Survival and racing performance after surgical treatment of rib fractures in foals.

OBJECTIVE: To evaluate the short and long-term outcomes of foals treated surgically for fractured ribs and variables that may affect outcome. STUDY DESIGN: Retrospective. ANIMALS: Seventy-three equine neonates with surgically repaired fractured ribs. METHODS: Medical records were reviewed to include sex, breed, the side of thorax affected, number of ribs fractured, co-morbidities directly associated with rib fracture, and surgical technique used. Short-term outcome was defined as survival to discharge. Long-term outcome was whether or not they started a race. Race records of maternal siblings were obtained for comparison. RESULTS: Seventy-three neonates underwent surgery for fractured ribs. Fifty-seven neonates (78%) survived to discharge from the hospital. Rib fractures were more commonly observed in colts and in the left hemithorax (61% and 57%, respectively). Sex, side affected, number of ribs fractured, co-morbidities, number of ribs repaired, and surgical technique did not affect the short- or long-term outcomes. Thirty-five of 57 (61%) foals treated surgically for rib fractures that survived to discharge started a race compared to 173 of 257 (67%) of maternal siblings that raced. CONCLUSIONS: Short- and long-term outcome were not affected by co-morbidities, surgical technique, or number of fractured ribs. CLINICAL SIGNIFICANCE: Neonates with surgically repaired fractured ribs had a good prognosis for survival and and those that survived had a similar chances of starting a race compared to maternal siblings.

Preoperative computed tomographic evaluation of neonatal foals with rib fractures.

OBJECTIVE: To compare ultrasonographic and computed tomographic findings in neonatal foals prior to surgical repair of rib fractures as well as postoperative outcomes in foals with and without preoperative thoracic computed tomography (CT). Study design Retrospective cohort study. Sample population 43 neonatal foals undergoing surgical treatment of rib fractures between 2013 and 2021. METHODS: Medical records were reviewed for age, sex, delivery method, comorbidities, presurgical anesthetic time, surgical time, number and location of fractured ribs identified with ultrasound and CT, number and location of ribs surgically repaired, survival to discharge, and post-mortem findings. Statistical analyses were performed using chi-square, Fisher's exact, and t-tests. RESULTS: Twenty-two foals underwent surgical repair of rib fractures after preoperative CT from 2019-2021 (median: 4/18/20) and 21 foals were anesthetized (20 underwent repair) for surgical repair of rib fractures without preoperative CT from 2013-2020 (median: 4/9/15). Ultrasound and CT findings differed in number and location of fractured ribs in 13/17 (76%) foals (p = .049). More cranially positioned ribs were identified as fractured with CT than with ultrasonography (p = .035). Survival to discharge was improved when foals underwent CT (20/22, 91%) than when they did not (12/20, 60%, p = .019). CONCLUSION: Ultrasound findings differed from CT findings in most foals. Foals evaluated with CT were more likely to survive to hospital discharge. CLINICAL SIGNIFICANCE: When available, CT is recommended prior to surgical repair of rib fractures in neonatal foals.

Multiple imaging modalities for the diagnosis of tracheal collapse in a calf: A case report.

A 4-month-old Holstein Friesian calf was presented to the Ontario Veterinary College with progressive respiratory distress. The calf was diagnosed with tracheal collapse following perinatal rib fractures. Tracheal collapse has been infrequently reported in calves and is a possible sequela after delivery by forced extraction. Clinical signs can appear from days to months after birth, making the connection between clinical signs and dystocia more challenging. Multiple imaging modalities were used to diagnose and determine the severity of the tracheal collapse, and to establish the most likely cause and prognosis.

