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Broken leg

From: Nate

Dear Jessica, three days ago we had to put down our gelding because he broke a bone in his leg. He was fourteen so not all that old, it was pretty sad. My wife and I have been discussing this since we knew what would have to happen. Sandman (our gelding) broke a front leg in two places and there was bone showing through the skin. He was very quiet and calm, didn't show pain, the vet got to our farm in just half an hour, and put Sandman down right away. He said there was no way to fix that leg and it wouldn't heal. I accepted this at the time but now we're both beginning to wonder. Our vet is a good man, but what if he was wrong? I thought that broken legs weren't such a problem for horses any more. Isn't there a way to fix a horse with a broken leg? What did the vet mean, that the leg wouldn't heal? How could he tell if he didn't try? I know some breaks are worse than others. Is it possible to make an artificial leg for a horse with a broken leg even if the leg won't heal? I didn't think so, but my wife thinks that she saw a peg-leg horse (amputated leg) on some TV program about animals. I'm sure it's costly and probably not something that an ordinary person could afford to do, but is it even possible? What about just a regular broken leg that would heal, is it true that today the horse is just put in a sling until the leg heals? I know the old-fashioned way involved shooting a horse with a broken leg, but aren't we beyond that?

Thanks. We always enjoy your answers so much, a lot of people say that there's no such thing as a stupid question, but you really seem to mean it, and we appreciate getting clear information without being talked down to. I hope we never need this information again, but you just never know and I'd like to be prepared.

Nate


Hi Nate! Thanks for the kind words. I do think there's no such thing as a stupid question, but I've heard more than a few stupid answers, so I try to provide the best information I can, and when I don't know, I'll say so. In the case of your question, it's something I've studied, and I've been lucky enough to know some vets who specialize in orthopedic injuries, repair, and rehabilitation, but you should still take this letter to your vet and discuss every bit of it, point by point, with him. He probably has more up-to-date information than I do, and he can certainly point you toward studies, cases, and published research on the subject. In the meantime, here's what I can tell you.

Yes, your wife is right, there are such things as artificial limbs for horses. They aren't common, they've very expensive, and they're not always successful, but they do exist.

A broken leg isn't an automatic death sentence these days - if you have a young, healthy animal with a simple fracture, today's veterinarians have a lot more options in the way of treatments and healing modalities. Some broken bones can be healed, some horses can be made "pasture sound", and some can continue to serve as riding horses, even if they are no longer up to the most demanding types of competition. But horses with broken legs DO get put down every day, it's just that nowadays, event organizers do their best to see that this doesn't happen in the sight of the public. Most of the injured horses that hobble onto the "equine ambulance" trailers at the racetrack aren't on their way to rehab...

Fracture-healing is not an easy process though, and it's SLOW, even if the horse is given the very best and latest forms of therapy (TENS, therapeutic ultrasound, active magnetic field therapy, cold laser therapy, etc.). Even though television programs and articles may feature the success stories, it's still the case that most broken legs will be "treated" with a bullet or a lethal injection. Horses just don't do well when their legs are fractured. There is so much weight involved - and it's held up by four very slender legs.

Whether to treat or euthanize a horse with a broken leg depends on many factors - it's not just a matter of the expense, or of what an ordinary person can afford. Some horses and some fractures are not treatable - an old horse, for instance, would be less likely to heal, and multiple and/or compound fractures are just too difficult to manage. Some horses, like the late, great Ruffian, are unable to remain calm after surgery, and injure themselves flailing around. Some remain calm but are unable to get through the lengthy process of convalescence, which is extremely stressful.

Some owners may have too much money for their horses' good - when someone can afford to ask for all the latest and most high-tech treatment options, and the expense is no object, it's quite possible to do too much, and treat the injury instead of the horse. Horses can often be kept alive in conditions that make any quality of life impossible. A horse that is constantly on drugs that irritate and ulcerate its stomach, for example, is not a horse with a good quality of life. Neither is a horse that can be kept alive and standing ONLY if it lives in a small padded stall and is never permitted to move freely, or indeed for more than a few steps at a slow walk. This sort of confinement and immobility is extremely stressful for horses, so owners who have empathy or even sympathy for their animals will usually opt to have them euthanized instead.

