Case report: clinical and postmortem findings in four cows with rib fracture
© The Author(s) 2017
Received: 9 July 2016
Accepted: 2 February 2017
Published: 6 February 2017
Published reports of rib fractures in adult cattle are limited to the occurrence of chronic rib swellings caused by calluses, which are unremarkable from a clinical standpoint, whereas studies identifying clinical signs of rib fractures were not found in a literature search. This report describes the clinical and postmortem findings in four cows with rib fractures.
The 13th rib was fractured in three cows and the 11th rib in the remaining cow; three fractures were on the right and one on the left side. Clinical and postmortem findings varied considerably, and percussion of the rib cage elicited a pain response in only one cow. One cow had generalised peritonitis because of perforation of the rumen by the fractured rib. One cow was recumbent because of pain and became a downer cow, and two other cows had bronchopneumonia, which was a sequel to osteomyelitis of the fracture site in one. In the absence of a history of trauma, the diagnosis of rib fracture based on clinical signs alone is difficult.
Although rib fractures undoubtedly are very painful, the four cases described in this report suggest that they are difficult to diagnose in cattle because associated clinical signs are nonspecific.
Clinical and postmortem findings in four cows with rib fractures
Rectal temperature (°C), heart and respiratory rates (per minute)
Main clinical signs
Main postmortem findings
Rumen atony, positive foreign body tests, abdominal guarding, loss of negative abdominal pressure, abdominocentesis yielded an exudate
Fracture of left 13th rib, perforation of rumen, generalised peritonitis
Tachypnoea, increased breath sounds, positive foreign body tests, percussion of right thoracic wall painful, epistaxis, terminal recumbency
Fracture of 13th thoracic vertebra and right 13th rib, purulent osteomyelitis with extension to lung, lung abscess
Downer cow postpartum initially because of hypocalcaemia and hypomagnesaemia and then because of pain caused by rib fracture
Downer cow syndrome
Fracture of right 11th rib with acute haemorrhage
Tachypnoea, increased breath sounds, pleuritic friction rubs, cough, epistaxis, pleural effusion, terminal recumbency
Acute splintered fracture of right 13th rib with soft tissue laceration, severe acute bronchopneumonia caused by Mannheimia haemolytica, coxarthrosis and rupture of the iliofemoral ligament on the left side
Results of haematological analysis in four cows with rib fractures
Variable (reference range)
Total leukocyte count (5000–10,000/µl)
Plasma protein (60–80 g/l)
Fibrinogen (3–5 g/l)
Glutaraldehyde test (10–15 mins)
Cow 1: A 3-year-old Brown Swiss cow that had calved without assistance six weeks previously was referred to our clinic because of mild ruminal tympany, lack of response to treatment with a magnet and a 3-day history of anorexia. The cow was in poor general health and had a rectal temperature of 39.3 °C, a heart rate of 80 beats per minute (bpm), a respiratory rate of 30 breaths per minute and no rumen motility. There was bruxism and guarding of the abdominal wall. Tests for foreign bodies (withers pinch, percussion of the reticular region and lateral thorax, upward pressure applied to the xyphoid region using a pole) were positive. Transrectal examination showed that there was no negative pressure in the abdomen. Radiographs of the reticulum were normal, and haematological analysis showed haemoconcentration. Retroperitoneal fluid collected by abdominocentesis was opaque and yellow and had a specific gravity of 1026, a protein concentration of 33 g/l and 10,500 leukocytes/µl (70% neutrophils, 29% monocytes and 1% lymphocytes). A diagnosis of peritonitis possibly caused by a perforating abomasal ulcer was made, and because of a poor prognosis, the cow was slaughtered. There was generalised peritonitis with widespread adhesions throughout the abdomen, particularly on the left side of the rumen, and the abdominal cavity contained a large amount of fibrinous exudate. The last rib on the left side was fractured, and a sharp bone fragment pointing inward had perforated the rumen, resulting in leakage of rumen contents and subsequent peritonitis.