Modalités multiples d'imagerie pour le diagnostic de collapse trachéal chez un veau : rapport de cas. Un veau de race Holstein Friesian âgé de 4 mois fut présenté au Ontario Veterinary College pour détresse respiratoire progressive. Un diagnostic de collapse trachéal à la suite de fractures de côtes périnatales fut posé. Le collapse de la trachée n'a été rapporté que très peu fréquemment chez les veaux et serait une séquelle possible d'une mise-bas par extraction forcée. Les signes cliniques peuvent apparaitre des jours jusqu'à des mois après la naissance, rendant l'association entre les signes cliniques et la dystocie encore plus difficile. Des modalités multiples d'imagerie furent utilisées pour diagnostiquer et déterminer la sévérité du collapse trachéal, et afin d'établir la cause la plus probable et le pronostic.(Traduit par Dr Serge Messier).

Repair of an acquired diaphragmatic hernia with surgical mesh in a foal.

A foal born with assisted delivery developed rib fractures and a diaphragmatic hernia. The hernia was repaired using surgical mesh. The filly was healthy 42 months later. Dystocia is a risk factor for rib fractures and traumatic acquired diaphragmatic herniation. Surgical mesh repair is an option for diaphragmatic defects.

Réparation d'une hernie diaphragmatique acquise à l'aide d'un treillis chirurgical chez un poulain. Un poulain né lors d'une parturition assistée a développé des fractures des côtes et une hernie diaphragmatique. La hernie a été réparée à l'aide d'un treillis chirurgical. La pouliche était en santé 42 mois plus tard. La dystocie est un facteur de risque pour les fractures des côtes et une hernie diaphragmatique acquise lors d'un traumatisme. Le treillis chirurgical est une option pour les défauts diaphragmatiques.(Traduit par Isabelle Vallières).

Internal fixation of fractured ribs in neonatal foals with nylon cable tie using a modified technique.

Nylon cable tie has been shown to be an effective and economical method for fixing fractured ribs in the neonatal foal. This article describes a modification of the previously described technique. Under general anesthesia, the fractured ribs were exposed and a hole was drilled in the dorsal and ventral fragments. The fracture was not reduced, leaving the fragments overriding each other. The nylon cable tie was passed through the hole in the dorsal fragment from the external surface of the rib. The free end of the cable tie was then passed through the hole in the ventral fragment from the external surface of the rib and the tie was tightened. This technique was used in 4 neonatal foals with no complications. The modification of the original technique represents a method to minimize soft tissue trauma, implant failure, and complications.

Technique modifiée pour la fixation interne de fractures de côtes chez le poulain nouveau-né avec des attaches de câbles en nylon. Cet article décrit une technique pour réparer les fractures de côtes chez le poulain nouveau-né en utilisant des attaches de câbles en nylon. Sous anesthésie générale, une incision verticale a été faite et les côtes fracturées ont été exposées. Une mèche de perceuse a été utilisée pour faire des trous dans les fragments dorsaux et ventraux des côtes fracturées, approximativement 5 à 10 mm de la ligne de fracture. Le câble a été introduit dans le trou du fragment dorsal et ensuite dans le trou du fragment ventral. Les attaches de câbles ont été resserrées. Les fractures n'ont pas été réduites et les fragments dorsaux chevauchaient les fragments ventraux. Cette technique a été utilisée sans complications chez quatre poulains nouveau-nés.(Traduit par les auteurs).

A retrospective analysis for criteria of surgical intervention in Japanese Black calves with respiratory signs caused by perinatal rib fracture.

Medical records of 16 Japanese Black calves with respiratory signs associated with perinatal rib fracture were analyzed, retrospectively, to speculate criteria of surgical intervention for the disease. For this analysis, the severity of respiratory condition was classified into three grades: Grade 1, with no wheezing, Grade 2, with wheezing after excitement but not at rest and Grade 3, with wheezing at rest. Grade 1 (n=3) received only conservative management. Seven of Grade 2 (n=8) and all of Grade 3 (n=5) had surgical management. Clinical outcome was good in all of Grade 1, and the surgical success rate was 83% in other groups. Our result suggests that surgical intervention should be considered for cases with more the severity of Grade 2.

