The inherit risks and costs associated with general anesthesia have led to an increase in the number of surgical procedures performed under standing sedation. Risks of general anesthesia include injury during recovery, cardiorespiratory collapse, and reduced blood flow, among others.
This type of surgery appears to offer advantages for the horse, the surgeon, and the owner, leading a pair of veterinarians from Rossdales Equine Hospital in Newmarket, England, to evaluate standing fracture repair outcomes.
Richard Payne, BSc, BVSc, CertES, Dipl. ECVS, MRCVS, a surgeon and partner, and Polly Compston, BSc, BVM&S, MRCVS, a resident in clinical research, studied the short- and long-term results of fracture repair performed under standing sedation on 34 racehorses.
"The only fractures that can be repaired in a standing horse are nondisplaced ones--where the bone hasn't moved along the fracture line," Compston explained. "Additionally, only specific fracture sites can be repaired in the standing horse--those that have available surgical access."
The study involved four Arabians and 30 Thoroughbreds that Payne performed standing fracture repair on at Rossdales between March 2004 and June 2011. Fracture sites included in the study were the proximal phalanx (the long pastern), third metacarpal bone (front cannon), or third metatarsal bone (hind cannon). The researchers used case records, owner/trainer questionnaires, and the 'Racing Post" website to obtain follow-up data.
After surgery, short-term follow-up (3-4 weeks after surgery) revealed:
- Thirty horses had no post-surgical health problems;
- One horse developed unresponsive cecal impaction, necessitating euthanasia;
- Two other horses developed signs of colic but recovered with medical management.; and
- One other horse developed mild skin sores from bandages but recovered with no further problems.
Mid-term follow-up (prior to return to racing), which excluded three horses due to how recently surgery was performed, revealed:
- Thirty horses were sound at a trot;
- Twenty-eight horses resumed race training;
- Three horses developed lameness in the fractured limb and were retired; and
- Four horses were retired due to lack of racing ability.
Long-term follow-up (upon return to racing), which excluded four more horses due to insufficient records--for a total of seven horses excluded--revealed:
- Twenty horses returned to racing in an average of 226 days after fracture repair;
- Twelve placed or won at least one race post-operatively; and
- All questionnaire respondents agreed they would have other fractures repaired with standing sedation.
Payne and Compston concluded there were no observed disadvantages to standing fracture repair as compared to surgical repair under general anesthesia for appropriate fractures. "The inherent risks of general anesthesia can be avoided, it reduces the complexity and time requirements of the procedure, and this in turn reduces the cost compared with fracture repair under general anesthesia," they noted.
The study, "Short- and long-term results following standing fracture repair in 34 horses," appeared in the April 2012 issue of the Equine Veterinary Journal. The abstract can be viewed online.
Disclaimer: Seek the advice of a qualified veterinarian before proceeding with any diagnosis, treatment, or therapy.