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Equine veterinary journal2025; doi: 10.1111/evj.70075

A longitudinal study of radiodensity and radiographic appearance of the proximal sesamoid bones in Thoroughbred racehorses.

Abstract: There are limited data on long-term follow-up of radiographic changes of the proximal sesamoid bones (PSBs) in Thoroughbred racehorses. The effect of training and racing on radiodensity of the PSBs in live Thoroughbreds has not been described. Objective: To follow radiographic changes of the PSBs in racehorses over 2 years and describe alterations in overall radiodensity. Methods: Prospective cohort study. Methods: Forty yearlings were enrolled at the first examination (T0). Re-examinations were performed four times, approximately 6 months apart, on 31 (T1), 23 (T2), 13 (T3) and 8 (T4) horses. Radiographic and fan-beam computed tomographic (CT) examinations of both metacarpophalangeal regions were performed. The PSBs were graded (0-3) based on the number of enlarged (width ≥2 mm) vascular channels. The presence of abaxial margin new bone formation, concavity, and irregularity were recorded. The mean Hounsfield Unit (HU) values of the PSBs were measured on multiplanar CT reconstructions. Multivariable mixed-effects regression models estimated the effect of horse signalment and radiographic appearance on mean HU (linear) and the association between radiographic appearance and horse signalment (logistic). Results: Mean HU was lowest at T0 (1064.0 ± 65.1) and highest at T3 (1194.5 ± 78.6). Increasing mean HU was associated with an increasing number of total starts (p < 0.001), increasing bodyweight: height ratio (p < 0.001) and was higher in medial vs. lateral PSBs (p = 0.01). Abaxial new bone formation was associated with a higher grade (p = 0.004) and lateral PSBs (p = 0.04). Abaxial margin concavity was more likely in younger horses (p = 0.01), medial PSBs (p = 0.03) and the left forelimb (p = 0.03). Abaxial margin surface irregularity was more likely in younger horses (p = 0.02) and medial PSBs (p < 0.001). Conclusions: Results may not be representative of all racehorse populations. A substantial number of horses were lost to follow-up. The PSBs were examined in isolation. Conclusions: Increasing PSB radiodensity in racehorses was associated with the number of race starts and related training. Abaxial margin concavities and irregularities may be normal developmental features. Radiographic improvement of PSB grades is possible. Unassigned: Es gibt nur begrenzte Daten zur langfristigen Nachverfolgung radiografischer Veränderungen der proximalen Sesambeine (PSBs) bei Vollblut‐Rennpferden. Der Einfluss von Training und Rennen auf die Röntgendichte der PSBs bei lebenden Vollblütern wurde bislang nicht beschrieben. Unassigned: Beobachtung radiografischer Veränderungen der PSBs bei Rennpferden über zwei Jahre und Beschreibung von Veränderungen in der gesamten Röntgendichte. Methods: Prospektive Kohortenstudie. Methods: Vierzig Jährlinge wurden bei der ersten Untersuchung (T0) eingeschlossen. Nachuntersuchungen erfolgten viermal im Abstand von etwa sechs Monaten bei 31 (T1), 23 (T2), 13 (T3) und 8 (T4) Pferden. Radiografische und fan‐beam‐CT‐Untersuchungen beider Vorderfuß‐Fesselgelenke wurden durchgeführt. Die PSBs wurden (0–3) nach der Anzahl verbreiterter (Breite ≥2 mm) Gefäßkanäle bewertet. Vorkommen von neuer Knochenbildung am abaxialen Rand, Konkavität und Unregelmäßigkeiten wurden dokumentiert. Die mittleren Hounsfield‐Einheiten (HU) der PSBs wurden anhand multiplanarer CT‐Rekonstruktionen gemessen. Multivariable gemischte Regressionsmodelle schätzten den Einfluss von Pferdeparametern und radiografischem Erscheinungsbild auf die mittleren HU‐Werte (linear) sowie den Zusammenhang zwischen radiografischem Erscheinungsbild und Pferdeparametern (logistisch). Results: Der mittlere HU‐Wert war bei T0 am niedrigsten (1064,0 ± 65,1) und bei T3 am höchsten (1194,5 ± 78,6). Ein Anstieg des mittleren HU‐Werts war mit einer höheren Anzahl an Rennstarts (p < 0,001), einem höheren Körpergewichts‐Größen‐Verhältnis (p < 0,001) und mit medialen im Vergleich zu lateralen PSBs (p = 0,011) assoziiert. Neue Knochenbildung am abaxialen Rand war mit einem höheren Grad (p = 0,004) und lateralen PSBs (p = 0,039) verbunden. Abaxiale Randkonkavitäten traten häufiger bei jüngeren Pferden (p = 0,01), medialen PSBs (p = 0,03) und der linken Vordergliedmaße (p = 0,03) auf. Oberflächenunregelmäßigkeiten des abaxialen Randes waren wahrscheinlicher bei jüngeren Pferden (p = 0,018) und medialen PSBs (p < 0,001). WICHTIGSTE EINSCHRÄNKUNGEN: Die Ergebnisse sind möglicherweise nicht auf alle Rennpferdepopulationen übertragbar. Ein erheblicher Teil der Pferde ging im Verlauf verloren. Die PSBs wurden isoliert untersucht. Unassigned: Eine zunehmende Röntgendichte der PSBs bei Rennpferden war mit der Anzahl an Rennstarts und dem zugehörigen Training assoziiert. Konkavitäten und Unregelmäßigkeiten am abaxialen Rand könnten normale entwicklungsbedingte Merkmale sein. Eine radiografische Verbesserung der PSB‐Bewertungen ist möglich.
© 2025 The Author(s). Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
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Publication Date: 2025-08-21 PubMed ID: 40841165DOI: 10.1111/evj.70075Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