Rib fractures in adult horses as a cause of poor performance; diagnosis, treatment and outcome in 73 horses.

BACKGROUND: Rib fractures in adult horses are poorly documented. OBJECTIVES: To describe the presenting signs, diagnosis, treatment and outcome of horses diagnosed with rib fracture. STUDY DESIGN: Retrospective case series. METHOD: The clinical records and diagnostic images of all adult horses diagnosed with a rib fracture at three referral centres over a 15-year period were reviewed. RESULTS: Seventy-three horses met the inclusion criteria. Horses presented due to either resistance to ridden work and poor performance (n = 41), lameness (n = 21) or trauma (n = 7). In four horses, the presenting complaint was not recorded. Clinical assessment and palpation localised the site of injury in 18/47 cases where recorded. Nuclear scintigraphic examination identified all fracture sites in which it was performed (59/59). In 10/24 horses, radiographic examination confirmed rib fracture. Ultrasonographic examination confirmed rib fracture in 58/59 horses (98%; 95% CI 92-100). Six horses underwent surgery due to ongoing clinical signs and non-healing fracture; all other horses were managed conservatively. Fifty-five horses were available for long-term follow up (>1 year), of which 28 (51%; 95% CI 38-64) returned to their previous level of exercise. Twelve horses did not return to their previous level of exercise due to lameness unrelated to the rib fracture and seven horses were subjected to euthanasia, of which three were as a result of the rib fracture. Eight horses did not return to their previous level of exercise for other reasons. MAIN LIMITATIONS: Incomplete data set due to retrospective case series. CONCLUSIONS: Although uncommon, rib fractures should be considered in cases of reduced performance or resistance during ridden exercise. Palpation may be unrewarding. Scintigraphy and ultrasonography are useful in identifying the fracture site. Rib fractures in horses carry a fair prognosis and can be managed conservatively in most cases.

Alopecia areata and humpy-back syndrome in suckling piglets.

This report describes an uncommon variant of humpy-back syndrome associated with multiple rib fractures and multisystemic vasculitis in several nursing piglets and, for the first time, a skin disease in swine consistent with alopecia areata. Both conditions were observed concurrently on the farm and occasionally in the same piglets.

RésuméAlopécie areata et syndrome du porc bossu chez des porcelets à la mamelle. Les auteurs rapportent chez plusieurs porcelets sous la mère une variante peu fréquente du syndrome de lordose et xyphose associée à des fractures costales multiples et à une vasculite multisystémique et, pour la première fois chez le porc, une maladie cutanée compatible avec l'alopécie areata. Les 2 conditions ont été observées simultanément sur la ferme et même chez certains porcelets.(Traduit par les auteurs).

Anesthetic management of a horse with traumatic pneumothorax.

A traumatic pneumothorax and severe hemorrhage were present in a mare with a large thoracic wall defect, lung perforation, and multiple rib fractures. General anesthesia was induced to allow surgical exploration. We describe the anesthetic technique, and discuss the management of the ventilatory, hemodynamic, and metabolic disturbances encountered.

Chronic nonchylous lymphatic pleural effusion in a bottlenose dolphin (Tursiops truncatus).

