Surgical repair of rib fractures in 14 neonatal foals: case selection, surgical technique and results.
Authors: Bellezzo F, Hunt R J, Provost R, Bain F T, Kirker-Head C
Journal: Equine veterinary journal
Summary
# Editorial Summary: Surgical Repair of Rib Fractures in Neonatal Foals Rib fractures in newborn Thoroughbreds frequently prove fatal, yet internal fixation techniques have remained largely unexplored as a management strategy in this population. Bellezzo and colleagues reviewed 14 cases of neonatal foals treated surgically across two equine hospitals, using reconstruction plates with self-tapping cortical screws and cerclage wire as the primary fixation method (12 cases), with Steinmann pins employed in one case and combined techniques in another; surgeons typically stabilised 1–3 ribs per foal depending on fracture severity and associated thoracic trauma. Follow-up data from seven foals demonstrated encouraging outcomes: one yearling entered training successfully, four were sold, and two deaths resulted from unrelated causes—a marked improvement on the historically guarded prognosis for rib fracture cases. The authors advocate for plate-and-screw fixation over Steinmann pin techniques, citing problems with cyclic failure, migration and iatrogenic internal injury in the latter approach. For farriers and equine practitioners supporting these young patients during recovery, understanding that selective surgical stabilisation can now preserve foals previously considered non-viable has significant implications for case management and owner counselling, particularly regarding realistic timelines for return to training and the importance of meticulous post-operative monitoring for complications.
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Practical Takeaways
- •Internal fixation with reconstruction plates and cortical screws should be considered for neonatal foals with rib fractures to reduce mortality from thoracic trauma
- •Selective surgical repair of 1-3 ribs per foal can provide adequate stabilization without addressing every fracture
- •Avoid Steinmann pins for rib stabilization in foals due to implant failure and migration risks; prefer plate and screw fixation
Key Findings
- •Surgical stabilization of rib fractures using reconstruction plates, cortical screws and cerclage wire was successfully performed in 12 of 14 foals with an average of 2 ribs repaired per foal (range 1-3)
- •Of 7 foals with follow-up data, 4 were sold, 1 was in training at age 2 years, and 2 died from unrelated causes
- •Steinmann pins showed suboptimal results due to cyclic failure, implant migration and risk of iatrogenic internal thoracic trauma
- •Surgical stabilization of selected fracture sites improved prognosis for foals with rib fractures and extensive internal thoracic trauma previously considered to have guarded to poor survival outcomes