  • This study tracked changes in the bone density and X-ray appearance of the proximal sesamoid bones (PSBs) in Thoroughbred racehorses over a two-year period to understand how training and racing affect these bones.

Background and Purpose

  • The proximal sesamoid bones (PSBs) are small bones in the lower limb of racehorses that support tendons and ligaments during movement.
  • Long-term data on how PSBs change over time in response to racing and training is scarce.
  • Radiodensity — the degree to which bones appear “dense” on imaging — and radiographic changes in live racehorses had not been comprehensively studied before.
  • The study’s objective was to follow radiographic changes and measure overall radiodensity of the PSBs over two years in a group of Thoroughbred racehorses.

Study Design and Methods

  • Type: Prospective cohort study following the same group of horses over time.
  • Subjects: 40 yearling Thoroughbred racehorses at the first examination (T0).
  • Re-examinations at approximately 6-month intervals, resulting in evaluations at T1 (31 horses), T2 (23 horses), T3 (13 horses), and T4 (8 horses).
  • Examinations included:
    • Radiographs (X-rays) of both metacarpophalangeal (fetlock) joints.
    • Fan-beam computed tomography (CT) scans for detailed imaging and measurement of radiodensity.
  • PSBs were graded on a scale from 0 to 3 based on the number of enlarged vascular channels (enlarged if width ≥2 mm).
  • Additional radiographic features recorded included:
    • New bone formation on the abaxial margin (outer edge of the bone).
    • Concavity of the abaxial margin.
    • Surface irregularities of the abaxial margin.
  • Radiodensity was quantified using mean Hounsfield Unit (HU) values derived from CT scans.
  • The study used multivariable mixed-effects regression models to analyze:
    • How horse demographics and radiographic features affected mean HU values.
    • Associations between radiographic changes and horse characteristics.

Key Findings

  • Radiodensity Changes:
    • The mean HU value was lowest at the initial exam (T0): approx. 1064 HU.
    • Radiodensity increased over time, peaking around T3 (~1195 HU).
    • Greater radiodensity correlated with:
      • A higher number of race starts (statistically significant, p < 0.001).
      • A higher bodyweight-to-height ratio (an indicator of body condition) (p < 0.001).
      • Medial PSBs (the bones on the inner side) showed higher HU values than lateral PSBs (p = 0.01).
  • Radiographic Features:
    • Abaxial new bone formation was linked to:
      • Higher PSB grades (p = 0.004), meaning more vascular channel enlargement.
      • Lateral PSBs (p = 0.04), i.e., outer side bones more often showed new bone growth.
    • Abaxial margin concavity was more common:
      • In younger horses (p = 0.01).
      • In medial PSBs (p = 0.03).
      • In the left forelimb (p = 0.03).
    • Surface irregularities at the abaxial margin were more likely:
      • In younger horses (p = 0.02).
      • On medial PSBs (p < 0.001).
  • Some radiographic features that might be considered abnormal could represent normal developmental variations, especially in younger horses.
  • In some cases, the radiographic grade of PSBs improved over time, indicating potential for healing or remodeling.

