[Navicular bone fractures in horses: Prognosis after conservative and surgical treatment].
Authors: Stucki, Fürst, Jackson
Journal: Schweizer Archiv fur Tierheilkunde
Summary
# Editorial Summary: Navicular Bone Fractures in Horses Between 2005 and 2017, researchers at the University of Zurich retrospectively analysed clinical outcomes in 12 horses treated for navicular fractures, comparing conservative management (n=4) with surgical fixation using cortical screws (n=8), with three cases augmented by computer-assisted or CT-guided techniques. Both treatment groups received identical foundational care: box rest, controlled exercise protocols, and therapeutic orthopedic shoeing. Conservative treatment yielded uniformly positive results with 100% of horses achieving very good or good outcomes, whilst surgical intervention produced more variable results—50% very good outcomes offset by 50% poor outcomes—despite technological advantages. Remarkably, radiographic evidence of bone healing was absent in all 67% of horses classified as having successful outcomes, raising important questions about how navicular fractures consolidate and what "clinical success" actually represents in these cases. Significant complications emerged in the surgical group, including screw fracture, fragmentation of small navicular bone fragments, coffin joint osteoarthritis, and progressive podotrochosis, suggesting that more invasive intervention may introduce additional pathological pathways without improving prognosis. For equine practitioners, this finding challenges the assumption that surgical repair offers advantages over conservative management; practitioners should consider navicular fractures cautiously regardless of treatment choice, whilst recognising that pre-existing degenerative changes to the navicular apparatus substantially worsen long-term outcomes.
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Practical Takeaways
- •Conservative management with box rest, controlled exercise, and therapeutic orthopedic shoeing produced equal or better outcomes than surgical intervention for navicular fractures in this cohort—question the automatic referral for surgery.
- •Radiographic bone healing is not a prerequisite for clinical improvement; focus on functional outcome (lameness reduction) rather than imaging findings when monitoring navicular fracture recovery.
- •Pre-existing degenerative changes in the navicular apparatus should prompt a cautious prognosis discussion with owners regardless of whether conservative or surgical treatment is chosen.
Key Findings
- •Conservative treatment achieved 100% favorable outcomes (50% very good, 50% good) in 4 horses, while surgical treatment achieved 50% favorable outcomes in 8 horses (50% very good, 50% poor).
- •Overall 67% of all treated horses achieved very good or good outcomes despite absence of radiographic evidence of bone healing in any case.
- •Surgical complications included screw fracture, navicular bone fragment fragmentation, coffin joint osteoarthritis, and progressive podotrochosis.
- •Pre-existing degenerative changes to the navicular apparatus significantly worsened prognosis regardless of treatment method.