Short frontal plane fractures involving the dorsoproximal articular surface of the proximal phalanx: Description of the injury and a technique for repair.
Authors: Wright I M, Minshall G J
Journal: Equine veterinary journal
Summary
# Editorial Summary Wright & Minshall's 2018 study examined a specific type of fracture affecting the dorsal proximal articular surface of the proximal phalanx in racehorses—injuries that begin at the joint surface but exit the bone below the metacarpophalangeal/metatarsophalangeal capsule attachment, distinguishing them from larger chip fractures. Reviewing 22 fractures across 21 Thoroughbreds at Newmarket Equine Hospital, the authors characterised the lesion morphology and developed a minimally invasive repair technique using a single lag screw placed under combined arthroscopic and radiographic guidance. Notably, 20 of the 22 fractures occurred on the medial aspect of the proximal phalanx, predominantly as acute racing or training injuries, with 16 horses returning to racing post-operatively and achieving performance levels comparable to their pre-injury baseline. Although the consistent anatomical presentation suggests a shared biomechanical mechanism—likely relating to medial-sided loading during athletic exertion—the study cannot identify precise causation or compare treatment efficacy against alternative approaches. For practitioners, these findings indicate that dorsoproximal frontal plane fractures exiting below the joint capsule represent a distinct and surgically manageable injury category with favourable prognosis, though understanding the precise loading conditions precipitating injury remains an avenue for future investigation.
Read the full abstract on PubMed
Practical Takeaways
- •Short frontal plane fractures of the proximal phalanx can be successfully managed with minimally invasive arthroscopic-guided lag screw fixation, offering good prognosis for return to racing
- •These fractures show consistent medial location and exit pattern distal to the joint capsule, which should guide diagnostic imaging and surgical planning in suspected cases
- •Expect approximately 76% of surgically repaired cases to return to racing with performance similar to pre-injury levels
Key Findings
- •22 frontal plane fractures in 21 Thoroughbred racehorses demonstrated consistent morphology with 20 medial, 1 lateral and 1 midline orientation
- •All fractures originated at the proximal articular surface and exited the dorsal cortex distal to the joint capsule (17 hindlimbs, 5 forelimbs)
- •Single lag screw repair using arthroscopic and radiographic guidance was successful in all cases with 16 of 21 horses returning to racing at pre-injury performance levels
- •16 of 22 fractures were acute racing or training injuries, suggesting a common pathophysiological mechanism despite unclear precise etiology