Limitations

  • Results may not generalize to all racehorse populations due to sample size and cohort characteristics.
  • Significant drop-out occurred over the 2 years, reducing the number of horses examined at later time points (from 40 to 8).
  • The PSBs were examined in isolation, without correlating findings to adjacent structures or clinical outcomes.

Conclusions and Implications

  • The study provides evidence that increased training and racing activity is associated with increased bone density in the PSBs, likely reflecting bone adaptation to mechanical stress.
  • Certain radiographic features such as abaxial margin concavities and irregularities may not be pathological but normal variations related to development.
  • Radiographic improvements over time suggest that PSBs can remodel or recover, which may be important for injury monitoring and management in racehorses.
  • The long-term monitoring approach combining radiographic grading with quantitative CT measurements offers a useful method to study bone health and adaptation in equine athletes.

Cite This Article

APA
Boros K, Dyson S, Pollard D, Nagy A. (2025). A longitudinal study of radiodensity and radiographic appearance of the proximal sesamoid bones in Thoroughbred racehorses. Equine Vet J. https://doi.org/10.1111/evj.70075

Publication

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

Researcher Affiliations

Boros, Koppány
  • Department and Clinic of Equine Medicine, University of Veterinary Medicine Budapest, Üllő Dóra Major, Hungary.
Dyson, Sue
  • The Cottage, Diss, UK.
Pollard, Danica
  • The Rodhams, Wisbech, UK.
Nagy, Annamária
  • Department and Clinic of Equine Medicine, University of Veterinary Medicine Budapest, Üllő Dóra Major, Hungary.

Grant Funding

  • 2020-4.1.1-TKP2020 / National Research, Development and Innovation Fund of Hungary
  • FK 138825 / Ministry of Innovation and Technology Hungary
  • János Bolyai Research Scholarship, Hungarian Academy of Science

