentage--maybe one in 500--will be born with one or more ribs that are cracked or broken. That condition can be difficult to find. While foals which recover from fractured ribs usually have no residual problems, the condition can result in death. Therefore, preventing the problem, or catching it early, can be critical to a foal's survival.

The ribs of a foal are usually damaged when a foal has some difficulty passing through the birth canal. The usual order for a foal is to come out forelegs first, followed by the head and shoulders, with the hind legs trailing, much like a diver going head first into a pool. If that sequence is changed or if, for example, one of the forelegs is trapped along the foal's side, the pressure that results can cause damage to the immature ribs.

It also is possible that an unusually large foal could sustain broken or cracked ribs from the pressure in the birth canal even if it is properly positioned.

The fractured or cracked ribs can cause further problems, by either failing to function properly or, because of the jagged edges that result from a fracture, cutting surrounding tissue. Depending on how many ribs are involved and where they are, they can slice arteries or puncture the lungs or heart of the foal.

William Bernard, DVM, Diplomate ACVIM, at Rood and Riddle Equine Hospital in Lexington, said the early signs of cracked or fractured ribs could turn up when the foal is palpated soon after birth. Among the signs Bernard said it is critical to watch for when palpating the new foal's ribs are:

  • simply feeling the crack or break in the rib or ribs;
  • observing that the foal is having difficulty breathing, particularly that one side of the chest appears to be collapsed or lagging the other as the foal breathes;
  • paleness in the foal, indicating difficulty breathing or a puncture in the lungs or heart;
  • any sign of air pockets just underneath the skin outside the foal's ribcage. Called crepitance, those air pockets feel like plastic bubble wrap or like small air holes that can develop under cellophane. "If I'm feeling that, I know those fractures are pretty bad," Bernard said.

Sometimes a veterinarian or an experienced person handling the foal can feel a problem with the ribs. If severe enough, the problem will be evident because a foal's ribs are collapsed on one side or the foal will have extreme difficulty breathing. In the most severe cases, the foal will become "totally pale, blanched, or white," Bernard said.

The injured ribs can cause problems because they might not function properly, and because they could harm other organs. The ribs act like a billows around the lungs, helping them open and close in the normal act of breathing. If one or more ribs are injured, they will not do that work as well or efficiently as they should, causing a condition known as "flailed chest." As a result, even if they do no other harm, injured ribs can affect the foal's ability to breathe. If one side does not work efficiently, more work might be shifted to the other.

More critically, though, if the ribs are fractured it means there will be sharp, jagged edges in the chest cavity. Those sharp edges can lacerate surrounding tissue, whether an artery, the lungs, or the foal's heart. Such an injury can kill a foal quickly.

While the symptoms might be severe, it is not always easy to find cracked or fractured ribs or to tell how many have been injured, which ones are involved, or how severely they are cracked or fractured. "They can be sometimes very difficult to find, especially if you've got a little foal that's jumping around--that doesn't want to be touched--and you just have a little crack," Bernard remarked. "There is movement in that area anyway, as the foal breathes, so it's not easy to find them; they can be missed."

Bernard said that if he suspects a cracked or broken rib, he will order an ultrasound on the foal's chest on the side where he thinks the injured rib is located. Radiographs, or X rays, are not always helpful when looking for cracked ribs because they will penetrate the entire chest cavity, showing both sets of ribs. While fractures might be easy to pick out, cracks could be obscured in an X ray. An ultrasound will show only one side of the chest, making it easier to identify problems with the ribs.

If there are cracked or broken ribs, the treatment is likely to be inactivity. The idea is to limit the foal's movement to prevent further damage to the ribs as well as to reduce movement in fractured ribs that could allow them to do damage to surrounding tissues or organs. The good news is that foals who recover from fractured ribs usually have no further problems. But the period of inactivity can be as long as a month, something many horsemen do not like during a period when they usually promote activity to assist in bone and muscle development.

Sometimes, though, the damage is so severe that inactivity might not be enough. Bernard said assessing the damage usually means trying to determine the number of ribs that are broken and their location. If several are injured close to the heart, for example, the need for intervention is more compelling.

But it is difficult to set out a course of treatment, even in severe cases. Treatments that work in other species have not usually been effective in foals. Taping the chest to stabilize the ribs, as is commonly done in humans, has been tried in foals, but is not a common practice. "We've gone back and forth on that," Bernard said. But if a foal is taped securely enough to restrict movement on the injured side, it can also restrict movement on the good side, further compromising the foal's ability to breathe. Additionally, as is often the case in equine treatment, a foal will rarely restrict its movement, as a human would, to accommodate the tape.

When dogs suffer severe rib injuries, which is common because they are often hit by cars, they are sometimes treated with surgically attached external devices that literally pull the ribs away from the chest cavity, allowing them to heal without doing further damage. Bernard said he has only used that approach once with a foal. "We have only done that in situations where if we didn't do it the foal was certainly going to die. It is difficult to take these foals to surgery because they are already so compromised," Bernard said.

With treatment alternatives so limited, prevention is important. People attending a mare cannot do much about the foal's placement as it approaches the birth canal. Bernard did suggest that allowing the mare to foal as naturally as possible could prevent some pressure on the foal and its ribs. "Don't start pulling until you have to," Bernard said. Additionally, it is important to watch the mare's behavior with the foal after birth. While almost all mares are extremely cautious, it does occasionally happen that a mare will step on a foal, damaging ribs.

Although most foal managers will face the problem, there is almost no mention of fractured ribs in scientific literature. Bernard said the time may have come to take another look at fractured ribs, both the situations in which they are dangerous and possible treatment alternatives for the condition. "It's really an area where a good surgical procedure should be developed," he said.

About the Author

Jacalyn Carfagno

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