CASE DESCRIPTION: A 19-year-old male bottlenose dolphin (Tursiops truncatus) presented with inappetence and avoidant behavior. CLINICAL FINDINGS: Ultrasound revealed a large-volume left-sided pleural effusion, which was consistent with chronic nonchylous lymphatic effusion and mild chronic hemorrhage by cytology. Computed tomography identified ipsilateral rib fractures, atelectasis, nodular pleuritis, marginal lymph node enlargement, and suspected dilation of the thoracic duct and internal thoracic veins. Fifteen lipids were significantly higher in serum of the dolphin as compared with controls (n = 3) using nontargeted lipidomics. TREATMENT AND OUTCOME: A series of thoracentesis procedures were performed. Follow-up CT demonstrated marked reduction in pleural effusion with persistence of thoracic duct dilation and mass-like areas of pleural thickening. Ultrasonographic resolution of pleural effusion occurred 14 months after presentation; however, recrudescence was noted 5 months later. Over a total of 24 months, 21.52 L of pleural effusion was removed. Despite the presence of pleural effusion, the patient was clinically stable during this time and quality of life was considered good on the basis of continuous animal welfare evaluations. Humane euthanasia was elected following acute clinical decline 27 months after initial diagnosis. Necropsy confirmed severe pleural effusion, chronic severe pleural fibrosis with chronic hemorrhage, and mediastinal fibrosis with entrapped lymph nodes and thymic tissue. CLINICAL RELEVANCE: Pleuritis and effusion were suspected sequelae of previous rib fractures. To our knowledge, this is the first report of nonchylous lymphatic pleural effusion with repeated pleural drainage and diagnostic imaging for clinical management in a bottlenose dolphin.

The use of nylon cable ties to repair rib fractures in neonatal foals.

Commercially available nylon cable ties were used as a method of internal fixation for displaced rib fractures in 8 equine neonates. The procedure was effective, well-tolerated, rapid, and inexpensive. The use of nylon cable ties as internal fixation for displaced rib fractures in foals is an effective surgical procedure.

Rib fracture in a horse during an endurance race.

We describe a fatal case, in which a horse suffered a fall and as a consequence, rib fractures. Diagnosis was made postmortem and the horse died without showing clear signs of respiratory dysfunction. The retrospective reports of injuries can be important to reduce these traumatic events and to avoid fatalities.

Resolution of tracheal collapse and stenosis without surgical intervention in two Holstein calves.

CASE DESCRIPTION: A 4-month-old 127.5-kg (280.5-lb) Holstein heifer calf (patient 1) and a 4-month-old 174-kg (382.8-lb) Holstein bull calf (patient 2) of high genetic value were examined because of signs of respiratory tract disease (dyspnea, wheezing, and coughing) of 2 and 3 months' duration, respectively, that did not respond to antimicrobial and anti-inflammatory treatment. Patient 1 was born with assistance owing to malpresentation and dystocia. The birth of patient 2 was unobserved. CLINICAL FINDINGS: For both calves, results of a physical examination, CBC, serum biochemical analysis, thoracic radiography and CT, and nasotracheal endoscopy led to the diagnosis of tracheal collapse and stenosis secondary to perinatal rib fractures. Neither calf had evidence of substantial lower airway disease. TREATMENT AND OUTCOME: Both calves were discharged from the hospital with the recommendation that they be individually housed in cool, well-ventilated stalls with no access to headlocks. The clinical signs abated, and surgical intervention was not pursued in either patient. Both patients grew as expected and achieved reproductive maturity, with patient 1 becoming an oocyte donor and patient 2 being purchased by a commercial bull stud company. Patient 1 was reevaluated at 21 months old, and patient 2 was reevaluated at 26 months old. Results of follow-up thoracic radiographic (patient 1) and nasotracheal endoscopic (both patients) examinations indicated an anatomically normal trachea with no evidence of collapse or stenosis. CLINICAL RELEVANCE: This report was the first to describe successful resolution of tracheal collapse and stenosis secondary to perinatal rib fracture in dairy calves without surgical intervention.

Multiple rib fracture repair in a neonatal Holstein calf.

OBJECTIVES: To report rib fracture repair in a neonatal calf using the Securos Cranial Cruciate Ligament Repair System (SCCLRS). STUDY DESIGN: Case report. ANIMALS: A 2-day-old female Holstein calf with fracture of right ribs 4-10. METHODS: On the day of admission the calf was anesthetized and rib fractures were repaired using open reduction and the SCCLRS. RESULTS: Rib fractures were successfully stabilized and the calf discharged from the hospital 8 days postoperatively. CONCLUSIONS: Modification of previously reported use of the SCCLRS to repair rib fractures in foals was required because of the different anatomy in the calf. This new technique was rapidly and easily performed for a large number of fractured ribs in this case. CLINICAL RELEVANCE: Effective rib fracture repair in calves can be readily performed using the SCCLRS with modification of the technique reported in foals.

