equis - Articles
Rib: fracture
Introduction
- Cause: blunt thoracic trauma to foal during birth or collision, blow or kick in the adult.
- History: foals recently born to primiparous mares, dystocic parturition or in adults following blunt thoracic trauma with difficulty in breathing.
- Signs: contusions and rib fractures may → pain, pulmonary compromise and secondary complications, eg flail chest, pneumothorax, hemothorax.
- Diagnosis: ultrasonography, radiography and nuclear scintigraphy help confirm diagnosis.
- Treatment: many cases apparently remain subclinical and will heal without specific treatment or complications, but pain control and supportive care are important especially in neonatal foals. Surgical stabilization is useful in some cases.
- Prognosis: depends on age of patient, degree of damage and secondary complications but varies from guarded to good.
Presenting signs
Neonates
- Many cases are subclinical.
- Born to mares following dystocia or primiparous birth. Size of foal not always significant.
- Difficulty in breathing.
- Palpable rib pain +/- deformity/fracture.
- Usually unilateral, 1-5 ribs.
- Sudden death.
- Flail chest and other complications are rare.
Adults
- Blunt thoracic trauma - falls, collisions, kicks.
- Difficulty in breathing and painful chest on palpation.
- Deformation of thoracic wall and/or rib fractures.
- Other injuries to soft tissues, pneumothorax Pneumothorax and hemothorax.
Acute presentation
- Difficulty breathing.
- Swelling over thorax.
- Thoracic wounds in adult cases Thorax trauma.
Age predisposition
- Common in neonatal foals.
- Adults.
Breed/Species predisposition
- Larger breed foals.
Cost considerations
- Costs of diagnosis and treatment.
Special risks
- Increased risks if general anesthesia Anesthesia: general - overview is required.
Pathogenesis
Etiology
- Birth-related, blunt, thoracic trauma due to excessive or incorrect force applied to foal during passage through the birth canal. There is increased incidence in fetal oversize or dystocia foals. In one study 263 foals were examined within 3 days of birth and 55 (21%) had evidence of blunt thoracic trauma that had occurred during parturition.
- Collision with objects, falls or kicks, may cause blunt or penetrating thoracic trauma in older animals. Blunt trauma is associated with pulmonary contusions and rib fractures whereas penetrating injuries (more common) may → pneumo- or hemothorax.
- Excessive chest compression during cardiopulmonary resuscitation Emergency resuscitation is less likely in neonatal foals because of compliant nature of ribs.
Predisposing factors
General
- Thoracic trauma.
Specific
- Dystocia.
- Fetal oversize.
- Incorrect obstetric techniques.
Pathophysiology
- Blunt thoracic trauma at birth or by collisions/falls, etc.
- Abnormalities at birth predispose foals to rib fractures.
- Fractures are usually at or near the costochondral junction of the ribs in the cranial and ventral half of the thorax (ribs 3-8). Left and right sides are equally affected.
- Fractures on the left side between ribs 3 and 6, at the costochondral junction, may carry a greater risk due to their proximity to the heart.
- Rib fractures may be subclinical or → painful breathing, pulmonary compromise and cardiovascular embarrassment.
- Secondary complications including damage to vital structures (cardiac and lung laceration), pneumothorax Pneumothorax and hemothorax, diaphragmatic hernia Diaphragm: hernia, flail segment, respiratory distress and sudden death.
- Blunt trauma often → contusions and rib fractures.
- The resultant rib fractures can lacerate the pulmonary parenchyma or perforate the heart/cardiac vessels/large vessels. Also been associated with diaphragmatic hernias Diaphragm: hernia.
- Secondary hemothorax and/or pneumothorax may occur.
- Major concerns are the possibility of cardiovascular embarrassment, pain and pulmonary compromise → inadequate ventilation and oxygenation Respiratory: nasal oxygen administration.
- Hypoventilation may progress to hypercarbia, hypoxia and infection compounding the problem and → adult respiratory distress syndrome.
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Alvarez A V et al (2022) Survival and racing performance after surgical treatment of rib fractures in foals. Vet Surg 51 (1), 62-67 PubMed.
- Boullhesen Williams T et al (2017) Internal fixation of fractured ribs in neonatal foals with nylon cable tie using a modified technique. Can Vet J 58 (6), 579-581 PubMed.
- Dahlberg J A et al (2011) Clinical relevance of abnormal scintigraphic findings of adult equine ribs. Vet Radiol Ultrasound 52 (5), 573-579 PubMed.
- Downs C & Rodgerson D (2011) The use of nylon cable ties to repair rib fractures in neonatal foals. Can Vet J 52 (3), 307-309 PubMed.
- Jean D, Picandet V, Macieira S et al (2007) Detection of rib trauma in newborn foals in an equine critical care unit: a comparison of ultrasonography, radiography and physical examination. Equine Vet J 39 (2), 158-163 PubMed.
- Kraus B M et al (2005) Multiple rib fracture in a neonatal foal using a nylon strand suture repair technique. Vet Surg 34 (4), 399-404 PubMed.
- Bellezzo F et al (2004) Surgical repair of rib fractures in 14 neonatal foals: case selection, surgical technique and results. Equine Vet J 36 (7), 557-562 PubMed.
- Schambourg M A et al (2003) Thoracic trauma in newborn foals: Post mortem findings. Equine Vet J 35 (1), 78-81 PubMed.
- Jean D, Laverty S, Halley J, Hannigan D & Leville R (1999) Thoracic trauma in newborn foals. Equine Vet J 31 (2), 149-152 PubMed.
- Rossdale P D (1999) Birth trauma in newborn foals. Equine Vet J 31 (2), 92 PubMed.