On all four feet

Developments in surgery now allow for certain fractures to be repaired under sedation only, allowing vets to avoid the use of general anaesthetic. Phil Cramp MRCVS explains when standing fracture repair is an option

- Phil Cramp

IT is not uncommon to be chatting with clients or friends and be met with astonishment when I say that “we can fix horses with broken legs”. But it is quite true. There are, of course, some parts of the body and some types of breaks that cannot be repaired.

This is typically due to the horse’s weight – they are simply too big and too heavy for the metal implants used to repair the fracture to withstand.

For the sake of this article, fractures that are more proximal – that is to say, further up the horse, such as those of the tibia, femur, radius and humerus – cannot be repaired, and certainly not with the horse standing up.

By “standing”, I mean that the horse is sedated in the same way as it might be for clipping or for your dental work, and remains standing throughout the surgery. The area of the leg that is being operated on is then “blocked” using local anaesthetic to desensitise the region, so that screws and plates can be applied to repair and stabilise the fracture.

For us to do this, the fracture needs to be non displaced, or only minimally displaced, so that the horse can still bear weight on the leg – the leg still needs to be mechanically stable.

Most of the fractures suitable for standing repair are distal limb fractures – those below the carpus (knee) and tarsus (hock), and it is these to which this article will refer.

However, as we become more skilled as surgeons, then more fracture repairs in different parts of the body are being attempted in the standing and sedated patient.

For example, a recently published paper describes a series of elbow fractures that have been repaired in a standing sedated horse.

Often, the fact that the horse is standing – and therefore all the anatomy is in the “appropriate” location – makes accurate fracture repair easier.