The proximal phalanx is the first bone in the digit of a horse, located immediately distal to the metacarpophalangeal (fetlock) joint in the forelimb and the metatarsophalangeal joint in the hindlimb. It is a critical component of the equine limb, contributing to the overall biomechanics and functionality of the horse's movement. The proximal phalanx is subject to various stressors and can be affected by fractures, osteoarthritis, and other orthopedic conditions. Understanding the anatomy, biomechanics, and pathology of the proximal phalanx is essential for diagnosing and managing equine lameness and injuries. This page compiles peer-reviewed research studies and scholarly articles that explore the structure, function, and clinical implications of the proximal phalanx in horses.
Faulkner JE, Joostens Z, Broeckx BJG, Hauspie S, Mariën T, Vanderperren K.Injuries of the sagittal groove of the proximal phalanx (P1) in equine athletes are considered to predominantly occur due to chronic bone stress overload. Objective: To describe the range of abnormalities that is present in the sagittal groove in a large group of horses diagnosed with sagittal groove disease (SGD) on low-field MRI. Methods: Retrospective, cross-sectional. Methods: Medical records were searched to identify initial MRI images of horses diagnosed with SGD and these were blindly evaluated using a semi-quantitative grading scheme and novel SGD MRI classification system reflecting p...
Koshyk A, Pohl AJ, Takahashi Y, Scott WM, Sparks HD, Edwards WB.Fractures of the equine metacarpophalangeal (MCP) joint are among the most common and fatal injuries experienced by racehorses. These bone injuries are a direct result of repetitive, high intensity loading of the skeleton during racing and training and there is consensus that they represent a mechanical fatigue phenomenon. Existing work has found the fatigue life of bone to be strongly determined by bone microarchitecture and the resulting stressed volume (i.e., the volume of bone stressed above assumed yield). The purpose of this study was to quantify the influence of bone microarchitecture o...
Ciamillo SA, Wulster KB, Gassert TM, Richardson DW, Brown KA, Stefanovski D, Ortved KF.Catastrophic injuries of the fetlock joints occur in Thoroughbred racehorses and are preceded by stress-induced bone injury. Early detection of subchondral bone injury is essential to prevent irreversible damage or bone failure. Objective: To investigate the use of standing, robotic cone-beam computed tomography (CBCT) for assessing longitudinal changes in subchondral bone morphology and pathology of the fetlock joints associated with race training in young Thoroughbreds. Methods: Observational cohort study. Methods: Forty-one 2-year-old Thoroughbred racehorses were recruited prior to the star...
Faulkner JE, Joostens Z, Broeckx BJG, Hauspie S, Mariën T, Vanderperren K.Evolution of magnetic resonance imaging (MRI) findings in horses with sagittal groove disease (SGD) of the proximal phalanx is relatively sparsely described. This retrospective, descriptive, longitudinal study describes the findings of sequential low-field MRI fetlock examinations in horses with SGD of the proximal phalanx using a classification system. Twenty-nine horses were included, predominantly warmbloods used for show jumping (79%). For 29 limbs re-examined during the initial rehabilitation period, classification remained constant (n = 18), increased (n = 2), decreased (n = 7), and fluc...
Pige C, Spriet M, Perez-Nogues M, Katzman S, Le Jeune S, Galuppo L. F-sodium fluoride ( F-NaF) positron emission tomography (PET) has been validated as a useful imaging technique in the racehorse fetlock. The use of F-NaF PET in the nonracehorse fetlock has not been reported. Objective: To describe F-NaF PET findings in nonracehorse fetlocks, to compare with computed tomography (CT) findings and to compare PET findings between horses with and without fetlock pain. Methods: Retrospective observational study. Methods: All horses undergoing F-NaF PET and CT imaging of the fetlock between October 2016 and March 2021 were included in the study. Medical records ...
Colgate VA, Robinson N, Barnett TP, Bathe AP, Coleridge MOD, Smith LCR, Payne RJ.Repair of sagittal proximal phalanx (P1) and parasagittal metacarpal/metatarsal III (MC/MTIII) fractures has evolved over recent decades from a procedure carried out solely under general anaesthesia, to one commonly performed under standing sedation. To date, standing fracture repair has not been evaluated for large cohorts. Objective: To determine short-term (survival to discharge) and long-term (return to racing) outcomes of horses undergoing standing repair of MC/MTIII and P1 fractures, and to compare pre-surgical and post-surgical racing performance. Methods: Single-centre retrospective co...
