Fracture repair in horses has advanced significantly over the past 20 years. Many horse owners, however, still don’t understand what’s medically possible and that certain fractures (e.g., simple, nondisplaced, or non-weight-bearing) have good outcomes—they simply assume it’s a death sentence for a horse.
This is why it’s so important for equine veterinarians and surgeons to communicate that not all fractures are the same and treatment success varies widely. Christoph J. Lischer, DrMedVet, DECVS, AssocDECVDI,Large Animal CertIVAS, of Freie Universität Berlin, Germany, described how veterinarians can manage owner expectations about fracture repair during his presentation at the 2025 British Equine Veterinary Association Congress.
Early Conversations
Your initial communication with the owner of a horse with a fracture must be honest and realistic about the animal’s prognosis (e.g., survival vs. return to function), said Lischer. Be very clear about the implications for the horse’s quality of life and welfare. Keep in mind the horse’s intended use and what the owner expects for that horse.
Cite any literature about return to function for the patient’s particular fracture, he said, and provide examples if possible. For instance, you might share that you’ve repaired five similar fractures this year, and three of those five recovered to a good level of comfort. Remember that not all fractures are the same, however, and that you can’t compare outcomes of different types.
Be upfront about hospitalization and costs, said Lischer, including length of stay and what it might entail (e.g., use of a sling, monitoring for complications, bandage changes). When discussing financial commitments, share the cost of surgery, intensive care for however many days, imaging, and follow-up visits. If the horse is insured, determine how much the insurance company will pay. Then, he emphasized the importance of giving the horse owner a list of estimated costs so there are no surprises.
Lastly, talk to the owner about possible complications, including infection risk, implant failure, support limb laminitis, delayed fracture union, and persistent lameness or reduced athletic ability, said Lischer.
Making Difficult Decisions
Have conversations about pursuing fracture repair versus euthanasia properly. “Don’t just do it while holding a leg or talking to somebody,” said Lischer. “Lead your clients into a small room, explain everything, show them radiographs, show them bones. Understanding the owner’s background, values, and specific circumstances is vital to shaping this dialogue.”
He said most owners fall into one of two categories:
- Those who see the horse as a beloved partner, but they have financial or emotional limits.
- Those who insist on treating the horse regardless of cost or prognosis.
Lischer said it’s typically easier to come to a decision with Owner A once you clearly explain what the procedure entails and its costs. Owner B doesn’t want to take “No” for an answer and can be more challenging to work with. In these cases, Lischer said he takes the following approach that balances realism with compassion:
- In clearly hopeless cases, communicate firmly and empathetically that all factors are against a successful outcome, and humane euthanasia is the best option. Many people will agree to this if you emphasize it’s severe enough.
- If fracture repair has a slim chance of success, present a conditional plan to attempt perfect reduction and stable fixation and to contact the owner for permission to euthanize if that does not end up being achievable.
- In cases with reasonable prognoses, agree to proceed with treatment while ensuring the owner understands the intensity of aftercare and the potential for serious complications.
Once you make a decision, review all plans with the owner and referring vet, including the implications of the injury, first-aid stabilization, transport logistics, the surgical procedure, and how the horse will be recovered.
Also insist on writing these things down. “Provide written instructions and timelines and what’s to be expected,” said Lischer. “Then do regular rechecks and radiographs to track healing. Offer realistic milestones.”
For example, you might tell the owner if the horse survives six weeks, it’s a good sign and you can expect him to be comfortable without painkillers. Or, at three months you should see signs of healing and continuous comfort.
“When you have this explanation and discussion with the owner, encourage them the ask questions and voice concerns,” Lischer added.
If recovery does not proceed as hoped, be prepared to bring everyone together and start from scratch discussing quality of life, expenses, and the possibility of euthanasia.
In Summary
Realistic owner expectations are an essential part of treatment. “You as a veterinarian shape the owner’s expectations one way or the other—be aware of that,” said Lischer.
Use all the resources you have (e.g., scientific evidence of outcomes, consults with specialists, etc.) to help horse owners make informed decisions. “By aligning veterinary possibilities with owner understanding, we increase the likelihood of a successful outcome and preserve the trust at the heart of the veterinarian-client relationship,” he concluded.
Related Reading
- Considerations for Conservative Management of Horse Fractures
- Daily Vet Life: Standing Fractured Splint Bone Removal
- PPID Horses Might Have Lower Lumbar Vertebral Bone Density
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