Surgical repair of mid-body proximal sesamoid bone fractures in 25 horses.
Authors: Busschers Evita, Richardson Dean W, Hogan Patricia M, Leitch Midge
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Surgical repair of mid-body proximal sesamoid bone fractures Mid-body proximal sesamoid bone (PSB) fractures represent a challenging injury in performance horses, with limited data on optimal surgical management. Busschers and colleagues retrospectively analysed 25 horses treated surgically between 1996 and 2006, comparing wire fixation versus arthroscopically assisted lag screw fixation and examining factors associated with return to racing. The medial forelimb sesamoid was affected in 80% of cases, and fracture reduction quality differed markedly between techniques: 88% of lag screw repairs achieved improved reduction compared with only 22% of wire repairs, a difference that proved statistically significant (P=0.002). Critically, 44% of horses undergoing screw fixation returned to racing, whilst none of those receiving wire fixation raced subsequently—with the authors noting that none of the horses with unimproved fracture reduction raced postoperatively regardless of technique. Practitioners should consider lag screw fixation combined with external coaptation as the superior approach for mid-body PSB fractures, though tempering expectations remains important given that only 28% of all surgically repaired horses achieved return to racing, suggesting careful case selection and realistic owner counselling are essential components of managing this injury.
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Practical Takeaways
- •Arthroscopically assisted lag screw fixation combined with external coaptation offers significantly better outcomes than wire fixation for mid-body PSB fractures in sport horses
- •Quality of fracture reduction is critical—horses with unimproved reduction did not return to racing, emphasizing the importance of technique and post-operative support
- •Even with optimal surgical technique, expect only ~44% of horses to return to racing; set realistic client expectations about return-to-athletic-use outcomes
Key Findings
- •Medial forelimb PSBs were affected in 80% of cases
- •44% of horses treated with screw repair raced post-operatively versus 0% with wire fixation (P=0.047)
- •Screw fixation achieved improved fracture reduction in 88% of cases compared to 22% with wire fixation (P=0.002)
- •Only 28% of all horses with mid-body PSB fractures returned to racing after surgery