Computed tomographic assessment of fracture characteristics and subchondral bone injury in Thoroughbred racehorses with lateral condylar fractures and their relationship to outcome.
Authors: Cianci Justine M, Wulster Kathryn B, Richardson Dean W, Stefanovski Darko, Ortved Kyla F
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Lateral Condylar Fractures in Racehorses—CT Assessment Predicts Racing Comeback Lateral condylar fractures of the third metacarpal and metatarsal bones are career-threatening injuries in Thoroughbred racehorses, yet their prognosis varies considerably depending on fracture morphology and concurrent joint damage. Cianci and colleagues retrospectively evaluated preoperative CT scans and surgical records from 50 racehorses with lateral condylar fractures treated with internal fixation, correlating fracture characteristics (length, completeness, displacement) and associated pathology (subchondral bone injury, sesamoid fractures, articular comminution) with post-operative racing performance obtained from racing databases. Two-thirds of horses (66%) returned to racing; however, those presenting with complete rather than incomplete fractures, sesamoid bone fractures, condylar comminution, and intra-articular fragmentation were significantly less likely to race postoperatively, whilst interestingly, concurrent subchondral bone injury alone did not negatively impact outcome. Sex also emerged as a predictor, with fillies less likely to return to racing than colts. For the equine veterinary team, these findings underscore the clinical value of detailed preoperative CT imaging in prognostication—a complete fracture with additional articular involvement warrants more guarded prognosis discussions with owners, whilst incomplete fractures without such complications carry substantially better racing prospects despite surgical intervention being required.
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Practical Takeaways
- •Use preoperative CT imaging to fully characterize lateral condylar fractures and identify concurrent joint pathology—the presence of comminution, fragmentation, or sesamoid fractures substantially reduces return-to-racing prognosis
- •Set realistic expectations with owners: approximately 1 in 3 horses with lateral condylar fractures will not return to racing, with worse prognosis in mares and those with complete fractures involving multiple fragments
- •The presence of subchondral bone injury alone should not be used to counsel against surgery, as it did not independently predict poor outcomes
Key Findings
- •66% of horses (33/50) with lateral condylar fractures returned to racing after surgical fixation
- •Sesamoid bone fractures, MC3/MT3 comminution, and intra-articular fragmentation were significant negative predictors of return to racing (P = 0.021, 0.016, and 0.015 respectively)
- •Complete fractures and female sex were the strongest independent predictors of failure to return to racing (P = 0.007 and 0.015)
- •Concurrent subchondral bone injury did not significantly affect racing outcome