The exceptions - the situations in which horses are given the maximum surgical/technological efforts to repair the break - usually involve a combination of two factors: an owner who can afford to keep the horse alive at any cost, and a financial reason to invest in the horse's prolonged, even if miserable, life. A successful stallion with a high stud fee, for instance, might be kept alive as long as possible just to ensure the greatest possible income from his stud fees, or, perhaps, in some cases, from a more legitimate motive - to ensure that his bloodlines (if rare) are not lost. In neither case is this done for the sake of the quality of life of the individual animal. When you hear of a horse with an artificial limb, this is usually the sort of scenario involved.

You'd think that everyone could relax when the surgery was done, but no. Horses are tricky animals. Your gelding was almost certainly in shock when you found him, and probably wasn't feeling the pain of his injury. If you'd kept him alive, he would have felt it later, and you'd be faced with some hard decisions.

There are really two problems involved when dealing with a horse with a fractured leg - one is the fracture itself (where is it? how bad is it? can it be repaired?) and the other is the horse. Horses are meant to spend their lives in motion - it's their nature, and their design. They do not react well to the insecurity that comes with lameness and pain and the inability to get away from predators (real or imagined). They do not respond well to confinement and inactivity. Their health and attitude are both put at risk by the very conditions necessary for healing - confinement, inactivity, and (usually) drugs.

Drugs given to horses to keep them quiet tend to slow the healing process. Inactivity reduces circulation and slows the healing process. But - without the drugs, the horse would be trying to tap-dance in the stall, and would certainly re-injure itself. And without the forced confinement and inactivity, the horse would definitely be tap-dancing, and would injure itself again, possibly so badly that it would need to be euthanized immediately.

Then there are the pain-killing - or pain-reducing - drugs. If you use them, you don't want to use them so liberally that the horse feels fine and tries to tap-dance. The drugs are stressful to the horse's system, which is another reason you don't want the horse pumped full of pain-killers. On the other hand, pain is also stressful to the horse's system.... so once again, you (and your entourage of veterinarians) are walking a tightrope and trying not to tip too far in any direction. It's very, very difficult. Mother Nature isn't kind - horses with broken legs are not meant to be hospital patients, but DINNER for the local predator(s).

You asked about a sling. This brings us right back to the question of stress. Being in a sling is sressful for a horse - again, his ability to get away or even to move around is compromised. There are other complications, as well. A sling is great if you need to transport a horse, rescue a horse, or keep a starving/ill rescue horse upright until you can get it clean, dry, and sufficiently well-fed to remain alive, but slings are not good for long-term use. The pressure compromises the horse's circulatory system, the horse's skin can develop contact or pressure sores, the fact that the horse is not carrying its own weight on its legs causes its bone density to diminish, and once again, the horse's entire circulatory system is interfered with... which, as you remember, slows healing.

Even a seemingly successful fracture-healing can go wrong. For instance, the bone itself can die - bone is a live structure, constantly changing. If something like that happens, it's unlikely that the horse would be able to cope with the additional stress of the initial injury, surgery, and treatment plus additional surgery and treatment. Then, if you add in the complicated process of designing and fitting a prosthetic device that would, in most cases, allow the horse only very limited movement... You can see why veterinarians don't automatically suggest this.

So you're dealing with several issues here. Even a limited recovery from a serious fracture is unlikely - the prognosis typically is not good. Injury, treatment, and convalescence are all extremely stressful for the horse. Successful post-surgical convalescence can't be assumed and is likely to be prolonged and unpleasant. Prostheses are possible in some cases, but not something to count on, whether you're an average owner or an extremely wealthy one. And the horse itself can be its own worst enemy. Horses are big, heavy animals on slender legs. Horses have quick reflexes, a terror of being on insecure footing or not being able to move and "get away", and a physical body that's designed to be moving ALL the time. For all these reasons, "recovery" from a broken leg is still a very "iffy" matter. I know that you must miss your gelding terribly, but I'm sure that your vet evaluated the situation, used his good, trained judgement, and took the appropriate action.

Jessica

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