Use of the Animal Trauma Triage Score, RibScore, Modified RibScore and Other Clinical Factors for Prognostication in Canine Rib Fractures.

OBJECTIVES: To characterize the clinical features among dogs sustaining rib fractures and to determine if age, type and severity of injury, entry blood lactate, trauma score and rib fracture score were associated with outcome. METHODS: A retrospective study was performed to include dogs that were presented with rib fractures. Risk factors evaluation included breed, age, body weight, diagnosis, presence of a flail chest, bandage use, puncture wound presence, rib fracture number, location of the fracture along the thoracic wall, hospital stay length, body weight, other fractures, pleural effusion, pulmonary contusions, pneumothorax and occurrence of an anaesthetic event. A retrospective calculation of an animal trauma triage (ATT) score, RibScore and Modified RibScore was assigned. RESULTS: Forty-one medical records were collected. Motor vehicular trauma represented 56% of the rib fracture aetiology, 41% of patients sustained dog bites and one case was of an unknown aetiology. Significant correlations with risk factors were found only with the ATT score. All patients that died had an ATT score ≥ 5. The ATT score correlated positively with mortality (p < 0.05) with an ATT score ≥ 7 was 88% sensitive and 81% specific for predicting mortality. A 1-point increase in ATT score corresponded to 2.1 times decreased likelihood of survival. Mean hospital stay was 3 days longer for dog bite cases. CLINICAL SIGNIFICANCE: There was no increased mortality rate in canine patients that presented with the suspected risk factors. The only risk factor that predicted mortality was the ATT score.

Biomechanical Comparison between Preloaded Position Screw and Lag Screw Fixations for Their Compressive Effects in a Porcine Rib Fracture Model.

OBJECTIVES: The aim of this study was to compare the compressive effect between preloaded position screws and lag screws in fracture fixation. METHODS: Pairs of semi-cylindrical bone fragments were created on a porcine rib model to simulate fractured bones. The compressive forces of fracture fixation generated by preloaded position screws (P group) and conventional lag screws (L group) were recorded by a film stress sensor. In the P group, a pair of Angus bone holding forceps was used to compress the interfragmentary interface until reaching the preloading force of 1.3 MPa. Similar preloading procedure was applied on lag screw fixations to explore its potential of additional compressive force. RESULTS: With 1.3 MPa preloading force and 0.2 Nm screw insertion torque force, the interfragmentary compressive force of P group was similar to that of L group. When the insertion torque force was increased to 0.4 Nm, all screws in the L group failed due to thread stripping. When screws in the P group were installed under 0.4 Nm torque and in the L group under 0.2 Nm torque, the P group generated significantly greater compressive force. With preloading device applied on lag screw installation, it did not further increase the interfragmentary compressive force. CLINICAL SIGNIFICANCE: Compared with lag screws, preloaded position screws tolerated greater torque in screw installation and provided greater interfragmentary compressive force. The study suggests the applicability of preloaded position screws in fracture fixation requiring interfragmentary compression.

Detection of rib trauma in newborn foals in an equine critical care unit: a comparison of ultrasonography, radiography and physical examination.