Lin ST, Foote AK, Bolas NM, Peter VG, Pokora R, Patrick H, Sargan DR, Murray RC.Fissure in the third metacarpal/tarsal parasagittal groove and proximal phalanx sagittal groove is a potential prodromal pathology of fracture; therefore, early identification and characterisation of fissures using non-invasive imaging could be of clinical value. Thirty-three equine cadaver limbs underwent standing cone-beam (CB) computed tomography (CT), fan-beam (FB) CT, low-field magnetic resonance imaging (MRI), and macro/histo-pathological examination. Imaging diagnoses of fissures were compared to microscopic examination. Imaging features of fissures were described. Histopathological fin...
van Veggel ECS, Selberg KT, van der Velde-Hoogelander B, Vanderperren K, Cokelaere SM, Bergman HJ. To describe the MRI findings for 13 horses with deep digital flexor tendon (DDFT) injury at the proximal phalanx where the tendon goes from ovoid to bilobed in frontlimbs with tendon sheath distension. In addition, the prognosis of this lesion was assessed. Retrospective case series. Thirteen client-owned horses. Medical records were reviewed, and data were collected regarding signalment, history, MRI findings, and outcomes of horses. Findings of MRI were recorded and whether the case was confirmed with tenoscopy. A diagnosis of DDFT injury at the junction between ovoid and bilobed portio...
Kol'vek F, Krešáková L, Vdoviaková K, Medvecký Ľ, Žert Z.After the medial femoral condyle (MFC), the phalanges are the second most common site for osseous cyst-like lesions (OCLLs). Conservative treatment of phalangeal cysts on the convex surface of proximal phalanx presents a technical problem with access to the stoma of the cyst. Surgical therapy options usually aim to avoid cyst enlargement through drilling or screw placement or to encourage lesion filling with osteoconductive material. This paper describes a case of treatment of the OCLL in a yearling Czech warmblood filly with surgical arthrodesis, together with the packing of the OCLL with cal...
Mizobe F, Nomura M, Ueno T, Yamada K.This study focused on 8 Thoroughbred racehorses showing bone marrow oedema-type signal in the proximal sagittal groove of the proximal phalanx, with the aim of understanding its clinical significance. Standing magnetic resonance imaging played an important role in assessing osseous abnormalities that were not radiographically identifiable. Further, a histopathological result from one of the cases showed there was oedema surrounding adipose tissues with increase in density of trabecular scaffolding. This may indicate presence of osseous injury within the area of decreased elasticity due to subc...
Lipreri G, Bladon BM, Giorio ME, Singer ER.To compare the outcome following conservative vs surgical management of sports horses with a diagnosis of subchondral bone trauma of the proximal aspect of the proximal phalanx (PP) by low-field MRI. Methods: Retrospective case series. Methods: Twenty-one mature sports horses with evidence of high water signal within the proximal sagittal groove of the PP according to low-field MRI of the fetlock, with no definitive radiographic evidence of fracture. Methods: Medical records (2010-2017) of horses admitted to 2 referral hospitals were reviewed. Historical, clinical, radiographic, and MRI findin...
Wright IM, Minshall GJ.Chip fractures of the dorsoproximal articular margin of the proximal phalanx are common injuries in racehorses. Large fractures can extend distal to the joint capsule insertion and have been described as dorsal frontal fractures. Objective: To report the location and morphology of short frontal plane fractures involving the dorsoproximal articular surface of the proximal phalanx and describe a technique for repair under arthroscopic and radiographic guidance. Methods: Single centre retrospective case study. Methods: Case records of horses with frontal plane fractures restricted to the dorsopro...
Smith MR, Wright IM.Fractures of the proximal phalanx are generally considered to result from monotonic supraphysiological loads, but radiological observations from clinical cases suggest there may be a stress-related aetiology. Objective: To determine whether there are radiologically identifiable prodromal changes in Thoroughbred racehorses with confirmed parasagittal fractures of the proximal phalanx. Methods: Retrospective cross-sectional study. Methods: Case records and radiographs of Thoroughbred racehorses with parasagittal fractures of the proximal phalanx were analysed. Thickness of the subchondral bone p...
