Successful reduction and internal fixation of an open tibial fracture in an adult Icelandic horse

Fractures caused by a kick or fall are the most common injury of the tibia in horses. Frequent complications after surgical reduction of the fracture are implant failure during recovery from general anaesthesia and infection. The outcome of surgery depends heavily on the use of sound preoperative first aid measures. Fixation of the proximal tibia with a splint for transportation is difficult. This case report describes successful internal fixation of an open tibial fracture after a kick injury in a seven-year-old Icelandic gelding. The fractured leg was stabilized with a splint, and the horse was transported in lateral recumbency to the Department of Equine Surgery, University of Zurich, by the Large Animal Rescue Service CH/FL. During transportation, the horse received oxygen via a nasal cannula and intravenous fluids. Radiographs showed an open oblique fracture of the tibia with additional small fragments. With the horse under general anaesthesia, the fracture was stabilized with two large 4.5 dynamic compression plates. The horse was recovered from general anaesthesia in a pool and suspended in a sling (Animal Rescue and Transportation Sling [ARTS]) for four weeks to prevent it from lying down. Following this, the horse was restricted to a box stall for six weeks with hand walking for short periods each day. Three months postoperatively, there was loosening of one screw, which was removed with the horse standing and sedated. Five months postoperatively, the horse could be ridden normally. Both plates were removed 17 months after surgery under general anaesthesia because the horse hod intermittent lameness during cold weather. The horse returned to its previous level of activity after the second surgery and no complications occurred. The size and weight of the horse were favourable to a successful outcome in this case.