Slab fractures of the third tarsal bone: Minimally invasive repair using a single 3.5 mm cortex screw placed in lag fashion in 17 Thoroughbred racehorses.
Authors: Barker W H J, Wright I M
Journal: Equine veterinary journal
Summary
Third tarsal bone (central tarsal bone) slab fractures present a significant challenge in racing Thoroughbreds, yet published evidence on surgical repair outcomes has been lacking. Barker and Wright's 2017 retrospective case series evaluated a minimally invasive technique using a single 3.5 mm cortex screw placed in lag fashion across the fracture line, analysing 17 cases to establish surgical efficacy and safety. All fractures achieved union within 4–6 months post-operatively with no perioperative complications, and 79% of horses returned to racing—a compelling outcome compared to the uncertainty surrounding conservative management of these career-threatening injuries. The key technical innovation involves establishing the optimal screw trajectory (dorsolateral proximal to plantaromedial distal) using preplaced needles to account for individual variation in third tarsal bone curvature and the surrounding anatomy of adjacent joints. For practitioners managing performance horses with confirmed slab fractures of the third tarsal bone, this evidence supports referral for surgical repair as a viable, predictable alternative to prolonged box rest and rehabilitation, particularly where return to racing is the treatment goal.
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Practical Takeaways
- •Minimally invasive screw fixation offers a viable surgical alternative to conservative management for third tarsal bone slab fractures in racehorses, with high return-to-racing rates
- •Careful pre-operative planning using needle placement to determine screw trajectory is essential given the anatomical complexity of the tarsal joint and bone curvature variation
- •This technique appears safe and repeatable with predictable healing timelines (4-6 months), making it suitable for adoption in equine surgical practice
Key Findings
- •A minimally invasive technique using a single 3.5 mm cortex screw in lag fashion successfully repaired third tarsal bone slab fractures in all 17 Thoroughbred racehorses with no complications
- •Fracture healing occurred in 4-6 months post-surgery across all cases
- •79% of horses returned to racing following surgical repair
- •18% of cases presented with wedge-shaped third tarsal bones, requiring dorsolateral proximal-plantaromedial distal screw trajectory