Dyson S, Nagy A, Murray R.Eight sports horses with unilateral (4) or bilateral (3) forelimb or unilateral hindlimb (1) lameness had subtle radiologic abnormalities of the subchondral bone of the sagittal groove of the proximal phalanx associated with moderate or intense increased radiopharmaceutical uptake. High-field or low-field magnetic resonance (MR) imaging confirmed the presence of a fissure fracture or subchondral and trabecular bone trauma. Seven of eight lesions were located approximately midway between the dorsal and palmar cortices of the proximal phalanx; the eighth was sited more dorsally. Two horses under...
Ramzan PH, Powell SE.Sagittal fracture of the proximal phalanx (P1) is an important musculoskeletal injury of the performance horse. Although widely considered to be monotonic in nature, there is emerging evidence that some P1 fractures may have stress-injury aetiology. Three cases are described in which imaging features found were suggestive of prodromal bone injury. All cases returned to full performance use after a period of rest. The authors conclude that it is possible that some P1 fractures in the Thoroughbred racehorse may develop through stress/fatigue injury pathways. It is proposed that intervention prio...
Elce YA, Richardson DW.To report a technique for, and outcome after, arthroscopic removal of dorsoproximal chip fractures of a proximal phalanx in standing horses. Methods: Retrospective study. Methods: A total of 104 horses, 1 to 13 years of age, with a dorsoproximal chip fracture of a proximal phalanx. Methods: Horses were restrained in standing stocks and sedated with intravenous xylazine, detomidine, or a combination of both drugs. Local analgesia was achieved with 2% mepivacaine administered intra-articularly and by subcutaneous infiltration in a crescent-shaped block dorsal to the fetlock. Sterile drapes were ...
Stiglhuber A, Breit S, König HE.The equine fetlock joint cavity shows ten pouches. The dorsal recess, which is oriented to the proximal side, is separated from those three pouches, which show to the distal direction, by several capsular folds. These folds are documented by means of sagittal sections through the fetlock joint. A medial/lateral recess is covered by the deep part of the collateral ligament of the fetlock joint. The collateral ligaments as well as the sesamoidean collateral ligaments are closely connected with the joint capsule, from which two capsular folds are separated. Between the part of the sesamoidean col...
Fortier LA, Foerner JJ, Nixon AJ.Medical records from 119 horses that had undergone arthroscopic surgery for removal of axial osteochondral fragments of the palmar/plantar proximal aspect of the proximal phalanx were reviewed. Standardbred racehorses represented 109 (92%) of those affected. Ninety-three (78%) of the horses were < 3 years old. Gender distribution was consistent with that of the equine hospital population. Fragments most commonly were observed in the hind limbs (155/164; 95%), specifically, on the medial aspect of the left hind limb (72/164; 44%). Bilateral fragmentation occurred in 21 of 119 (18%) horses, a...
Barclay WP, Foerner JJ, Phillips TN.Osteochondral fragmentation of the plantar aspect of the proximal phalanx was diagnosed as a cause of hind limb lameness in 19 horses. The lameness was evident at the upper levels of the horses' performance capabilities, and was isolated to the metatarsophalangeal joints by use of intra-articular or regional anesthesia. Fragments were surgically removed from 10 horses that later returned to full use. Seven horses were treated intra-articularly with polysulfated glycosaminoglycans or corticosteroids; only one horse was able to return to full use. One horse was retired from work at the time of d...
Ellis DR, Simpson DJ, Greenwood RE, Crowhurst JS.A retrospective study of 119 cases of fracture of the proximal phalanx is described. The short incomplete sagittal fracture (split pastern) was most common and carried a good prognosis for a return to racing following conservative treatment. Longer incomplete fractures also had a good prognosis but complete fractures, either through the lateral cortex of the proximal phalanx or through the bone into the proximal interphalangeal joint, required internal fixation. Careful assessment of these and comminuted fractures was essential before surgery was undertaken. Most comminuted fractures were trea...
