Equis ISSN 2398-2977

Rib: fracture

Contributor(s): Bud G E Fackelman, Graham Munroe

Introduction

  • Cause: blunt thoracic trauma to foal during birth or collision, blow or kick.
  • History: foals recently born to primiparous mares, dystocic parturition or in adults following blunt thoracic trauma with difficulty in breathing.
  • Signs: contusions and rib fractures may   →   pain, pulmonary compromise and secondary complications, eg flail chest, penumothorax, hemothorax.
  • Diagnosis: pain on breathing, palpation of ribs, other signs dependent on subsequent complications.
  • Treatment: many cases apparently remain subclinical and will heal without specific treatment or complications, but pain control and supportive care are important especially in neonatal foals.
  • Prognosis: depends on age of patient, degree of damage and secondary complications but varies from guarded to good.

Pathogenesis

Etiology

  • Birth-related, blunt, thoracic trauma due to excessive or incorrect force applied to foal during passage through the birth canal. There is increased incidence in fetal oversize or dystocia foals. In one study 263 foals were examined within 3 days of birth and 55 (21%) had evidence of blunt thoracic trauma that had ocurred during parturition.
  • Collision with objects, falls or kicks, may cause blunt or penetrating thoracic trauma in older animals. Blunt trauma is associated with pulmonary contusions and rib fractures whereas penetrating injuries (more common) may   →   pneumo- or hemothorax.
  • Excessive chest compression during cardiopulmonary resuscitation   Emergency resuscitation  is less likely in neonatal foals because of compliant nature of ribs.

Predisposing factors

General
  • Thoracic trauma.

Specific

  • Dystocia.
  • Fetal oversize.
  • Incorrect obstetric techniques.

Pathophysiology

  • Blunt thoracic trauma at birth or by collisions/falls, etc.
  • Abnormalities at birth predispose foals to rib fractures.
  • Rib fractures may be subclinical or   →   painful breathing, pulmonary compromise and cardiovascular embarrassment.
  • Secondary complications including damage to vital structures, pneumo- and hemothorax can occur.
  • Blunt trauma often   →   contusions and rib fractures.
  • The resultant rib fractures can lacerate the pulmonary parenchyma or perforate the heart/cardiac vessels/large vessels.
  • Secondary hemothorax and/or pneumothorax may occur.
  • Major concerns are the possibility of cardiovascular embarrassment, pain and pulmonary compromise   →   inadequate ventilation and oxygenation   Respiratory: nasal oxygen administration  .
  • Hypoventilation may progress to hypercarbia, hypoxia and infection compounding the problem and   →   adult respiratory distress syndrome.

Diagnosis

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Treatment

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Prevention

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Outcomes

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Jean D, Picandet V, Macieira S, Beauregard G, D'Anjou M A & Beauchamp G (2007)Detection of rib trauma in newborn foals in an equine critical care unit: a comparison of ultrasonography, radiography and physical examination.Equine Vet J39(2), 158-163 PubMed.
  • Jean D, Laverty S, Halley J, Hannigan D & Leville R (1999)Thoracic trauma in newborn foals.Equine Vet J31(2), 149-152 PubMed.
  • Rossdale P D (1999)Birth trauma in newborn foals.Equine Vet J31(2), 92 PubMed.


ADDED