Assessment of historical worldwide fracture & fatality rates and their implications for thoroughbred racing’s social licence

Article by Ian Wright MRCVS

Racing’s social licence is a major source of debate and is under increasing threat. The principal public concern is that racing exposes horses to significant risk of injury including catastrophic (life-ending) injuries of which fractures are the commonest cause. The most recent studies in the UK indicate that fractures account for approximately 75% of racecourse fatalities. Recent events highlight the need for urgent stakeholder discussion, which necessarily will be uncomfortable, in order to create cogent justification for the sport and reliant breeding industry.

A necessary prelude to discussion and debate is an objective assessment of risk. All and any steps to reduce risks and mitigate their impact are important and must be embraced by the horseracing industry (and quite possibly all other horse sports). To begin this, a here and now assessment is important: put simply, does the price paid (risk) justify the benefit (human pleasure, culture, financial gain, employment, tax revenue, etc). Objective data provides perspective for all interested parties and the voting public via their elected representatives, who ultimately provide social licence, with other welfare issues—both human and animal—on which society must pass judgement. 

The data in Tables 1 to 12 report a country by country survey of fracture and fatality rates reported in scientific journals and documented as injuries/fatalities per starters. It may be argued that little of the data is contemporary; the studies range from the years 1980 to 2013. However, the tabulated data provided below is the most up to date that can be sourced from independently published, scrutinised scientific papers with clear—albeit sometimes differing—metric definitions and assessable risk rates.

In assimilating and understanding the information, and in order to make comparisons, some explanatory points are important. The first, and probably the most important, is identification of the metric. Although at first glance, descriptor differences may appear nuanced, what is being recorded massively influences the data. 

These include fatality, catastrophic injury, fracture, orthopaedic injury, catastrophic distal limb fracture, fatal musculoskeletal injury, serious musculoskeletal injury, and catastrophic fracture. The influence of the metric in Japanese racing represents the most extreme example of this: ‘fracture’ in the reporting papers included everything from major injuries to fragments (chips) identified after racing in fetlocks and knees, i.e. injuries from which recovery to racing soundness is now an expectation.  At the opposite pole, studies in other countries document ‘catastrophic’, i.e. life-ending fractures which have a substantially lower incidence. The spectrum of metric definitions will all produce different injury numbers and must be taken into account when analysing and using the data. 

Studies also differ in the methods of data collection that will skew numbers in an undetermined manner. Some only record information available at the racecourse, others by identifying horses that fail to race again within varying time periods, horses requiring hospitalisation following racing, etc. The diagnostic criteria for inclusion of horses also vary between reports: some document officially reported incidents only, some are based only on clinical observations of racecourse veterinary surgeons, while others require radiographic corroboration of injuries. 

From a UK perspective, the data is quite robust in concluding that risks differ significantly between race types. The majority of fractures that occur in flat racing, and between obstacles in jump racing, are the result of stress or fatigue failure of bone. They are not associated with traumatic events, occur during high speed exercise, are site specific and have repeatable configurations. In large part these result from a horse’s unique athleticism: in the domesticated species, the thoroughbred racehorse represents the pinnacle of flight-based evolution. Fractures that result from falls in jump racing are monotonic—unpredictable, single-event injuries in which large forces are applied to bone(s) in an abnormal direction. 

This categorisation is complicated slightly as fatigue failure at one site, which may be bone or supportive soft tissue, can result in abnormal loads and therefore monotonic fracture at another. The increased fracture rate in jump racing is explained in part by cumulative risk. However, it is complicated by euthanasia of horses with injuries with greater post injury commercial value and/or breeding potential that might be treated. Catastrophic injuries and fatality rates in NH flat races are most logically explained by a combination of the economic skew seen in jump racing and compromise of musculoskeletal adaptation.

Racing surface influences both injury frequency and type. Studies in the UK have consistently documented an increased fatality rate and incidence of lower limb injury on synthetic (all weather) surfaces compared to turf.  Although risk differences are clear, confounding issues, such as horse quality and trainer demographic, mean that the surface per se may not be the explanation. In the United States, studies reporting data from the same geographic location have produced mixed results. In New York, these documented greater risks on dirt than turf surfaces; while a California study found no difference, and a study in Florida found a higher risk on turf. A more recent study gathering data from the whole of the U.S. reported an increased risk on dirt surfaces. Variations in the nature of injury between surfaces may go some way toward explaining fatality differences.

