Some surgeons manage splint bone fractures surgically under standing (S) sedation, but to our knowledge the technique has not been reported or compared with the procedure under general anesthesia (GA). This study aims to compare medical and economical aspects between both surgical techniques (S vs. GA) to manage splint bone fractures. Information from horses treated surgically for splint bone fracture between 2008 and 2020 was retrospectively retrieved from medical records. Telephone follow-up was performed. The standing technique is performed similarly as performed under GA with the addition of a tourniquet above or below the tarsus/carpus and a regional anesthetic block. Sedation with alpha-2 agonists and opioids were used. Forty-nine horses (13 in the S group and 36 in the GA) with 57 fractures (17 infected (IF) and 40 not (NIF)) fulfilled the inclusion criteria. Seven fractures were located in the proximal third, 18 in the middle third, and 30 were distal. No significant differences in mean surgical time were seen between the S and GA groups (62 vs. 64 minutes, respectively) (P = 0.7). Average total cost was $522 lower for the S group, but only for NIF (P = 0.0013). One case of the S group was reoperated due to sequestration. Colic signs were detected postoperatively in three horses in the GA group. Cosmetic and athletic outcomes were similar for both groups. Surgical management of splint bone fractures in standing horse is a successful alternative while avoids the risks associated with GA and reduces the cost.