Unfortunately, it’s not uncommon to see broken (fractured) legs in horses. We often associate broken legs with sport horses and racehorses being injured in competition. But we also see them in riding and companion horses, because of riding accidents or trauma in the field.

Traditionally, a broken leg has meant euthanasia of the horse, and this remains the case for horses who suffer breaks of the important long bones of the leg, or those with some of joint fractures and so on. However, thankfully, we now have some options for fracture management.  

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Why are broken legs such a problem in horses?

It seems somewhat absurd that an apparently trivial problem like a broken leg should be life-threatening. After all, broken bones are readily fixed in cats, dogs and humans. Unfortunately, when we see a horse with a broken leg we are dealing with a number of factors that, when put together, can mean that keeping the horse alive isn’t the right thing to do. 

Weight

Horses weigh a lot! It’s difficult to find strong enough, acceptable implants to repair the horse’s limb bones that can withstand enough stress whilst the break completely heals. This is not surprising given that surgery and implant placement involves a nerve-wracking, often uncoordinated recovery immediately after the surgery. 

The horse’s mindset

No horse can understand that it needs to keep a broken leg immobilised, nor that it must endure strict rest whilst the area heals. 

Fracture biology

A lot of fractures aren’t simple, clean breaks, and they may involve displacement of the fragments, communication with a joint, damage to blood supply and often an open wound. All of these take the fracture to a whole new level of complicated and severely worsen the prognosis for healing or return to normal life.

Return to function

The damage caused to the bone during the fracture, the type of fracture and additional concerns like the stress put onto the other limbs (which can lead to problems like laminitis), can all mean a high level of uncertainty when considering the horse’s prognosis athletically, even if the break does heal. During the recuperation phase, the musculotendinous structures of the injured limb also change. It often becomes weaker, affecting how the horse uses the limb. 

Physiotherapy and physical rehabilitation is important to try and maximise the function of the broken leg. But it’s no guarantee that the horse will have the same mobility or agility as before. This is why it often ends the careers of sports horses.

It’s also possible that despite fracture management, and time, he may suffer chronic pain from the injury. This is also not acceptable for his welfare. These are just some of the factors that may lead an owner and veterinarian to decide that euthanasia is the most realistic and pain-free option for the horse. 

So, what can we do for broken legs?

Well, this mostly depends on where the break is and what type of break it is. If we are dealing with severe fractures of the long leg bones like the femur, radius, humerus or tibia, there’s often no other option than euthanasia. That said, in foals, given their small size and weights, we may be able to attempt some form of treatment.  

Rest and symptomatic care

Breaks of the third phalanx (the coffin bone) that are clean and not displaced can often be treated with a corrective shoe whilst the fracture heals. Fractures involving small chips may require arthroscopy for removal of the fragments. While fractures of the second and fourth metatarsal and metacarpal bones (the splint bones) may require surgical removal to allow healing. Rest may also be sufficient for the healing of minor fractures of smaller bones in the hock or knee. 

Following rest, the horse will be gradually turned out before being assessed for its suitability to return to work, and an appropriate rehabilitation routine will be devised to give it the best chance of a good recovery.  

Surgery

Surgery is often required for fractures that have become displaced, are more severe, unstable or affect other soft tissue structures (like the sesamoid bones). Pins, plates and screws are used to stabilise and reduce the fracture. We can now even perform standing surgery for some fractures, using local anaesthesia, helping to avoid the potential complications of a general anaesthesia where the knock-down and recovery processes are all potentially detrimental to a fracture. 

Even when surgery is appropriate, it is still just the start of the treatment process. The horse must undergo a prolonged period of strict rest (perhaps in conjunction with other modalities like shockwave therapy), before it can be given the all clear to begin a rehabilitation program which will help restore the movement and function of the affected leg, and help its return to fitness.  

Appropriate attention to the recovery phase is very important, carefully recuperating a horse and later guiding him through a dedicated rehabilitation program, can make the difference between retirement and successful return to his prior use.