Conservative versus surgical treatment of 21 sports horses with osseous trauma in the proximal phalangeal sagittal groove diagnosed by low-field MRI.
Authors: Lipreri Giulia, Bladon Bruce M, Giorio Maria Elisabetta, Singer Ellen R
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Osseous Trauma in the Proximal Phalanx – Conservative versus Surgical Management Subchondral bone trauma affecting the proximal phalangeal sagittal groove presents a diagnostic and therapeutic challenge in sports horses, particularly when radiographs appear normal but low-field MRI reveals high water signal indicating bone oedema or microfracture. This retrospective review of 21 cases treated at two referral hospitals between 2010 and 2017 compared outcomes between conservative management (stall rest followed by gradual exercise reintroduction) and surgical intervention (cortical screw fixation across the proximal phalanx), with long-term follow-up available in 17 horses. Results demonstrated no statistically significant difference between treatment approaches: 50% of conservatively managed horses (4 of 8) and 56% of surgically managed horses (5 of 9) returned to soundness and athletic function. Given that approximately half of affected horses regain useful soundness regardless of treatment modality, prognosis remains guarded, suggesting that the traumatic insult itself—rather than management choice—may be the primary determinant of outcome. For practitioners, these findings support informed discussion with owners about realistic expectations and comparable outcomes, whilst emphasising that conservative management with appropriate rest protocols may be considered a viable first-line option before committing to surgical intervention and its associated costs and recovery demands.
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Practical Takeaways
- •Conservative management (stall confinement + gradual exercise reintroduction) performs as well as surgical screw fixation for proximal phalangeal sagittal groove trauma; consider conservative approach first given lower cost and invasiveness
- •Inform owners that roughly half of affected sports horses will return to work, making prognosis guarded; manage expectations early regardless of treatment chosen
- •Low-field MRI can identify subchondral bone trauma in the fetlock when radiographs appear normal, helping guide diagnosis and treatment planning
Key Findings
- •50% of horses (4/8) treated conservatively returned to soundness
- •56% of horses (5/9) treated surgically returned to soundness
- •No statistically significant difference in outcome between conservative and surgical management (P > 0.99)
- •Prognosis for return to athletic function is guarded regardless of treatment approach