04/16/2026
Palpation of the ribs is just one of the things we include in all neonatal exams. The most common area for foal fractures is the costochondral junction right behind the elbows.
Rib Fractures in Neonatal Foals
Brian S. Burks, DVM
Diplomate of the American Board of Veterinary Practitioners®
394 Fox Road
Apollo, PA 15613
(724) 727-3481
www.foxrunequine.com
Rib fractures are a common injury in neonatal foals, occurring in 3-5% of foals. Fractured ribs can cause no symptoms and be an incidental finding or can be a cause of trauma to thoracic organs and a significant cause of death. Rib fractures cause death in about a third of foals with thoracic injuries.
Rib fractures can occur following dystocia or an apparently normal birth. Repositioning the foal can cause significant trauma, leading to injury. The elbows may become positioned over the third to sixth ribs, increasing the pressure over them, leading to fracture, most commonly at the costochondral junction (bone and cartilage connection).
Risk factors for increased birth trauma include a mare that is giving birth for the first time, a difficult birth or one which requires excessive manipulation with an assisted delivery, and a narrower than usual pelvic canal and associated vaginal structures. The shape of the chest, particularly in Thoroughbred foals, has been considered a risk factor. In addition, lifting foals from under the chest may lead to rib fractures, so it is best to never lift a foal from under the thorax or abdomen, but rather from either end. This becomes even more important if rib fractures are present, as further thoracic trauma may occur from handling.
Clinical signs seen in foals with rib fracture/s may include:
• Mild to moderate pain
• Increased respiratory effort
• A depressed demeanor
• A reluctance to make sudden movements
• Swelling and bruising over the ribs around the fracture sites
Rib fractures may lead to the following:
• Internal bleeding leading to hypovolemic shock.
• Pneumothorax if the pleural lining around the lungs is damaged.
• A diaphragmatic hernia if ribs lying close to the diaphragm are fractured and lacerate the diaphragm.
• Sudden death if the heart muscle is lacerated.
If several consecutive ribs are fractured a ‘flail chest’ may occur where a section of the foal’s chest wall will sink in during inspiration rather than expanding as air is inhaled, making it difficult for the foal to breath.
Rib fracture should be suspected in a foal that grunts or groans during thoracic palpation, especially if there is edema over the ribs. Ultrasound is the leading imaging modality to identify a rib fracture, being four times more sensitive than radiography. It also allows assessment of the surrounding soft tissues, allowing identification of any fluid around the heart or contusions of the lung.
Affected foals may also present with concurrent septicemia or hypoxic-ischemic encephalopathy, which can influence case management. Otherwise healthy foals, with non-displaced fractures, can be managed conservatively, but foals with multiple, displaced fractures that have traumatized thoracic organs may require surgery.
Medical treatment involves several weeks of complete stall rest and an attempt to keep the foal quiet, as increased activity may cause fracture displacement and sudden death. Initially, foals with complex problems should be cushioned with the affected side down to maximize function of the unaffected lung and ribs. Intranasal oxygen will help to maintain proper blood oxygen levels. If there is substantial air within the pleural cavity, it will require evacuation to reinflate the lung. Hemothorax can be life-threatening due to lung compression and severe blood loss. Treatment will be required for shock and the cause of blood loss addressed.
Surgical treatment should be considered when the affected ribs are near the heart or where there is significant internal injury. This stabilization reduces pain, the risk of additional life-threatening injury, and improves respiratory function. Healing will take 4-6 weeks, after which the surgical implants may require removal.
Rib fractures heal well in most cases. The prognosis is influenced by secondary thoracic trauma and concurrent diseases. Once the foal has survived the initial injury, it will have a healthy and productive life.
Fox Run Equine Center
www.foxrunequine.com
(724) 727-3481
