The Surgical Repair of a Salter-Harris Type-2 Physeal Fracture of the Proximal Phalanx in a Foal.
Authors: Breen Louise J, Coleridge Matthew O D, O'Brien Tom
Journal: Journal of equine veterinary science
Summary
# Editorial Summary A 6-month-old thoroughbred colt presented with acute severe lameness and soft tissue swelling of the hindlimb following a Salter-Harris type-2 physeal fracture of the proximal phalanx, a growth-plate injury that initially appeared amenable to conservative casting but proved inadequately reduced through immobilisation alone. Following unsuccessful conservative management, the fracture was stabilised surgically using a multimodal fixation construct comprising a cortical lag screw, four locking head screws and a locking T-plate to restore anatomical alignment and prevent displacement during the critical healing phase. At two-year follow-up, the foal had returned to full soundness and was in active race training, demonstrating complete functional recovery without reported complications. This case substantiates the clinical argument that early surgical intervention with rigid internal fixation should be favoured over prolonged conservative casting for physeal fractures of the first phalanx in young horses, particularly where initial reduction proves inadequate. For practitioners managing acute pastern injuries in foals, the findings reinforce the importance of radiographic assessment at presentation and readiness to escalate to surgical stabilisation promptly when conservative methods fail to achieve stable reduction, thereby optimising outcomes in this performance-critical anatomical region.
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Practical Takeaways
- •Salter-Harris type-2 physeal fractures of the proximal phalanx in foals may require surgical intervention when conservative casting fails to achieve reduction
- •Internal fixation using a combination of lag screws and locking compression plates provides adequate stabilization for successful healing of this fracture type
- •Foals managed surgically for this fracture type have favorable long-term prognoses including return to athletic function
Key Findings
- •Conservative cast immobilization failed to achieve adequate fracture reduction in a 6-month-old foal with proximal phalanx physeal fracture
- •Surgical fixation using cortical lag screw, four locking head screws, and locking T-plate successfully stabilized the fracture
- •Foal achieved complete recovery and returned to race training by 2-year follow-up with soundness maintained