Auer JA.Bilateral angular limb deformities of the metacarpo/metatarsophalangeal regions in 2 foals are discussed. Periosteal transection was used to correct the deformity in both foals. In one foal, only the right forelimb was treated because the deformity in the left forelimb did not appear to warrant surgery. Subsequently, an angular limb deformity, which could have been prevented, developed in the left forelimb. A third foal developed a deformity in the proximal phalanx after periosteal transection of the distal third metatarsal bone.
Dyson S, Nagy A, Murray R.Eight sports horses with unilateral (4) or bilateral (3) forelimb or unilateral hindlimb (1) lameness had subtle radiologic abnormalities of the subchondral bone of the sagittal groove of the proximal phalanx associated with moderate or intense increased radiopharmaceutical uptake. High-field or low-field magnetic resonance (MR) imaging confirmed the presence of a fissure fracture or subchondral and trabecular bone trauma. Seven of eight lesions were located approximately midway between the dorsal and palmar cortices of the proximal phalanx; the eighth was sited more dorsally. Two horses under...
Ramzan PH, Powell SE.Sagittal fracture of the proximal phalanx (P1) is an important musculoskeletal injury of the performance horse. Although widely considered to be monotonic in nature, there is emerging evidence that some P1 fractures may have stress-injury aetiology. Three cases are described in which imaging features found were suggestive of prodromal bone injury. All cases returned to full performance use after a period of rest. The authors conclude that it is possible that some P1 fractures in the Thoroughbred racehorse may develop through stress/fatigue injury pathways. It is proposed that intervention prio...
Smith MR, Wright IM.Fractures of the proximal phalanx are generally considered to result from monotonic supraphysiological loads, but radiological observations from clinical cases suggest there may be a stress-related aetiology. Objective: To determine whether there are radiologically identifiable prodromal changes in Thoroughbred racehorses with confirmed parasagittal fractures of the proximal phalanx. Methods: Retrospective cross-sectional study. Methods: Case records and radiographs of Thoroughbred racehorses with parasagittal fractures of the proximal phalanx were analysed. Thickness of the subchondral bone p...
Mizobe F, Nomura M, Ueno T, Yamada K.This study focused on 8 Thoroughbred racehorses showing bone marrow oedema-type signal in the proximal sagittal groove of the proximal phalanx, with the aim of understanding its clinical significance. Standing magnetic resonance imaging played an important role in assessing osseous abnormalities that were not radiographically identifiable. Further, a histopathological result from one of the cases showed there was oedema surrounding adipose tissues with increase in density of trabecular scaffolding. This may indicate presence of osseous injury within the area of decreased elasticity due to subc...
Fortier LA, Foerner JJ, Nixon AJ.Medical records from 119 horses that had undergone arthroscopic surgery for removal of axial osteochondral fragments of the palmar/plantar proximal aspect of the proximal phalanx were reviewed. Standardbred racehorses represented 109 (92%) of those affected. Ninety-three (78%) of the horses were < 3 years old. Gender distribution was consistent with that of the equine hospital population. Fragments most commonly were observed in the hind limbs (155/164; 95%), specifically, on the medial aspect of the left hind limb (72/164; 44%). Bilateral fragmentation occurred in 21 of 119 (18%) horses, a...
van Veggel ECS, Selberg KT, van der Velde-Hoogelander B, Vanderperren K, Cokelaere SM, Bergman HJ. To describe the MRI findings for 13 horses with deep digital flexor tendon (DDFT) injury at the proximal phalanx where the tendon goes from ovoid to bilobed in frontlimbs with tendon sheath distension. In addition, the prognosis of this lesion was assessed. Retrospective case series. Thirteen client-owned horses. Medical records were reviewed, and data were collected regarding signalment, history, MRI findings, and outcomes of horses. Findings of MRI were recorded and whether the case was confirmed with tenoscopy. A diagnosis of DDFT injury at the junction between ovoid and bilobed portio...
Ellis DR, Simpson DJ, Greenwood RE, Crowhurst JS.A retrospective study of 119 cases of fracture of the proximal phalanx is described. The short incomplete sagittal fracture (split pastern) was most common and carried a good prognosis for a return to racing following conservative treatment. Longer incomplete fractures also had a good prognosis but complete fractures, either through the lateral cortex of the proximal phalanx or through the bone into the proximal interphalangeal joint, required internal fixation. Careful assessment of these and comminuted fractures was essential before surgery was undertaken. Most comminuted fractures were trea...