Much has been done to reduce recognisable risk factors particularly in jump racing; but in the UK, it is likely (for obvious data supported reasons) that it will come under the greatest scrutiny. The incidence of fractures and fatalities in flat racing are low, and the number of currently identified risk factors are high. Over 300 potential influences have been investigated, and over 50 individual factors demonstrated statistically are associated with increased risk of catastrophic injury. 

The majority of fractures occurring in flat racing (and non-fall related fractures in jump racing) are now also treatable, enabling horses to return to racing and/or to have other comfortable post-racing lives. 

The common public presumption that fractures in horses are inevitably life-ending injuries is a misconception that could readily be remedied. An indeterminate number of horses are euthanised on the basis of economic viability and/or ability to care for horses retired from racing. On this point, persistence with a paternalistic approach is a dangerous tactic in an educated society. Statements that euthanasia is ‘the kindest’ or ‘best’ thing to do, that it is an ‘unavoidable’ consequence of fracture or that only ‘horsemen understand or know what is best’ can be seen as patronising and will not stand public scrutiny. 

At some point, data to distinguish between horses euthanised as a result of genuinely irreparable injuries and those with fractures amenable to repair will become available. Before this point is reached, the consequences require discussion and debate within the racing industry.

Decisions on acceptable policies will have to be made and responsibility taken. In its simplest form, this is a binary decision. Either economic euthanasia of horses, as with agricultural animals, is considered and justified as an acceptable principle by the industry or a mechanism for financing treatment and lifetime care of injured horses who are unlikely to return to economic productivity will have to be identified.  The general public understands career-ending injuries in human athletes: These appear, albeit with ongoing development of sophisticated treatments at reducing frequency, in mainstream news. 

Death as a direct result of any sporting activity is a difficult concept in any situation and draws headlines. Removal of the treatable but economically non-viable group of injuries from data sets would reduce, albeit by a currently indeterminate number, the frequency of race course fatalities. However, saving horses' lives whenever possible will not solve the problem: it will simply open an ethical debate viz is it acceptable to save horses that will be lame? In order to preserve life, permanent lameness is considered acceptable in people and is not generally considered inhumane in pets. Two questions arise immediately: (i) How lame can a horse be in retirement for this to be considered humane? (ii) Who decides? There is unquestionably a spectrum of opinion, all of which is subjective and most of it personal. It will not be an easy debate and is likely to be complicated further by consideration of sentience, which now is enshrined in UK law (Animal Welfare (Sentience) Act 2022); but it requires honest ownership of principles and an agreed policy.

For the avoidance of doubt, while the focus of this article and welfare groups’ concerns are on racecourse injuries, those sustained in training follow a parallel pathway. These currently escape attention simply by being, for the most part, out of sight and/or publicity seeking glare. 

Within racing, there is unquestionably a collective desire to minimise injury rates. Progress has been made predominantly by identification of extrinsic (i.e. not related to the individual horse) risk factors followed by logical amendments. In jump racing (monotonic fractures), obstacle modification, re-siting and changing ground topography are obvious examples of risk-reducing measures that have been employed. 

In flat racing progress has involved identification risk factors such as race type and scheduling, surface, numbers of runners, track conditions etc which have guided changes. However, despite substantial research and investment, progress in identification of intrinsic (ie relating to the individual horse) risk factors is slow. While scientifically frustrating, a major reason for this is the low incidence of severe fractures: this dictates that the number of horses (race starters) that need to be studied in order to assess the impact of any intervention is (possibly impractically) high. Nonetheless, scientific justification is necessary to exclude a horse from racing and to withstand subsequent scrutiny.

Review of potential screening techniques to identify horses at increased risk of sustaining a fracture while racing is not within the scope of this article, but to date none are yet able, either individually or in combination, to provide a practical solution and/or sufficiently reliable information to make a short-term impact. It is also important to accept that the risk of horses sustaining fractures in racing can never be eliminated. Mitigation of impact is therefore critical. 

When fractures occur, it is imperative that horses are evaluated to be given the best possible on course care. This may, albeit uncommonly be euthanasia. Much more commonly, horses can be triaged on the course and appropriate support applied before they are moved to the racecourse clinical facility for considered evaluation and discussion. The provision of fracture support equipment to all British racecourses in 2022 marked a substantial step forward in optimising injured horse care.

Neither racing enthusiasts nor fervent objectors are likely to change their opinions. The preservation of social licence will be determined by the open-minded majority who lie between: it is the proverbial ‘man on the street’ who must be convinced. The task of all who appreciate horse racing's contributions to society and wish to see it continue is to remain focussed on horse welfare, if necessary to adjust historical dogmas, absorb necessary costs and to encourage open, considered, honest (factually correct) risks versus benefits discussion.