Computed tomographic guidance for internal fixation of type II distal phalangeal fractures in 51 horses.
Authors: Smanik Lauren E, Stefanovski Darko, Reilly Patrick T, Richardson Dean W
Journal: Equine veterinary journal
Summary
# Editorial Summary: CT-Guided Internal Fixation of Type II Distal Phalangeal Fractures Type II distal phalangeal fractures represent a significant source of lameness in horses, yet robust outcome data following surgical repair have been limited. This retrospective review of 51 horses undergoing computed tomographic-guided internal fixation found that 86% successfully returned to work, a success rate comparable to conservative management approaches. Implant infection occurred in 15 cases and distal interphalangeal joint osteoarthritis in 9, with the latter substantially reducing return-to-work likelihood (odds ratio 0.09), whilst infection delayed rehabilitation without necessarily preventing athletic return. Critically, the investigators identified that deeply countersinking the screw head and filling the hoof defect with acrylic hoof adhesive (rather than polymethylmethacrylate) reduced delayed infection risk eightfold. These technical modifications merit adoption into standard surgical protocols, and clinicians should base rehabilitation timelines on clinical soundness rather than radiographic union alone, recognising that radiographic healing did not predict functional outcome.
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Practical Takeaways
- •Internal fixation of type II P3 fractures achieves comparable success rates to conservative management, offering an alternative treatment option with 86% return to athletic work
- •Surgical technique modifications—using acrylic hoof adhesive and deep screw countersinking—significantly reduce post-operative infections; prioritize these details in operative planning
- •Base return-to-work decisions on clinical signs rather than radiographic healing alone, as radiographic appearance did not predict success
Key Findings
- •86% of horses (44/51) successfully returned to work following CT-guided internal fixation of type II P3 fractures
- •Distal interphalangeal joint osteoarthritis significantly reduced likelihood of successful return to work (OR=0.09, P=0.02)
- •Implant infection occurred in 29% of cases (15/51) and delayed return to work (HR=0.5, P=0.03)
- •Filling hoof defects with acrylic adhesive and deeply countersinking screw heads reduced infection rates (OR=0.08, P=0.001)