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Home / Equine Research Bank / Equine Vet J / A case-matched controlled retrospective performance indexed ...
Equine veterinary journal2025; doi: 10.1111/evj.70088

A case-matched controlled retrospective performance indexed analysis of Thoroughbred racehorses that underwent surgical repair of proximal phalanx and third meta-carpal/tarsal condylar fractures.

Abstract: Standing fracture repair has become established as an acceptable technique with a good long-term prognosis. However, no study has compared racing outcomes with case-matched controls. Objective: To compare racing outcomes between a large dataset of horses undergoing standing fracture repair against case-matched controls. Methods: Retrospective case-matched controlled comparative study. Methods: Thoroughbred racehorses undergoing standing repair of distal limb fracture(s) over 10 years (2012-2022) at five hospital centres across North America and Europe were included. Data retrieved included age, sex, fracture type, pre- and post-operative racing status, days elapsed between repair and first start, and number of starts and places (1-3), which were used to generate a performance index (PI) and a performance index per start (PI/S). Two case-matched controls were assigned and used for post-operative comparison of racing performance. Results: 185/265; 69.8% (confidence interval (CI): 63.9%-75.4%) of horses raced post-surgery. No significant difference in the proportion of cases and case-matched controls (260/342; 76% (CI: 71.3%-80.4%)) that returned to racing was observed. No significant difference in post-operative performance indicators (N starts, PI, PI/S) between cases ((9, inter-quartile-range (IQR): 14) (7, IQR: 14) (0.64, IQR: 1)) respectively, and case-matched controls ((9, IQR: 17) (5, IQR: 14.8) (0.6, IQR: 0.66)) respectively, was observed. Fracture type, limb, sex, or pre-operative racing experience did not affect the proportion of horses returning to racing. Conclusions: The retrospective nature of this study may lead to the omission of data for analysis. Conclusions: Horses undergoing standing internal fixation of select proximal phalanx and third metacarpal/tarsal condylar fractures have a good prognosis for return to racing and comparable performance with case-matched controls. Horses that undergo standing fracture repair have good longevity, outweighing surgical costs and loss of training. Unassigned: Die Versorgung von Frakturen im Stehen hat sich als akzeptable Technik mit guter Langzeitprognose etabliert. Es gibt jedoch keine Studie, in der die Ergebnisse von Rennen mit fallgleichen Kontrollen verglichen wurden. Unassigned: Vergleich der Rennergebnisse eines großen Datensatzes von Pferden, bei denen eine Fraktur im Stehen repariert wurde, mit den Ergebnissen einer Kontrollgruppe. Methods: Eine retrospektive, kontrollierte und vergleichende Fallstudie. Unassigned: Eingeschlossen wurden Vollblutrennpferde, bei denen über einen Zeitraum von 10 Jahren (2012‐2022) in fünf Kliniken in Nordamerika und Europa eine Fraktur der distalen Gliedmaßen stehend operiert wurde. Zu den erfassten Daten gehörten Alter, Geschlecht, Frakturtyp, prä‐ und postoperativer Rennstatus, verstrichene Tage zwischen Reparatur und erstem Start sowie die Anzahl der Starts und Platzierungen (1‐3), die zur Erstellung eines Leistungsindex (PI) und eines Leistungsindex pro Start (PI/S) verwendet wurden. Für den postoperativen Vergleich der Rennleistung wurden zwei fallgleiche Kontrollen zugewiesen und verwendet. Unassigned: 185/265; 69,8 % (Konfidenzintervall (CI): 63,9‐75,4 %) der Pferde nahmen nach der Operation wieder an Rennen teil. Es wurde kein signifikanter Unterschied im Anteil der Fälle und der fallgleichen Kontrollen (260/342; 76 % (KI: 71,3‐80,4 %)) festgestellt, die wieder an Rennen teilnahmen. Es wurde kein signifikanter Unterschied bei den postoperativen Leistungsindikatoren (N Starts, PI, PI/S) zwischen den Fällen ((9, Inter‐Quartil‐Bereich (IQR): 14) (7, IQR: 14) (0,64, IQR: 1)) bzw. den fallgleichen Kontrollen ((9, IQR: 17) (5, IQR: 14,8) (0,6, IQR: 0,66)) festgestellt. Frakturtyp, Gliedmaße, Geschlecht oder präoperative Rennerfahrung hatten keinen Einfluss auf den Anteil der Pferde, die in den Rennsport zurückkehrten. Unassigned: Der retrospektive Charakter dieser Studie kann dazu führen, dass Daten für die Analyse nicht berücksichtigt werden. Unassigned: Pferde, die sich einer stehenden internen Fixierung ausgewählter Frakturen der proximalen Phalanx und des dritten Karpalknochens bzw. der Tarsalkondylen unterziehen, haben eine gute Prognose für die Rückkehr in den Rennsport und eine vergleichbare Leistung wie fallkontrollierte Vergleichstiere. Pferde, deren Frakturen im Stehen repariert werden, haben eine gute Lebenserwartung, die die chirurgischen Kosten und den Trainingsverlust aufwiegt.
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Publication Date: 2025-09-04 PubMed ID: 40908707DOI: 10.1111/evj.70088Google Scholar: Lookup
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Summary

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Overview

  • This study retrospectively compared the racing outcomes of Thoroughbred racehorses that underwent standing surgical repair for specific limb fractures with matched control horses that did not have surgery.
  • The goal was to determine if horses that had surgery returned to racing at similar rates and performed equally well compared to controls, indicating the surgery’s long-term effectiveness and impact on racing careers.

