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When Time Limit and Sorcerer suffered fatal breakdowns in the Jim Beam in 1998, many people wondered why these injuries are so often fatal. Here is an excellent explanation from a veterinarian online, Dr. Sarah McCarthy.
First of all many, many fractures can be and are repaired. However, the majority of horses who breakdown badly enough to fall, can not be saved. The ones that pull up midrace can go either way. The most common reasons why some fractures are not be repaired include:
1) Gross contamination of a compound fracture. Racetrack dirt is a really bad thing to have contaminating a fracture. Even with good internal repair of the fracture, bone infections often result and are usually impossible to control even with high levels of potent antibiotics.
2) Loss of blood supply to the lower limb. There is no muscle below the knee and hock of a horse, and therefore there is very little protection for the veins, arteries and nerves. Often, the bony part of a fracture could be repaired, but there is too much loss of circulation to the foot and the horse would essentially develop gangrene below the fracture. The sort of vascular surgery that would be required to overcome this is not really developed for the horse. There is so little extra soft tissue in this area that even finding enough healthy skin to pull over the bone is not always possible.
In most of the fractures you see where the horse falls during a race and is euthanized on the track, it is because of a combination of both 1 & 2.
3) Shattered bone. If the bone fragments are too numerous and small, some of those pieces individually lose their blood supply. Such a fragment will die and infection sets in which is likely to invade neighboring bone fragments. Bone grafting can help, but not eliminate the problem. Horse bone is very dense, and heals slowly.
4) Because horses can not remain lying down for long periods of time, the horse will spend a good deal of time standing on three legs if the fourth is fractured. Unfortunately, especially with front legs, the other foot tends to develop laminitis from over-use. This is a condition which can be more painful than the original fracture. Often if you hear about a breakdown that they try to repair, and the horse is put down a few weeks or months later, it will be because the horse foundered (developed laminitis). Putting horses in slings, is a real problem. They can be life saving if the horse can be induced to tolerate being slung (Nureyev, 1986). But many horses don't tolerate slings well, (Alydar, 1990)
5) Big bones. When horses break bones above the knee or hock, the prognosis is even worse. These bones are very slow to heal, very difficult to approach surgically, often make it very hard if not impossible for the horse get up and lie down, and are often spiral fractures with very little solid bone left to put screws or plates into. Also there is not always hardware available that is large enough for the job. (Nearly all techniques and hardware are developed for human use, and adapted for use in horses.)
6) Humane reasons. With some cases the odds for survival are low but not impossible. With an enough good luck, some horses overcome incredible odds (Root Boy), others seem plagued with bad luck (Ruffian). Some horses cooperate Root Boy), some horses seem to work against themselves and those who try to help them (Ruffian). Or a combination (Nureyev, who helped save himself, but did break his vets arm during the process.) Sometimes what you end up with is alive, but not very comfortable. The healing process is not fun for the horse, and sometimes it is fairer to the horse not even to try.
7) Economics. Depending on the nature of the injury, the cost of saving a horse with a severe fracture can be extraordinarily high. One of my clients spent over $7000 last year to save a young foal with a fractured cannon bone. Things went well for that baby. It could easily have gone higher, and she still might have lost her colt. Foals heal relatively very well, an adult horse that survived the same injury would probably have cost the owner more.
If the horse has high enough residual value as a breeding stallion, or broodmare, the economics may be somewhat less of a problem. Unfortunately with no guarantee of success it can still be a big risk. With cheaper horses, it is frequently the economics which ultimately kills the horse. It ain't fair but it is certainly true. Dr Bramlage who pioneered a technique for saving horses who break both sesamoid bones, has been asked to save many horses. (Saratoga Six, et al) ALL of them have been stallions or mares except for one lone gelding whose owners thought enough of him to have the same surgery performed even though it would leave him purely a pet. This was so unusual that there were articles written about it!
8) There are exceptions to nearly every rule. A former employer of mine was asked to look at a horse shortly after he graduated from vet school. It was a 2yo palomino in a rural backyard in Tennessee. He examined the horse and found a very obvious fracture of the tibia (hind leg just below where it meets the body). The leg was so unstable that it could swing from side to side. He explained the injury and said that sadly there was no hope of saving him. The little girl who owned him (You knew there had to be one involved, didn't you?) refused to allow him to put the horse down. He explained what they could expect, bed sores, founder, etc, etc. He said that when the horse got so bad that they couldn't stand it, he would come back and put it to sleep. I think the vet was really angry that these people would not see reason (I would have been furious myself) and that they were bent on putting the horse through hell. Well you guessed it. He never heard a word from the people, and it was six month later that he was visiting a nearby farm. He looked wistfully over at the property where the horse had been, and sure enough there was that same little girl walking that palomino horse bareback in slow circles around his paddock. Miraculously, he had survived.