REASONS FOR PERFORMING STUDY: Previous studies have shown that in man ultrasonography is more accurate than radiography for detecting rib fractures. OBJECTIVES: To describe clinical, radiographic and ultrasonographic findings related with rib fractures in newborn foals in an equine critical care unit; and to compare diagnostic accuracy of ultrasonography to radiography. METHODS: A prospective ultrasonographic study was performed on 29 foals presented to the emergency unit. This study was performed at the Centre Hospitalier Universitaire Vétérinaire (CHUV), University of Montreal. Physical examination as well as radiographic and ultrasonographic examinations were performed. RESULTS: Thoracic radiographs revealed 10 rib fractures in 5 of 26 (19%) foals. Ultrasonography revealed 49 fractures in 19 of 29 (65%) foals of which fillies (n = 13; 68%) were significantly over represented as were fractures to the left thorax (n = 15; 78%). Seventeen of 19 foals (90%) had rib fractures located 3 cm or less from the costochondral junction, the distal part of the rib being displaced laterally in all cases. In 2 foals, where both thoracic radiographs and ultrasonography detected rib fractures, the site of fractures was located on the mid portion of the rib. Rib fractures were detected only by thoracic radiographs in one foal. Sixty-five percent (32/49) of fractured ribs had a moderate displacement (1-4 mm). CONCLUSIONS: Rib fractures are seen frequently in newborn foals in equine critical care units. Ultrasonography is more accurate than radiography and reveals fractures in most patients presented in emergency. The position (costochondral junction) of rib fractures and of the fragments suggest that most thoracic trauma probably occurs during parturition. POTENTIAL RELEVANCE: Ultrasound imaging increases awareness and improves the diagnosis of rib fractures in newborn foals.

Thoracic trauma in horses.

Thoracic trauma represents an important cause of morbidity in mortality after injury in human beings and animals. After any form of suspected chest wall trauma, initial emergency management should include assurance of a patent airway and adequate ventilation, along with treatment for shock if present. As with any open wound, tetanus prophylaxis should be instituted. Types of trauma to the thoracic region of the horse include pectoral and axillary lacerations, penetrating chest wounds, flail chest, fractures of the ribs, blunt thoracic trauma, and several potential sequelae that include pneumothorax, pneumomediastinum, hemothorax, pleuritis, fistulae of the sternum or ribs, and diaphragmatic hernia. Emergency management of these various forms of thoracic trauma is discussed.

Retrospective evaluation of coyote attacks in dogs: 154 cases (1997-2012).

OBJECTIVE: To describe the clinical presentation and outcome of known attacks in client-owned dogs caused by the common coyote, Canis latrans. DESIGN: Retrospective observational study. SETTING: Private referral hospital. ANIMALS: One hundred fifty-four client-owned dogs known to be attacked by coyotes. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Records from a private referral hospital from May 1997 through December 2012 were reviewed. Time of day and month/season of year, signalment, body temperature, heart rate, respiratory rate, body weight, location and severity of wounds inflicted, common injuries, length of hospitalization, necessity of surgical wound repair under anesthesia, antimicrobial use and mortality were recorded. Eighty-six percent of dogs presenting following coyote attack weighed <10 kg. Overall mortality rate was 15.6%. Dogs with bite wounds to the thorax had the highest mortality at 21.3%. Criteria for systemic inflammatory response syndrome (SIRS) based on admission vital signs were met in 58.8% of dogs and the presence of SIRS was significantly associated with mortality (P < 0.001). Common coyote-induced injuries included rib fracture (38/154; 24.6%), pulmonary contusion (30/154; 19.4%), tracheal tear (18/154; 11.6%), pneumothorax (16/154; 10.3%), abdominal wall hernia (9/154; 5.8%), and abdominal penetrating wounds (8/146; 5.5%). Dogs <10 kg were significantly more likely to incur wounds to multiple body parts or sustain abdominal penetrating wounds. The presence of rib fracture was significantly associated with mortality. Frequency of coyote attacks over the time of this study increased by 330%. CONCLUSIONS: Coyote attacks on dogs are a problem in Southern California and are associated with substantial morbidity and mortality, especially in dogs with wounds to the thorax. Aggressive management involving surgical wound repair was associated with survival to discharge.