Risk Factors Associated With Survival to Hospital Discharge of 54 Horses With Fractures of the Radius.
Authors: Stewart Suzanne, Richardson Dean, Boston Ray, Schaer Thomas P
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Radial Fractures in Horses—Prognosis and Management Outcomes Radial fractures present a significant clinical challenge in equine practice, yet limited contemporary data exist on survival rates and predictive factors for different management approaches. This retrospective case series of 54 horses admitted between 1990 and June 2012 examined survival to discharge in both conservatively and surgically managed radial fractures (excluding stress fractures and distal osteochondral fragments), assessing variables including fracture configuration, age, surgical technique, operative duration, and complications such as surgical site infection (SSI) and implant failure. Conservative management of minimally displaced incomplete fractures yielded encouraging results, with 12 of 14 horses (86%) surviving to discharge, whereas open reduction and internal fixation (ORIF) achieved 56% survival overall (15 of 27 horses), with substantially worse outcomes in adult horses; notably, six of eight surgically managed open fractures did not survive, and open fractures were significantly more likely to develop SSI, which independently increased implant failure risk 17-fold (P < 0.005). Young age and operative duration exceeding 168 minutes emerged as additional protective and risk factors, respectively, suggesting that case selection and surgical efficiency substantially influence survival likelihood. For practitioners, these findings emphasise the importance of conservative management where fracture configuration permits, cautious patient selection for ORIF in mature horses, and meticulous infection control protocols given the catastrophic consequences of SSI in this fracture type.
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Practical Takeaways
- •Conservative management of minimally displaced incomplete radial fractures offers excellent survival prospects (86%) and should be considered first-line for suitable cases
- •Open radial fractures carry a poor prognosis even with surgery—aggressive prevention and management of infection is critical as SSI drives implant failure and mortality
- •Age matters significantly: young horses benefit from surgical repair of complete radial fractures, but adult horses have poor outcomes with ORIF and may warrant conservative management or euthanasia consideration based on fracture type and individual circumstances
Key Findings
- •Overall survival to discharge was 50% in horses with radial fractures; 86% of conservatively managed horses with minimally displaced incomplete fractures survived
- •Surgical site infection increased implant failure 17-fold and was strongly associated with catastrophic failure in open fractures
- •Young horses undergoing ORIF had good survival prognosis, while adult horses had poor prognosis for ORIF
- •Open fractures were significantly more likely to develop SSI (P = .008), with 6 of 8 surgically managed open fractures not surviving to discharge