References

This article includes 51 references
  1. Kane AJ, Park RD, McIlwraith CW, Rantanen NW, Morehead JP, Bramlage LR. Radiographic changes in Thoroughbred yearlings. Part 1: prevalence at the time of the yearling sales.. Equine Vet J 2003;35(4):354–365.
    doi: 10.2746/042516403776014280google scholar: lookup
  2. Gibson KT, Steel CM. Conditions of the suspensory ligament causing lameness in horses.. Equine Vet Educ 2002;14:39–50.
    doi: 10.1111/j.2042-3292.2002.tb00137.xgoogle scholar: lookup
  3. Bukowiecki CF, Bramlage LR, Gabel AA. In vitro strength of the suspensory apparatus in training and resting horses.. Vet Surg 1987;16(2):126–130.
    doi: 10.1111/j.1532-950x.1987.tb00923.xgoogle scholar: lookup
  4. Vanderperren K, Saunders JH. Diagnostic imaging of the equine fetlock region using radiography and ultrasonography. Part 1: soft tissues.. Vet J 2009;181:111–122.
    doi: 10.1016/j.tvjl.2008.03.005google scholar: lookup
  5. McLellan J, Plevin S. Do radiographic signs of sesamoiditis in yearling Thoroughbreds predispose the development of suspensory ligament branch injury?. Equine Vet J 2014;46:446–450.
    doi: 10.1111/evj.12154google scholar: lookup
  6. Plevin S, McLellan J. The effect of insertional suspensory branch desmitis on racing performance in juvenile Thoroughbred racehorses.. Equine Vet J 2014;46:451–457.
    doi: 10.1111/evj.12161google scholar: lookup
  7. Plevin S, McLellan J, O'Keeffe T. Association between sesamoiditis, subclinical ultrasonographic suspensory ligament branch change and subsequent clinical injury in yearling Thoroughbreds.. Equine Vet J 2015;48(5):543–547.
    doi: 10.1111/evj.12497google scholar: lookup
  8. Peat FJ, Kawcak CE, McIlwraith CW, Berk JT, Keenan DP. Concurrent radiological and ultrasonographical findings in the forelimb proximal sesamoid bones and adjacent suspensory ligament branches in yearling and 2‐year‐old Thoroughbred sales horses.. Equine Vet J 2025;57(3):654–665.
    doi: 10.1111/evj.14120google scholar: lookup
  9. Spike‐Pierce DL, Bramlage LR. Correlation of racing performance with radiographic changes in the proximal sesamoid bones of 487 Thoroughbred yearlings.. Equine Vet J 2003;35(4):350–353.
    doi: 10.2746/042516403776014262google scholar: lookup
  10. Peat FJ, Kawcak CE, McIlwraith CW, Keenan DP, Berk JT, Mork DS. Radiological findings in the proximal sesamoid bones of yearling and 2‐year‐old Thoroughbred sales horses: prevalence, progression and associations with racing performance.. Equine Vet J 2025;57(1):87–100.
    doi: 10.1111/evj.14051google scholar: lookup
  11. Poulos PW. Radiographic and histologic assessment of proximal sesamoid bones changes in young and working horses.. InProceedings of the 34th Annual Convention of the American Association of Equine Practitioners. San Diego, CA: Lexington (KY): American Association of Equine Practicioners; 1988. p. 347–358.
  12. Kane AJ, McIlwraith CW, Park RD, Rantanen NW, Morehead JP, Bramlage LR. Radiographic changes in Thoroughbred yearlings. Part 2: associations with racing performance.. Equine Vet J 2003;35(4):366–374.
    doi: 10.2746/042516403776014307google scholar: lookup
  13. Boros K, Dyson S, Kovács Á, Lang Z, Nagy A. Computed tomographic evaluation of the sagittal ridge of the third metacarpal bone in young Thoroughbred racehorses: a longitudinal study.. Animals 2024;14(5):812.
    doi: 10.3390/ani14050812google scholar: lookup
  14. Ciamillo SA, Wulster KB, Gassert TM, Richardson DW, Brown KA, Stefanovski D. Prospective, longitudinal assessment of subchondral bone morphology and pathology using standing, cone‐beam computed tomography in fetlock joints of 2‐year‐old Thoroughbred racehorses in their first year of training.. Equine Vet J 2025;57(1):126–139.
    doi: 10.1111/evj.14048google scholar: lookup
  15. Ciamillo SA, Bills KW, Gassert TM, Richardson DW, Brown KA, Stefanovski D. Effect of high‐speed exercise on subchondral bone in the metacarpo−/metatarsophalangeal joints of 2‐year‐old Thoroughbred racehorses in their first year of training.. Equine Vet J 2025.
    doi: 10.1111/evj.14524google scholar: lookup
  16. Young DR, Nunamaker DM, Markel MD. Quantitative evaluation of the remodeling response of the proximal sesamoid bones to training‐related stimuli in Thoroughbreds. Am J Vet Res 1991;52(8):1350–1356.
