Standing repair of short frontal plane fractures involving the dorsoproximal articular surface of the proximal phalanx in six Thoroughbred racehorses.
Authors: Drahonovska Anna, Bladon Bruce M, O'Neill Henry D
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Dorsal proximal P1 fractures in racehorses have historically presented a challenging surgical problem, particularly when they involve the articular surface and occur in the frontal plane. Drahonovska and colleagues report outcomes in six Thoroughbred racehorses treated with standing internal fixation using a single 3.5 mm cortical screw placed in lag fashion under radiographic guidance, all of which were hindlimb cases with medial bias extending from the central proximal P1 to the dorsomedial prominence. Mean fracture length was 23 mm (range 19–28 mm), screw placement averaged 13 minutes, and postoperative radiographs in five cases demonstrated fracture plane resolution without complications. All six horses returned to racing, with mean return-to-race time of 205 days (range 144–284 days) and an average of 21 race starts subsequently. This technique represents a viable alternative to traditional surgical approaches for select short, incomplete articular fractures of the proximal phalanx, offering the advantages of standing surgery (reduced general anaesthesia risk, faster recovery) whilst achieving anatomical reduction and stable fixation—making it particularly valuable for practitioners managing performance horses where swift return to work is essential, though careful case selection based on fracture morphology and radiographic assessment remains critical.
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Practical Takeaways
- •Standing repair of small P1 fractures is a viable alternative to general anaesthesia for selected cases, potentially reducing recovery time and anaesthetic risk
- •These short frontal plane fractures can achieve successful racing comebacks (mean 205 days) with proper internal fixation, making early diagnosis and intervention worthwhile
- •This technique requires advanced standing surgery skills and radiographic capability—refer appropriately or develop this skill set if managing high-performance horses
Key Findings
- •Standing surgical repair of short P1 frontal plane fractures using a single 3.5 mm cortical screw placed in lag fashion was successful in all 6 Thoroughbreds with mean fracture plane length of 23 mm
- •Mean time from surgery to first race was 205 days (range 144-284 days) with all horses returning to racing and mean of 21 starts per horse
- •No complications were reported related to the repair method, and postoperative radiographs in 5 horses showed resolution of the fracture plane
- •Mean surgical time for screw placement was 13 minutes (range 9-21 minutes) under standing sedation and local anesthesia with radiographic guidance