Use of preoperative computed tomography (CT) to plan repair of comminuted fractures of the middle phalanx in six Warmblood horses: Configuration, treatment and long-term outcome.
Authors: Marcatili Marco, Kalinovskiy Andrey, Christoph Lischer
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Comminuted middle phalanx fractures in horses present considerable surgical challenges, particularly in larger breeds where complex fracture patterns may not be fully characterised on radiographs alone. Marcatili and colleagues reviewed six Warmblood horses that underwent preoperative computed tomography before internal fixation with dorsal plating and proximal interphalangeal joint arthrodesis, employing a standardised fast protocol to systematically evaluate fracture anatomy. Beyond revealing the full extent of fracture comminution invisible on radiography, CT identified clinically significant concurrent pathology in three cases—including navicular bone fractures and deep digital flexor tendon rupture—that fundamentally altered surgical planning and construct design. Four of the six horses remained sound with only mild (3/5 AAEP) lameness at follow-up beyond six months, with the CT-guided approach enabling more precise screw positioning to optimise biomechanical stability of the repair. For practitioners managing high-value performance horses with complex middle phalanx injuries, this work demonstrates that preoperative CT provides essential information for selecting appropriate surgical technique and predicting outcomes, justifying the additional cost and logistics when dealing with comminuted fractures.
Read the full abstract on PubMed
Practical Takeaways
- •Request preoperative CT for comminuted middle phalanx fractures in Warmbloods—it reveals fracture patterns and concurrent injuries that radiographs miss, directly improving your surgical planning and implant positioning
- •Be aware that these cases often have hidden injuries (navicular involvement, tendon rupture) that CT can identify before surgery, potentially changing your approach
- •Expect mild lameness (3/5) as a realistic long-term outcome even with optimal surgical planning; discuss this prognosis honestly with owners
Key Findings
- •CT imaging provided fracture configuration details not visible on radiographs in all 6 cases, enabling superior surgical planning
- •CT identified concurrent pathology in 3 of 6 cases: navicular bone fractures (2 cases) and DDFT rupture (1 case)
- •Four horses survived to >6 months follow-up with mild 3/5 AAEP lameness after internal fixation with dual dorsally-located plates
- •CT-guided surgical planning improved construct stability through precise positioning of multiple cortical lag screws