Diagnosis, management, and outcome in 19 horses with deltoid tuberosity fractures.
Authors: Fiske-Jackson Andrew R, Crawford Andrew L, Archer R Michael, Bolt David M, Smith Roger K
Journal: Veterinary surgery : VS
Summary
Deltoid tuberosity fractures are a poorly characterised injury in horses, presenting with marked lameness and often impaired protraction of the affected forelimb. This retrospective case series of 19 horses treated between 1992 and 2009 demonstrates that whilst standard mediolateral radiographs detected only one-third of fractures, a cranio-45° medial-caudolateral oblique view identified all cases, with ultrasonography proving equally sensitive (86% detection rate) except where subcutaneous gas obscured the fracture line. Conservative management comprising stall rest and local wound care yielded successful outcomes in 93% of the 14 horses with documented follow-up, with all returning to athletic function without residual lameness. These findings have important implications for diagnostic protocols—radiographers and veterinarians should specifically request the oblique projection when deltoid tuberosity fracture is suspected, as reliance on routine views risks missing this injury entirely. The excellent prognosis with non-surgical management should inform treatment discussions with owners and may reduce pressure for aggressive intervention in cases where conservative therapy offers reliable resolution.
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Practical Takeaways
- •Request the cranio-45° medial-caudolateral oblique radiographic projection specifically when deltoid tuberosity fracture is suspected, as standard mediolateral views will miss most cases
- •Conservative management alone can successfully resolve deltoid tuberosity fractures in most horses—surgery was not required in this case series
- •Combine radiography with ultrasonography for diagnosis, as ultrasound can identify fractures even when gas prevents visualization on radiographs
Key Findings
- •Cranio-45° medial-caudolateral oblique radiographic projection identified all 19 deltoid tuberosity fractures compared to only 32% on mediolateral views
- •Ultrasonography detected 86% of fractures but was limited by gas accumulation artifacts
- •Conservative treatment (local wound care and stall rest) resulted in return to athletic function without lameness in 13 of 14 horses with follow-up (93%)
- •Most horses (16/19) presented with marked lameness and 53% had reduced protraction of the affected limb