  17. Shaffer SK, To C, Garcia TC, Fyhrie D, Uzal FA, Stover SM. Subchondral focal osteopenia associated with proximal sesamoid bone fracture in Thoroughbred racehorses. Equine Vet J 2021;53:294–305.
    doi: 10.1111/evj.13291google scholar: lookup
  18. Noordwijk KJ, Chen L, Ruspi BD, Schurer S, Papa B, Fasanello DC. Metacarpophalangeal joint pathology and bone mineral density increase with exercise but not with incidence of proximal sesamoid bone fracture in Thoroughbred racehorses. Animals 2023;13:827.
    doi: 10.3390/ani13050827google scholar: lookup
  19. Ayodele BA, Hitchens PL, Wong ASM, Mackie EJ, Whitton RC. Microstructural properties of the proximal sesamoid bones of Thoroughbred racehorses in training. Equine Vet J 2021;53:1169–1177.
    doi: 10.1111/evj.13394google scholar: lookup
  20. Beck C, Hitchens PL, Whitton RC. Post‐mortem computed tomography features associated with fracture of the fetlock joint in racing Thoroughbreds. Equine Vet J 2025.
    doi: 10.1111/evj.14465google scholar: lookup
  21. Nagy A, Boros K, Dyson S. Magnetic resonance imaging, computed tomographic and radiographic findings in the metacarpophalangeal joints of 40 non‐lame Thoroughbred yearlings. Animals 2023;13(22):3466.
    doi: 10.3390/ani13223466google scholar: lookup
  22. Papanikolaou N, Battista JJ, Boyer AL, Kappas C, Klein E, Mackie TR. Tissue inhomogeneity corrections for megavoltage photon beams. 2004; AAPM Report No 85; Task Group No. 85; Task Group No. 65.
    doi: 10.37206/86google scholar: lookup
  23. Fedorov A, Beichel R, Kalpathy‐Cramer J, Finet J, Fillion‐Robin JC, Pujol S. 3D slicer as an image computing platform for the quantitative imaging network. Magn Reson Imaging 2012;30(9):1323–1341.
    doi: 10.1016/j.mri.2012.05.001google scholar: lookup
  24. Greenway K, Luijkx T, Knipe H, Weerakkody Y, Banerjee AK, Sharma R. Hounsfield Unit. Reference article; Radiopaedia.org .
    doi: 10.53347/rid-38181google scholar: lookup
  25. Bates D, Mächler M, Bolker B, Walker S. Fitting linear mixed‐effects models using lme4. J Stat Soft 2015;67(1):1–48.
    doi: 10.18637/jss.v067.i01google scholar: lookup
  26. Kuznetsova A, Brockhoff PB, Christensen RHB. lmerTest package: tests in linear mixed effects models. J Stat Softw 2017;82(13):1–26.
    doi: 10.18637/jss.v082.i13google scholar: lookup
  27. Crookshank MC, McErlain DD, Ransegnola BP, Boyd SK, Holdsworth DW. Repeatable calibration of Hounsfield units to mineral density and effect of scanning medium. Med Eng Phys 2013;35(8):1123–1130.
    doi: 10.1016/j.medengphy.2012.10.014google scholar: lookup
  28. Firth EC. The response of bone, articular cartilage and tendon to exercise in the horse. J Anat 2006;208(4):513–526.
    doi: 10.1111/j.1469-7580.2006.00547.xgoogle scholar: lookup
  29. Martig S, Hitchens PL, Lee PVS, Whitton RC. The relationship between microstructure, stiffness and compressive fatigue life of equine subchondral bone. J Mech Behav Biomed Mater 2020;101:103439.
    doi: 10.1016/j.jmbbm.2019.103439google scholar: lookup
  30. Anthenill LA, Gardner IA, Pool RR, Garcia TC, Stover SM. Comparison of macrostructural and microstructural bone features in Thoroughbred racehorses with and without midbody fracture of the proximal sesamoid bone. Am J Vet Res 2010;71(7):755–765.
    doi: 10.2460/ajvr.71.7.755google scholar: lookup
  31. Whitton RC, Trope GD, Ghasem‐Zadeh A, Anderson GA, Parkin TD, Mackie EJ. Third metacarpal condylar fatigue fractures in equine athletes occur within previously modelled subchondral bone. Bone 2010;47(4):826–831.
    doi: 10.1016/j.bone.2010.07.019google scholar: lookup
  32. Shaffer SK, Garcia TC, Stover SM, Fyhrie DP. Exercise history predicts focal differences in bone volume fraction, mineral density and microdamage in the proximal sesamoid bones of Thoroughbred racehorses. J Orthop Res 2022;40(12):2831–2842.
    doi: 10.1002/jor.25312google scholar: lookup
  33. Shaffer SK, Stover SM, Fyhrie DP. Training drives turnover rates in racehorse proximal sesamoid bones. Sci Rep 2023;13:205.
    doi: 10.1038/s41598-022-26027-ygoogle scholar: lookup
