Standing repair of long frontal plane fractures of the proximal phalanx in UK Thoroughbred racehorses: A retrospective analysis of 13 fractures.
Authors: Findley, Bladon, O'Neill
Journal: Equine veterinary journal
Summary
# Editorial Summary: Standing Repair of Frontal Plane Proximal Phalanx Fractures Frontal plane fractures of the proximal phalanx (P1) in Thoroughbred racehorses are far less documented than their sagittal counterparts, despite occurring with reasonable frequency in performance animals; Findley and colleagues addressed this knowledge gap by retrospectively analysing 13 such fractures treated at a single UK referral centre using standing lag screw fixation. The surgical approach employed a median of four screws with a median operative time of 30 minutes, applicable across fractures of varying complexity—ranging from incomplete injuries to biarticular complete fractures—with all cases occurring in hindlimbs. Return-to-racing rates of 73% (8 of 11 horses) at a median of 356 days post-operatively compare favourably with published outcomes for sagittal P1 fractures, suggesting that careful case selection and appropriate fixation technique yield reliable performance restoration. One post-operative complication requiring screw removal at 257 days highlights the need for ongoing monitoring, though this represents a favourable complication rate for intra-articular fracture repair. For farriers, veterinarians, and rehabilitation professionals involved in managing fracture cases, this work provides valuable evidence that certain frontal plane P1 fractures—specifically those propagating from the central third of the proximal articular surface—are amenable to successful standing surgical repair, expanding treatment options beyond conservative management or arthroscopic intervention.
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Practical Takeaways
- •Long frontal P1 fractures can be successfully managed in standing position with good racing prognosis—73% return rate is comparable to sagittal fracture repairs
- •Plan for extended recovery time (median 356 days) when counselling owners on realistic timelines for return to racing
- •Standing lag screw fixation for these previously underreported fractures is technically feasible (median 30 min surgery) and suitable for selected cases presenting to referral centres
Key Findings
- •73% of horses (8/11) returned to racing following standing lag screw fixation of long frontal P1 fractures at a median of 356 days (range 178-728 days)
- •All 13 fractures occurred in hindlimbs, with 2 biarticular cases, 3 complete uniarticular cases, and 8 incomplete cases successfully repaired
- •Median surgical time was 30 minutes (range 18-104 minutes) using a median of 4 screws (range 2-5)
- •Post-operative outcomes for frontal P1 fractures are comparable to sagittal P1 fractures, with one complication requiring screw removal at 257 days