Lipreri G, Bladon BM, Giorio ME, Singer ER.To compare the outcome following conservative vs surgical management of sports horses with a diagnosis of subchondral bone trauma of the proximal aspect of the proximal phalanx (PP) by low-field MRI. Methods: Retrospective case series. Methods: Twenty-one mature sports horses with evidence of high water signal within the proximal sagittal groove of the PP according to low-field MRI of the fetlock, with no definitive radiographic evidence of fracture. Methods: Medical records (2010-2017) of horses admitted to 2 referral hospitals were reviewed. Historical, clinical, radiographic, and MRI findin...
Kol'vek F, Krešáková L, Vdoviaková K, Medvecký Ľ, Žert Z.After the medial femoral condyle (MFC), the phalanges are the second most common site for osseous cyst-like lesions (OCLLs). Conservative treatment of phalangeal cysts on the convex surface of proximal phalanx presents a technical problem with access to the stoma of the cyst. Surgical therapy options usually aim to avoid cyst enlargement through drilling or screw placement or to encourage lesion filling with osteoconductive material. This paper describes a case of treatment of the OCLL in a yearling Czech warmblood filly with surgical arthrodesis, together with the packing of the OCLL with cal...
Barclay WP, Foerner JJ, Phillips TN.Osteochondral fragmentation of the plantar aspect of the proximal phalanx was diagnosed as a cause of hind limb lameness in 19 horses. The lameness was evident at the upper levels of the horses' performance capabilities, and was isolated to the metatarsophalangeal joints by use of intra-articular or regional anesthesia. Fragments were surgically removed from 10 horses that later returned to full use. Seven horses were treated intra-articularly with polysulfated glycosaminoglycans or corticosteroids; only one horse was able to return to full use. One horse was retired from work at the time of d...
Lin ST, Foote AK, Bolas NM, Peter VG, Pokora R, Patrick H, Sargan DR, Murray RC.Fissure in the third metacarpal/tarsal parasagittal groove and proximal phalanx sagittal groove is a potential prodromal pathology of fracture; therefore, early identification and characterisation of fissures using non-invasive imaging could be of clinical value. Thirty-three equine cadaver limbs underwent standing cone-beam (CB) computed tomography (CT), fan-beam (FB) CT, low-field magnetic resonance imaging (MRI), and macro/histo-pathological examination. Imaging diagnoses of fissures were compared to microscopic examination. Imaging features of fissures were described. Histopathological fin...
Wright IM, Minshall GJ.Chip fractures of the dorsoproximal articular margin of the proximal phalanx are common injuries in racehorses. Large fractures can extend distal to the joint capsule insertion and have been described as dorsal frontal fractures. Objective: To report the location and morphology of short frontal plane fractures involving the dorsoproximal articular surface of the proximal phalanx and describe a technique for repair under arthroscopic and radiographic guidance. Methods: Single centre retrospective case study. Methods: Case records of horses with frontal plane fractures restricted to the dorsopro...
Auer JA.Bilateral angular limb deformities of the metacarpo/metatarsophalangeal regions in 2 foals are discussed. Periosteal transection was used to correct the deformity in both foals. In one foal, only the right forelimb was treated because the deformity in the left forelimb did not appear to warrant surgery. Subsequently, an angular limb deformity, which could have been prevented, developed in the left forelimb. A third foal developed a deformity in the proximal phalanx after periosteal transection of the distal third metatarsal bone.
Stiglhuber A, Breit S, König HE.The equine fetlock joint cavity shows ten pouches. The dorsal recess, which is oriented to the proximal side, is separated from those three pouches, which show to the distal direction, by several capsular folds. These folds are documented by means of sagittal sections through the fetlock joint. A medial/lateral recess is covered by the deep part of the collateral ligament of the fetlock joint. The collateral ligaments as well as the sesamoidean collateral ligaments are closely connected with the joint capsule, from which two capsular folds are separated. Between the part of the sesamoidean col...
