Racehorse fractures: Surgeon says “RSI” the biggest risk factor

Dr Dean Richardson and Barbaro.
Professor Dean Richardson and his most famous former patient, Barbaro. © Kathy Freeborn

A renowned equine surgeon has declared that repetitive stress injuries of the bone are the single most important problem in racehorses.

Professor Dean Richardson made the comments in Australia this week, during the Bain Fallon Memorial Lectures hosted by Equine Veterinarians Australia (EVA).

Richardson is chief of Large Animal Surgery at the University of Pennsylvania School of Veterinary Medicine and a Diplomate of the American College of Veterinary Surgeons.

For thoroughbreds, repetitive stress injuries are common and not only limit the performance of the animal, but they can also lead to serious and career-ending fractures.

Richardson discussed the signs, diagnosis and management of repetitive stress injuries in the racehorse.

“The fetlock or Achilles heel of the racehorse is a high-impact area. When a horse runs at full speed, the bones in this area are placed under enormous strain and it’s common for horses to experience pain or injuries, which tend to be more intense in the forelimb, but very similar damage is also seen in the hind fetlocks,” he said.

“The signs of repetitive stress injury are quite broad. Although many horses appear obviously lame in one limb, this is a disorder that commonly afflicts two, three or four fetlocks. As a result, trainers or jockeys often describe the horse as simply ‘moving poorly’, and general observations give the impression that the horse just looks uncomfortable and stiff, not necessarily lame,” Richardson said.

The Equimagine robotics-controlled imaging system can be used with a standing and moving horse.
Professor Dean Richardon with New Bolton’s Equimagine robotics-controlled imaging system, which can be used with a standing and moving horse.

Physical signs of injuries in the fetlock such as heat, swelling or elicited pain are unreliable when making a diagnosis. Bone scans remain the single most valuable diagnostic tool to identify stress related bone injury because it is sensitive, potentially assesses the entire skeleton and does not require general anaesthesia. Three-dimensional imaging is unequivocally the future for early diagnosis of stress related injuries. Magnetic resonance imaging is useful in identifying varying types of damage to the bone but it is more expensive, and much more time consuming than computed tomography (CT). With the advent of standing CT over the next ten years, it is expected that vets will be able to predict horses at the most risk for catastrophic fracture.

“The best treatment for repetitive stress injuries in the fetlock depends on a few key factors including the specific nature of the lesion, the horse’s health history and the intended use of the animal. Management can range from simply sending a horse to a farm with where it can exercise in a large paddock, to surgery if the area has sustained a fracture,” Richardson said.

“Rest is always a consideration but by ‘rest’ I mean a break from race training. Very few stress related injuries of the fetlock require strict rest in the form of confinement, but a veterinarian will be able to advise on a case by case basis what’s in the best interests of the horse.”


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