  34. Beccati F, Gialletti R, Giontella A, Davanzo S, Di Meo A, Pepe M. Morphologic radiographic study of the proximal sesamoid bones of the forelimb in Thoroughbred racehorses in training. Anat Histol Embryol 2014;43:403–407.
    doi: 10.1111/ahe.12075google scholar: lookup
  35. Shaffer SK, Shelly K, Garcia TC, Samol MA, Hill AE, Fyhrie DP. In vitro motions of the medial and lateral proximal sesamoid bones under mid‐stance load conditions are consistent with racehorse fracture configurations. J Biomech 2022;130:110888.
    doi: 10.1016/j.jbiomech.2021.110888google scholar: lookup
  36. Harrison SM, Whitton RC, Kawcak CE, Stover SM, Pandy MG. Evaluation of a subject‐specific finite‐element model of the equine metacarpophalangeal joint under physiological load. J Biomech 2014;47(1):65–73.
    doi: 10.1016/j.jbiomech.2013.10.001google scholar: lookup
  37. Leach DH, Sprigings E. Gait fatigue in the racing Thoroughbred [Horses, factors for certain injuries]. J Equine Med Surg 1979;3:436–443.
  38. Nunamaker DM, Butterweck DM, Provost MT. Some geometric properties of the third metacarpal bone: a comparison between the Thoroughbred and standardbred racehorse. J Biomech 1989;22(2):129–134.
    doi: 10.1016/0021-9290(89)90035-3google scholar: lookup
  39. Nunamaker DM, Butterweck DM, Provost MT. Fatigue fractures in Thoroughbred racehorses: relationships with age, peak bone strain, and training. J Orthop Res 1990;8(4):604–611.
    doi: 10.1002/jor.1100080417google scholar: lookup
  40. Davies HM, McCarthy RN, Jeffcott LB. Surface strain on the dorsal metacarpus of Thoroughbreds at different speeds and gaits. Acta Anat 1993;146(2–3):148–153.
    doi: 10.1159/000147437google scholar: lookup
  41. Butcher MT, Ashley‐Ross MA. Fetlock joint kinematics differ with age in Thoroughbred [was Thoroughbred] racehorses. J Biomech 2002;35(5):563–571.
    doi: 10.1016/s0021-9290(01)00223-8google scholar: lookup
  42. Fraser JA. Some conditions of the proximal sesamoid bones in the horse. Equine Vet J 1971;3(1):20–24.
    doi: 10.1111/j.2042-3306.1971.tb04434.xgoogle scholar: lookup
  43. Okudaira M, Cresswell EN, Wollman CW, McDonough SP, Engiles JB, Reesink HL. Mineralization of equine proximal sesamoid bones precedes articular cartilage and fibrocartilaginous enthesis maturation in early postgestational development. Am J Vet Res 2024;85(10):ajvr.24.04.0101.
    doi: 10.2460/ajvr.24.04.0101google scholar: lookup
  44. Lloyd KA, Ayodele BA, Hitchens PL, Beck C, Mackie EJ, Whitton RC. Associations between the radiographic appearance of vascular channels in proximal sesamoid bones, their microstructural characteristics and past racing performance in Thoroughbreds. Equine Vet J 2020;52:670–677.
    doi: 10.1111/evj.13239google scholar: lookup
  45. Cornelissen BPM, Burma P, Rijkenhuizen ABM, Barneveld A. Innervation of the equine mature and immature proximal sesamoid bone by calcitonin gene‐related peptide and substance P‐containing nerve fibers. Am J Vet Res 1998;59:1378.
  46. Ross MW. Observations in horses with lameness abolished by palmar digital analgesia. Proc Am Assoc Equine Pract 1998;44:230.
  47. Schumacher J, Livesey L, DeGraves FJ, Schumacher J, Schramme MC, Hathcock J. Effect of anaesthesia of the palmar digital nerves on proximal interphalangeal joint pain in the horse. Equine Vet J 2004;36(5):409–414.
    doi: 10.2746/0425164044868404google scholar: lookup
  48. Nagy A, Bodo G, Dyson S, Szabo F, Barr ARS. Diffusion of contrast medium after perineural injection of the palmar nerves: an in vivo and in vitro study. Equine Vet J 2009;41:379–383.
    doi: 10.2746/042516409x372502google scholar: lookup
  49. Nagy A, Dyson SJ. Combined standing low‐field magnetic resonance imaging and fan‐beam computed tomographic diagnosis of fetlock region pain in 27 sports horses. Equine Vet J 2025;57(5):1313–1327.
    doi: 10.1111/evj.14504google scholar: lookup
  50. Rao T. Understanding survivorship bias: implications for research and decision‐making. J Emerg Technol Innov Res 2024;11(6):604–612.
    doi: 10.1729/journal.39901google scholar: lookup
  51. Heederik D. Micro‐epidemiology of the healthy worker effect?. Occup Environ Med 2006;63(2):83.
    doi: 10.1136/oem.2005.024307google scholar: lookup

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