Elce YA, Richardson DW.To report a technique for, and outcome after, arthroscopic removal of dorsoproximal chip fractures of a proximal phalanx in standing horses. Methods: Retrospective study. Methods: A total of 104 horses, 1 to 13 years of age, with a dorsoproximal chip fracture of a proximal phalanx. Methods: Horses were restrained in standing stocks and sedated with intravenous xylazine, detomidine, or a combination of both drugs. Local analgesia was achieved with 2% mepivacaine administered intra-articularly and by subcutaneous infiltration in a crescent-shaped block dorsal to the fetlock. Sterile drapes were ...
Colgate VA, Robinson N, Barnett TP, Bathe AP, Coleridge MOD, Smith LCR, Payne RJ.Repair of sagittal proximal phalanx (P1) and parasagittal metacarpal/metatarsal III (MC/MTIII) fractures has evolved over recent decades from a procedure carried out solely under general anaesthesia, to one commonly performed under standing sedation. To date, standing fracture repair has not been evaluated for large cohorts. Objective: To determine short-term (survival to discharge) and long-term (return to racing) outcomes of horses undergoing standing repair of MC/MTIII and P1 fractures, and to compare pre-surgical and post-surgical racing performance. Methods: Single-centre retrospective co...
Pige C, Spriet M, Perez-Nogues M, Katzman S, Le Jeune S, Galuppo L. F-sodium fluoride ( F-NaF) positron emission tomography (PET) has been validated as a useful imaging technique in the racehorse fetlock. The use of F-NaF PET in the nonracehorse fetlock has not been reported. Objective: To describe F-NaF PET findings in nonracehorse fetlocks, to compare with computed tomography (CT) findings and to compare PET findings between horses with and without fetlock pain. Methods: Retrospective observational study. Methods: All horses undergoing F-NaF PET and CT imaging of the fetlock between October 2016 and March 2021 were included in the study. Medical records ...
Faulkner JE, Joostens Z, Broeckx BJG, Hauspie S, Mariën T, Vanderperren K.Evolution of magnetic resonance imaging (MRI) findings in horses with sagittal groove disease (SGD) of the proximal phalanx is relatively sparsely described. This retrospective, descriptive, longitudinal study describes the findings of sequential low-field MRI fetlock examinations in horses with SGD of the proximal phalanx using a classification system. Twenty-nine horses were included, predominantly warmbloods used for show jumping (79%). For 29 limbs re-examined during the initial rehabilitation period, classification remained constant (n = 18), increased (n = 2), decreased (n = 7), and fluc...
Ciamillo SA, Wulster KB, Gassert TM, Richardson DW, Brown KA, Stefanovski D, Ortved KF.Catastrophic injuries of the fetlock joints occur in Thoroughbred racehorses and are preceded by stress-induced bone injury. Early detection of subchondral bone injury is essential to prevent irreversible damage or bone failure. Objective: To investigate the use of standing, robotic cone-beam computed tomography (CBCT) for assessing longitudinal changes in subchondral bone morphology and pathology of the fetlock joints associated with race training in young Thoroughbreds. Methods: Observational cohort study. Methods: Forty-one 2-year-old Thoroughbred racehorses were recruited prior to the star...
Koshyk A, Pohl AJ, Takahashi Y, Scott WM, Sparks HD, Edwards WB.Fractures of the equine metacarpophalangeal (MCP) joint are among the most common and fatal injuries experienced by racehorses. These bone injuries are a direct result of repetitive, high intensity loading of the skeleton during racing and training and there is consensus that they represent a mechanical fatigue phenomenon. Existing work has found the fatigue life of bone to be strongly determined by bone microarchitecture and the resulting stressed volume (i.e., the volume of bone stressed above assumed yield). The purpose of this study was to quantify the influence of bone microarchitecture o...
Faulkner JE, Joostens Z, Broeckx BJG, Hauspie S, Mariën T, Vanderperren K.Injuries of the sagittal groove of the proximal phalanx (P1) in equine athletes are considered to predominantly occur due to chronic bone stress overload. Objective: To describe the range of abnormalities that is present in the sagittal groove in a large group of horses diagnosed with sagittal groove disease (SGD) on low-field MRI. Methods: Retrospective, cross-sectional. Methods: Medical records were searched to identify initial MRI images of horses diagnosed with SGD and these were blindly evaluated using a semi-quantitative grading scheme and novel SGD MRI classification system reflecting p...