Cow 2: A 3.5-year-old Brown Swiss cow that was 6 months pregnant was referred to our clinic because of stiff gait and reluctance to lie down, which had been observed for three months before referral. The cow had a normal appetite but appeared painful and uncomfortable particularly when the rumen was full. The general health of the cow was mildly abnormal, and the rectal temperature was 39.7 °C, the heart rate 72 bpm and the respiratory rate 52 breaths per minute. Respiration was costoabdominal but had a strong abdominal component, and breath sounds were increased. Rumen motility was strong and rumen fill and stratification were normal. Foreign body tests were consistently positive, abdominal guarding was present, and percussion of the right thoracic wall elicited a painful response. Haematological analysis showed anaemia and increased protein and fibrinogen concentrations, and the clotting time in the glutaraldehyde test was shorter than normal. Ultrasonography of the thorax and abdomen revealed no abnormalities, and radiography of the reticulum and lungs showed an increase in the radiodensity of the interstitial lung tissue. Endoscopy of the upper respiratory tract was normal. A tentative diagnosis of bronchopneumonia was made and the cow treated with danofloxacin (1.25 mg/kg, intravenously; Advocid, Zoetis, Switzerland) and 10 l of a solution containing 9 g NaCl and 50 g glucose per litre via an indwelling jugular vein catheter, daily, for three days. On the fourth day, the cow was unable to rise and was euthanased with pentobarbital (70 mg/kg, intravenously; Streuli Pharma, Uznach, Switzerland) immediately after blood and purulent material were seen flowing from both nostrils accompanied by severe tachypnoea during an attempt to lift the cow. Postmortem examination showed a fracture of the 13th thoracic vertebra and 13th rib on the right side and purulent osteomyelitis that had extended into the right lung with subsequent abscess formation.
Cow 4: A 9-year-old Holstein–Friesian cow was referred to our clinic for evaluation of anorexia. Five days before referral, the cow had been chased by another cow and had become trapped between a wall and a post. Strong traction was required to free the cow and for a short time afterwards, she was unable to rise. The referring veterinarian treated the cow with enrofloxacin, flunixin meglumine and dexamethasone. The general health of the cow was moderately abnormal, and physical examination revealed sunken eyes, reduced skin turgor, a rectal temperature of 39.3 °C, a heart rate of 96 bpm and a respiratory rate of 52 breaths per minute. The cow stood with her head and neck extended because of dyspnea, which was characterised by a marked abdominal component of respiration. There was bilateral seromucous nasal discharge and a spontaneous cough, and auscultation of the chest revealed increased breaths sounds and a pleuritic friction rub. The stride in the hind legs was shorter than normal and a cracking sound originating from the hind end of the cow was audible at the walk. The blood concentrations of calcium, phosphorus and magnesium were normal, and the activity of creatine kinase was mildly elevated (1355 U/l). Ultrasonograms of the thorax and abdomen showed bilateral pleural effusion, which had a depth of about 2 cm. The right lung was consolidated and suspended in the pleuritic fluid and the pleura had several comet-tail artifacts. The ventral lung regions were radiodense. Endoscopy of the trachea to the level of the bifurcation revealed white respiratory secretion, from which Mannheimia haemolytica was isolated. A diagnosis of bronchopneumonia attributable to Mannheimia haemolytica was made and the cow treated with cefquinom (2.5 mg/kg; Cobactan 7.5%, MSD Animal Health, Luzern, Switzerland), administered subcutaneously, and 10 l of a solution containing 9 g NaCl and 50 g glucose per l and calcium borogluconate (Calcamyl-40MP), administered intravenously via an indwelling jugular vein catheter. The condition of the cow deteriorated despite treatment, and euthanasia was elected because she could not stand and was groaning continuously. Postmortem examination showed an acute splintered fracture of the last rib on the right about 15 cm distal to the costovertebral joint accompanied by acute haemorrhage and soft tissue lacerations. The cow also had severe acute fibrinous and seropurulent bronchopneumonia because of infection with Mannheimia haemolytica and coxarthrosis with rupture of the iliofemoral ligament of the left hind limb.
