Treatment of traumatic disruption of the suspensory apparatus in Thoroughbred racehorses at risk of proximal interphalangeal joint subluxation using a locking compression-distal femur plate for double arthrodesis.
Authors: Orozco Lopez David, Garcia-Lopez Jose M, Carpenter Ryan, Bras Jose J, Richardson Dean W, Ortved Kyla F
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Traumatic disruption of the suspensory apparatus in racehorses represents a catastrophic injury with the additional risk of proximal interphalangeal joint subluxation—a complication that typically results in euthanasia. This multicentre retrospective study evaluated whether double arthrodesis of the metacarpophalangeal and proximal interphalangeal joints using a locking compression-distal femur plate could provide a stable construct whilst preserving long-term function in 26 affected Thoroughbreds treated between 2020 and 2024. The locking compression-distal femur plate successfully prevented PIPJ subluxation in all cases, with 13 horses (50%) achieving long-term survival beyond six months and becoming pasture sound without ongoing analgesia—a meaningful outcome for an injury that might otherwise necessitate euthanasia. However, significant complications occurred in 20 horses (77%), including support limb laminitis, incisional drainage, implant infection with osteomyelitis, and distal interphalangeal joint subluxation, substantially limiting the procedure's overall prognosis. Whilst the locking compression-distal femur plate offers a mechanically sound option for stabilising the digital column and preventing catastrophic PIPJ subluxation in horses with severe suspensory apparatus damage, the high perioperative morbidity and 50% long-term mortality mean this remains a salvage procedure requiring careful client counselling about realistic expectations.
Read the full abstract on PubMed
Practical Takeaways
- •The locking compression-distal femur plate effectively stabilizes the joint and prevents proximal interphalangeal subluxation in horses with severe suspensory apparatus damage, offering a surgical option when conservative management fails
- •Expect significant postoperative complications—over three-quarters of horses develop issues like support limb laminitis or infection—requiring intensive perioperative care and realistic owner counseling about survival rates (~50% long-term)
- •For working racehorses, this procedure offers a pathway to pasture soundness without chronic medication for roughly half of survivors, but should be reserved for cases at imminent risk of catastrophic joint failure rather than as a routine salvage procedure
Key Findings
- •Double arthrodesis using locking compression-distal femur plate successfully prevented proximal interphalangeal joint subluxation in all 26 horses treated
- •50% of horses (13/26) survived long-term (>6 months, range 6-32 months) and achieved pasture soundness without analgesics
- •Short-term complications occurred in 76.9% of horses (20/26), including support limb laminitis, incisional drainage, implant infection with osteomyelitis, and distal interphalangeal joint subluxation
- •Prognosis remains fair despite surgical success in preventing target complication, with mortality and morbidity from secondary complications limiting outcomes