Background and Importance

  • Standing fracture repair is a surgical method where horses remain standing under sedation during internal fixation of certain limb fractures.
  • This technique has become more accepted due to its potential for good long-term prognosis in horses sustaining proximal phalanx (a bone in the lower limb) and third metacarpal or metatarsal condylar fractures (bones in the lower front and hind limbs).
  • Prior to this study, no large-scale research had directly compared racing performance and return-to-race rates between horses undergoing this surgery and matched controls.

Study Objective

  • To compare post-operative racing outcomes between Thoroughbred racehorses that underwent standing repair of distal limb fractures and case-matched control horses without such surgery.
  • Key performance metrics included return to racing rate, performance index (PI), and performance index per start (PI/S).

Methodology

  • Study Design: Retrospective, case-matched controlled comparative study.
  • Subjects: 265 Thoroughbred racehorses treated from 2012 to 2022 at five hospitals in North America and Europe.
  • Fracture Types: Proximal phalanx and third metacarpal/tarsal condylar fractures addressed by standing surgical repair.
  • Data Collected: Age, sex, fracture type, pre- and post-operative racing status, days from repair to first race, number of starts, and race placements (1st–3rd).
  • Controls: Two case-matched controls per case were assigned for each surgery patient. Controls were matched on factors potentially influencing performance but did not undergo fracture repair.
  • Performance Measurement: The performance index (PI) was generated using race results, with PI per start (PI/S) to normalize performance across different numbers of starts.

Results

  • Return to Racing:
    • 69.8% (185/265) of operated horses returned to racing after surgery.
    • 76% (260/342) of control horses raced in the matching period.
    • There was no statistically significant difference between these proportions.
  • Performance Outcomes:
    • Median number of starts post-operatively was similar between cases (9 starts, IQR 14) and controls (9 starts, IQR 17).
    • Median performance index (PI) for cases was 7 (IQR 14) and for controls was 5 (IQR 14.8); this difference was not significant.
    • Median performance index per start (PI/S) was 0.64 (IQR 1) in cases and 0.6 (IQR 0.66) in controls, again showing no significant difference.
  • Influence of Variables:
    • Variables such as fracture type, affected limb, sex, or pre-operative racing experience did not significantly affect return-to-racing rates.

Conclusions

  • Horses undergoing standing internal fixation for selected fractures of the proximal phalanx and third metacarpal/tarsal condyles have a strong prognosis for returning to competitive racing.
  • The surgical repair technique delivers outcomes comparable to those of similar horses that did not sustain fractures, suggesting no long-term detriment to racing performance.
  • Standing fracture repair offers good longevity for racehorses, balancing surgical costs and training interruptions effectively.
  • The retrospective study design means some data may be missing or incomplete; however, the large multi-center sample strengthens the findings.

Implications for Practice

  • The study supports the use of standing fracture repair as a viable and effective treatment for certain fractures in Thoroughbred racehorses.
  • Owners and trainers can consider this surgical option without expecting decreased racing longevity or performance post-repair.
  • Veterinary surgical centers can use these data to counsel clients on prognosis and return-to-racing expectations following fracture repair procedures.

Cite This Article

APA
Yeomans A, Martinkovich D, O'Brien T, O'Neill H, Carpenter R, Georgetti M, Cramp P. (2025). A case-matched controlled retrospective performance indexed analysis of Thoroughbred racehorses that underwent surgical repair of proximal phalanx and third meta-carpal/tarsal condylar fractures. Equine Vet J. https://doi.org/10.1111/evj.70088

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English

Researcher Affiliations

Yeomans, Angus
  • Hambleton Equine Clinic, North Yorkshire, UK.
Martinkovich, Denise
  • Hambleton Equine Clinic, North Yorkshire, UK.
O'Brien, Tom
  • Fethard Equine Hospital, Tipperary, Ireland.
O'Neill, Henry
  • Donnington Grove Veterinary Group, Berkshire, UK.
Carpenter, Ryan
  • Equine Medical Center, Cypress, California, USA.
Georgetti, Mark
  • Three Counties Equine Hospital, Gloucestershire, UK.
Cramp, Phil
  • Hambleton Equine Clinic, North Yorkshire, UK.

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