Of 20,100 cattle with internal diseases examined at the Department of Farm Animals, University of Zurich, between 1991 and 2015, only four had clinical signs of a rib fracture. Thus, rib fracture had an incidence of 0.0005% over a 25-year period and can be considered an extremely rare cause of referral in cattle. Rib fractures are extremely painful in people, and it can be assumed that the same is true for cattle. In contrast, old rib fractures, which are apparent as rib swellings and not associated with clinical signs, are common in cattle with chronic lameness and some herds have a prevalence of about 16% . The discrepancy between the low incidence of cases with clinical signs in our study and the relatively high prevalence of healed rib fractures reported in the literature is likely because clinical signs of acute rib fracture in cattle often are nonspecific and not associated with visible and palpable signs. In contrast, inspiratory dyspnoea is a typical sign of rib fracture associated with callus formation at the fracture site in calves . In the cases described in this report, clinical signs varied depending on the circumstances of the injury that led to the fracture. In cow 1, perforation of the rumen by the fractured rib resulted in leakage of ingesta into the abdominal cavity and subsequent generalised peritonitis. Cow 3 had downer cow syndrome and acute haemorrhage at the fracture site, and it was assumed that the cow fell because of hypocalcaemia thereby sustaining a rib fracture. Rib swellings seen in lame cows indicating previous rib fractures also have been attributed to falls [14, 15, 18]. In the two remaining cows, the rib fracture was accompanied by acute bronchopneumonia. In cow 2, this was the direct result of osteomyelitis with spread of purulent material into the lungs. In the remaining cow, there was no obvious association between acute bronchopneumonia caused by Mannheimia haemolytica infection and the fracture of the last rib. However, two other cows from the same herd with bronchopneumonia caused by the same agent had been seen at our clinic a few weeks previously. It is therefore conceivable that the cow had a latent infection and the stress associated with the entrapment and rib fracture led to bronchopneumonia.
We are aware of only one reference that described the clinical signs of cattle with acute rib fractures; a distinct pain response, characterised by grunting, is elicited by percussion of or pressure applied to the rib cage . Although our examination protocol includes percussion of the rib cage using a rubber mallet—in addition to foreign body tests (withers pinch, percussion of the reticular region, pressure applied to the xyphoid region)—a pain response to percussion of the rib cage could be elicited only in cow 2.
Likewise, the results of haematological analysis were not specific for rib fracture. Two cows had haemoconcentration, which was attributed to generalised peritonitis (cow 1) and dehydration (cow 3). The increased protein and fibrinogen concentrations and the abnormal glutaraldehyde test result in cow 3 reflected inflammation attributable to osteomyelitis and lung abscessation.
The likely cause of the rib fracture was a fall associated with hypocalcaemia in cow 3 and entrapment in cow 4. In cows 1 and 2, the cause was not clear but injury caused by a fall or inflicted by the horns of herd mates was possible. Cattle with horn injuries are often seen at our clinic [20, 21]. The 13th rib was fractured in three cows and the 11th rib in the remaining cow, and three fractures were on the right and one on the left side. Other authors reported that ribs 9–11 are most commonly affected because they form the greatest curvature of the trunk and absorb the primary impact during a fall . This report was limited to the description of cows with rib fracture; it was not possible to establish valid diagnostic guidelines because of the wide variation in clinical signs and post-mortem findings in the affected cows. This underscores the importance of careful history taking (with respect to possible trauma and the presence of horned herd mates) and thorough clinical examination.
Although rib fractures undoubtedly are very painful, they are difficult to diagnose in cattle because associated clinical signs are nonspecific. Cows with splintered rib fracture, perforation of the rumen by the fractured rib and other complications including osteomyelitis, abscess formation and recumbency should be euthanased rather than treated. The occurrence of rib fracture can be minimised by installing non-slip barn floors, eliminating bottlenecks where cows become trapped and injured and by dehorning aggressive cows.
UB was in charge of clinical and ultrasonographic examination of the cows, writer of the manuscript, submission of the article initiated. SW involved in the clinical examination of cows 3 and 4. UH responsible for the postmortem examination of cows 3 and 4. KN involved in the clinical examination of the cows. All authors read and approved the final manuscript.
The authors thank the technicians of the Division of Diagnostic Imaging for the radiographic examination of the cows, the technicians of the Medical Laboratory for the haematological and biochemical analyses and the animal assistants for looking after the cows.
The authors declare that they have no competing interests.
Consent to publish
Consent was obtained from the owners of the cows for publication of this manuscript and any accompanying images.
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