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EQUINE VETERINARY EDUCATION


Equine vet. Educ. (2022) 34 (7) 338-339 doi: 10.1111/eve.13664


Highlights of recent clinically relevant papers


Rib fractures in adult horses The aim of this retrospective case series by Suzy Hall and co- workers in the UK was to describe the presenting signs, diagnosis, treatment and outcome of horses diagnosed with rib fracture. The clinical records and diagnostic images of all adult


horses diagnosed with a rib fracture at three referral centres over a 15-year period were reviewed. Seventy-three horses met the inclusion criteria. Horses presented due to either resistance to ridden work and poor performance (clinical signs included poor response to rider aids, bucking, bolting, napping, rearing or a reluctance to jump; n = 41), lameness (n = 21) or trauma (n = 7). In four horses, the presenting complaint was not recorded. Clinical assessment and palpation localised the site of injury in 18/47 cases where recorded. In 64 horses (88%; 95% CI 79–94), one rib was affected; in two horses, two ribs were affected; in three horses, three ribs were affected, and in four horses, four or more ribs were affected. One horse had fractures on both the left and right sides, but in all other horses, the fractures were unilateral: 40 on the left side and 32 on the right side. The 18th rib was the most commonly affected (n = 32; 42%; 95% CI 32–54). Nuclear scintigraphic examination identified all fracture sites in which it was performed (59/59). In 10/ 24 horses, radiographic examination confirmed rib fracture. Ultrasonographic examination confirmed rib fracture in 58/ 59 horses (98%; 95% CI 92–100). Six horses underwent surgery due to ongoing clinical signs and nonhealing fracture; all other horses were managed conservatively. Fifty-five horses were available for long-term follow-up (>1 year), of which 28 (51%; 95% CI 38–64) returned to their previous level of exercise. Twelve horses did not return to their previous level of exercise due to lameness unrelated to the rib fracture, and seven horses were subjected to euthanasia, of which three were due to the rib fracture. Eight horses did not return to their previous level of exercise for other reasons. Although uncommon, rib fractures should be considered


in cases of reduced performance or resistance during ridden exercise. Palpation may be unrewarding. Scintigraphy and ultrasonography are useful in identifying the fracture site. Rib fractures in horses carry a fair prognosis and can be managed conservatively in most cases.


Recurrent ipsilateral fractures


In this retrospective study, Hiroshi Mita and co-workers in Japan aimed to investigate the recent incidence of carpal fractures and the risk factors for recurrent ipsilateral fractures after arthroscopic removal of clinically active unilateral carpal chip fracture fragments in Thoroughbred racehorses. The records of horses managed under the Japan Racing


Association that developed carpal bone fractures between 2014 and 2018 were reviewed. The proportion of cases that developed a recurrent carpal fracture in the originally affected joint was calculated, and the risk factors for recurrent fractures were analysed.


© 2022 EVJ Ltd Risk factors for primary uveitis


The objectives of this prospective case-control longitudinal study by Fernando Malalana and co-workers at the University of Liverpool were to determine risk factors for the development of a first episode of primary uveitis in horses in the UK and to document the proportion of cases that experience recurrence following this first episode. Horses with the first episode of primary uveitis between


July 2014 and August 2018 were recruited for the study. For each case, two controls were selected. A questionnaire was completed for each horse and multivariable logistic


In total, 2858 carpal fractures were recorded in the study


period (incidence, 0.8%). Of the 554 horses that resumed racing after the treatment of the unilateral major carpal chip fracture, 144 had a recurrent fracture (26.0%). Chip fractures of the third carpal bone (OR 3.7) or a combination of the distal end of the radius and intermediate carpal bone (OR 3.0) were associated with a significantly higher risk of recurrent fractures than the distal aspect of the radial carpal bone.


The incidence of carpal fractures remained similar to that


reported in Japan in the 1990s. The rate of recurrent ipsilateral fractures differed among lesion sites.


Transvenous electrical cardioversion


Transvenous electrical cardioversion (TVEC) is one of the main treatment options for atrial fibrillation (AF) in horses. The objective of this retrospective study by Ingrid Vernemmen and co-workers at Ghent University, Belgium was to determine factors affecting cardioversion success, cardioversion difficulty and recurrence in a Warmblood study sample. Data were obtained from the TVEC records of 199 horses


admitted for AF without severe echocardiographic abnormalities. Horse and procedural factors for success and cumulative amount of energy (≤600 J vs. >600 J) were determined using multivariable logistic regression. A survival analysis was performed to determine risk factors for recurrence. A total of 231 TVEC procedures were included, with a


94.4% success rate and 31.9% recurrence rate (51/160). Mitral regurgitation (OR 0.151; 95% CI 0.032–0.715) and AF cycle length (OR 1.05; 95% CI 1.01–1.09) were independent determinants for success. Catheter type (OR 0.154; 95% CI 0.074–0.322), previous AF episode (OR 3.10; 95% CI 1.20–8.01), tricuspid regurgitation (OR 2.54; 95% CI 1.25–5.13) and body weight (OR 1.009; 95% CI 1.003–1.015) were significantly correlated with cumulative amount of energy delivered. Significant risk factors for recurrence after a first AF episode were sex (stallion; HR 3.05; 95% CI 1.34–6.95), mitral regurgitation (HR 1.91; 95% CI 1.08–3.38) and AF duration (HR 1.001; 95% CI 1.0001–1.0026). Both horse and procedural factors should be considered when assessing treatment options and prognosis in horses with AF.

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