Short incomplete sagittal fractures of the proximal phalanx in ten horses not used for racing.
Authors: Kuemmerle Jan M, Auer Jörg A, Rademacher Nathalie, Lischer Christoph J, Bettschart-Wolfensberger Regula, Fürst Anton E
Journal: Veterinary surgery : VS
Summary
# Short Incomplete Sagittal Fractures of the Proximal Phalanx: Surgery Outperforms Conservative Management Type Ia proximal phalanx (P1) fractures—short incomplete sagittal breaks—present a clinical dilemma in non-racing horses, yet evidence to guide treatment decisions remains limited. This retrospective analysis of ten affected horses compared conservative management (box rest for 2 months followed by hand walking) against surgical intervention, which involved lag screw fixation and, where present, curettage of concurrent subchondral cystic lesions. All six horses undergoing internal fixation achieved soundness at follow-up (mean 27 months) with radiographic evidence of fracture healing, whilst only one of four conservatively managed horses healed radiographically and remained clinically sound; notably, two conservatively treated horses suffered catastrophic fracture propagation at 20 and 30 months post-diagnosis. These outcomes suggest that failed fracture healing substantially elevates the risk of subsequent complete fracture displacement and severe lameness. For practitioners managing non-racing horses with type Ia P1 fractures, this evidence supports recommending surgical stabilisation to optimise both healing rates and long-term athletic prognosis, particularly given the substantial risk of late catastrophic failure associated with conservative approaches.
Read the full abstract on PubMed
Practical Takeaways
- •Type Ia P1 fractures in non-racing horses should be surgically repaired with lag screw fixation rather than managed conservatively, as conservative treatment shows poor healing rates (25%) and high risk of catastrophic fracture propagation
- •When concurrent subchondral cystic lesions are present, transcortical drilling and curettage performed simultaneously with fracture fixation improves outcomes
- •Non-surgical management results in persistent lameness in 75% of cases and delayed catastrophic failure months to years later, making early surgical intervention the preferred approach
Key Findings
- •All 6 horses treated surgically with internal fixation achieved soundness and radiographic fracture healing at mean follow-up of 27 months
- •Only 1 of 4 conservatively managed horses achieved radiographic fracture healing; 3 remained persistently lame
- •Catastrophic fracture propagation occurred in 2 non-surgically treated horses at 20 and 30 months post-diagnosis
- •Surgical treatment with lag screw fixation combined with concurrent SCL curettage had superior outcomes to conservative management