First of all many, many fractures can be and are repaired. However, the majority of horses who breakdown badly enough to fall, can not be saved. The ones that pull up midrace can go either way. The most common reasons why some fractures are not be repaired include:
1) Gross contamination of a compound fracture. Racetrack dirt is a really bad thing to have contaminating a fracture. Even with good internal repair of the fracture, bone infections often result and are usually impossible to control even with high levels of potent antibiotics.
2) Loss of blood supply to the lower limb. There is no muscle below the knee and hock of a horse, and therefore there is very little protection for the veins, arteries and nerves. Often, the bony part of a fracture could be repaired, but there is too much loss of circulation to the foot and the horse would essentially develop gangrene below the fracture. The sort of vascular surgery that would be required to overcome this is not really developed for the horse. There is so little extra soft tissue in this area that even finding enough healthy skin to pull over the bone is not always possible.
In most of the fractures you see where the horse falls during a race and is euthanized on the track, it is because of a combination of both 1 & 2.
3) Shattered bone. If the bone fragments are too numerous and small, some of those pieces individually lose their blood supply. Such a fragment will die and infection sets in which is likely to invade neighboring bone fragments. Bone grafting can help, but not eliminate the problem. Horse bone is very dense, and heals slowly.
4) Because horses can not remain lying down for long periods of time, the horse will spend a good deal of time standing on three legs if the fourth is fractured. Unfortunately, especially with front legs, the other foot tends to develop laminitis from over-use. This is a condition which can be more painful than the original fracture. Often if you hear about a breakdown that they try to repair, and the horse is put down a few weeks or months later, it will be because the horse foundered (developed laminitis). Putting horses in slings, is a real problem. They can be life saving if the horse can be induced to tolerate being slung (Nureyev, 1986). But many horses don't tolerate slings well, (Alydar, 1990)
5) Big bones. When horses break bones above the knee or hock, the prognosis is even worse. These bones are very slow to heal, very difficult to approach surgically, often make it very hard if not impossible for the horse get up and lie down, and are often spiral fractures with very little solid bone left to put screws or plates into. Also there is not always hardware available that is large enough for the job. (Nearly all techniques and hardware are developed for human use, and adapted for use in horses.)
6) Humane reasons. With some cases the odds for survival are low but not impossible. With an enough good luck, some horses overcome incredible odds (Root Boy), others seem plagued with bad luck (Ruffian). Some horses cooperate Root Boy), some horses seem to work against themselves and those who try to help them (Ruffian). Or a combination (Nureyev, who helped save himself, but did break his vets arm during the process.) Sometimes what you end up with is alive, but not very comfortable. The healing process is not fun for the horse, and sometimes it is fairer to the horse not even to try.
7) Economics. Depending on the nature of the injury, the cost of saving a horse with a severe fracture can be extraordinarily high. One of my clients spent over $7000 last year to save a young foal with a fractured cannon bone. Things went well for that baby. It could easily have gone higher, and she still might have lost her colt. Foals heal relatively very well, an adult horse that survived the same injury would probably have cost the owner more.
If the horse has high enough residual value as a breeding stallion, or broodmare, the economics may be somewhat less of a problem. Unfortunately with no guarantee of success it can still be a big risk. With cheaper horses, it is frequently the economics which ultimately kills the horse. It ain't fair but it is certainly true. Dr Bramlage who pioneered a technique for saving horses who break both sesamoid bones, has been asked to save many horses. (Saratoga Six, et al) ALL of them have been stallions or mares except for one lone gelding whose owners thought enough of him to have the same surgery performed even though it would leave him purely a pet. This was so unusual that there were articles written about it!
8) There are exceptions to nearly every rule. A former employer of mine was asked to look at a horse shortly after he graduated from vet school. It was a 2yo palomino in a rural backyard in Tennessee. He examined the horse and found a very obvious fracture of the tibia (hind leg just below where it meets the body). The leg was so unstable that it could swing from side to side. He explained the injury and said that sadly there was no hope of saving him. The little girl who owned him (You knew there had to be one involved, didn't you?) refused to allow him to put the horse down. He explained what they could expect, bed sores, founder, etc, etc. He said that when the horse got so bad that they couldn't stand it, he would come back and put it to sleep. I think the vet was really angry that these people would not see reason (I would have been furious myself) and that they were bent on putting the horse through hell. Well you guessed it. He never heard a word from the people, and it was six month later that he was visiting a nearby farm. He looked wistfully over at the property where the horse had been, and sure enough there was that same little girl walking that palomino horse bareback in slow circles around his paddock. Miraculously, he had survived.
