FREE SHIPPING over $40
OVER 10000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Equine veterinary journal2024; doi: 10.1111/evj.14131

Comparison of radiography and computed tomography for identification of third metacarpal structural change and associated assessment of condylar stress fracture risk in Thoroughbred racehorses.

Abstract: Catastrophic injury has a low incidence but leads to the death of many Thoroughbred racehorses. Objective: To determine sensitivity, specificity, and reliability for third metacarpal condylar stress fracture risk assessment from digital radiographs (DR) and standing computed tomography (sCT). Methods: Controlled ex vivo experiment. Methods: A blinded set of metacarpophalangeal joint DR and sCT images were prepared from 31 Thoroughbreds. Four observers evaluated the condyles and parasagittal grooves (PSG) of the third metacarpal bone for the extent of dense bone and lucency/fissure and assigned a risk assessment grade for condylar stress fracture based on imaging features. Sensitivity and specificity for detection of subchondral structural changes in the condyles and PSG, and for risk assessment for condylar stress fracture were determined by comparison with a reference assessment based on sCT and joint surface examination. Agreement between observers and the reference assessment and reliability between observers were determined. Intra-observer repeatability was also assessed. Results: Sensitivity for detection of structural change was lower than specificity for both imaging methods and all observers. For agreement with the reference assessment of structural change, correlation coefficients were generally below 0.5 for DR and 0.49-0.82 for sCT. For horses categorised as normal risk on reference assessment, observer assessment often agreed with the reference. Sensitivity for risk assessment was lower than specificity for all observers. For horses with a reference assessment of high risk of injury, observers generally underestimated risk. Diagnostic sensitivity of risk assessment was improved with sCT imaging, particularly for horses categorised as having elevated risk of injury from the reference assessment. Assessment repeatability and reliability was better with sCT than DR. Conclusions: The ex vivo study design influenced DR image sets. Conclusions: Risk assessment through screening with diagnostic imaging is a promising approach to improve injury prevention in racing Thoroughbreds. Knowledge of sensitivity and specificity of fetlock lesion detection provides the critical guidance needed to improve racehorse screening programs. We found improved detection of MC3 subchondral structural change and risk assessment for condylar stress fracture with sCT ex vivo.
© 2024 The Author(s). Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
Get Full Text
Publication Date: 2024-08-14 PubMed ID: 39143731DOI: 10.1111/evj.14131Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • Journal Article

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.

The research investigates the effectiveness of digital radiographs (DR) and standing computed tomography (sCT) in assessing the risk of third metacarpal condylar stress fractures in Thoroughbred racehorses, finding that sCT offers improved sensitivity and reliability in detecting structural changes and assessing fracture risks.

Methodology

  • The study used a controlled ex vivo experiment, conducted with a blinded set of metacarpophalangeal joint DR and sCT images from 31 Thoroughbreds.
  • Four observers were responsible for evaluating the condyles and parasagittal grooves (PSG) of the third metacarpal bone for dense bone and lucency/fissure, and they also assigned a risk assessment grade for condylar stress fracture based on imaging features.
  • The sensitivity and specificity for detecting subchondral structural changes and for determining the risk assessment for condylar stress fractures were determined by comparing with a reference assessment based on sCT and joint surface examination.
  • Agreement between observer and reference assessments and reliability between observers were measured, and intra-observer repeatability was also tested.

Results

  • The sensitivity for detecting structural changes was found to be lower than the specificity for both imaging methods and all observers.
  • Agreement with the reference assessment saw correlation coefficients generally below 0.5 for DR, and between 0.49-0.82 for sCT.
  • Observers often agreed with the reference assessment for horses classified as normal risk, but generally underestimated risk for horses assessed as high injury risk through reference.
  • Assessment of risk was improved with sCT imaging, particularly for horses classified as having an elevated injury risk from the reference assessment.
  • sCT also demonstrated better assessment repeatability and reliability than DR.

Conclusion

  • The study concluded that sCT imaging offers advantages over DR in assessing the risk of third metacarpal condylar stress fractures in Thoroughbred racehorses, with higher sensitivity, reliability, and repeatability.
  • The researchers also found that diagnostic imaging is a promising approach to improving injury prevention in racing Thoroughbreds, by enabling better screening and risk assessment*
  • The study affirms the importance of understanding the sensitivity and specificity of lesion detection in improving racehorse screening programs.

Cite This Article

APA
Irandoust S, O'Neil LM, Stevenson CM, Franseen FM, Ramzan PHL, Powell SE, Brounts SH, Loeber SJ, Ergun DL, Whitton RC, Henak CR, Muir P. (2024). Comparison of radiography and computed tomography for identification of third metacarpal structural change and associated assessment of condylar stress fracture risk in Thoroughbred racehorses. Equine Vet J. https://doi.org/10.1111/evj.14131

Publication

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

Researcher Affiliations

Irandoust, Soroush
  • Department of Surgical Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA.
  • Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA.
O'Neil, Linnea M
  • Department of Surgical Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Stevenson, Christina M
  • Department of Surgical Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Franseen, Faith M
  • Department of Surgical Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Ramzan, Pieter H L
  • Rossdales Veterinary Surgeons, Newmarket, UK.
Powell, Sarah E
  • VetCT, Cambridge, UK.
Brounts, Sabrina H
  • Department of Surgical Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Loeber, Samantha J
  • Department of Surgical Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Ergun, David L
  • Asto CT, 7921 UW Health Ct., Middleton, Wisconsin, USA.
Whitton, R Chris
  • Department of Veterinary Clinical Sciences, Melbourne Veterinary School, Faculty of Science, University of Melbourne, Werribee, Victoria, Australia.
Henak, Corinne R
  • Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA.
  • Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA.
  • Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Muir, Peter
  • Department of Surgical Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA.

Grant Funding

  • Grayson-Jockey Club Research Foundation

References

This article includes 43 references
  1. Estberg L, Stover SM, Gardner IA, Johnson BJ, Jack RA, Case JT. Relationship between race start characteristics and risk of catastrophic injury in Thoroughbreds: 78 cases (1992).. J Am Vet Med Assoc 1998;212:544–549.
  2. Hitchens PL, Morrice‐West AV, Stevenson MA, Whitton RC. Meta‐analysis of risk factors for racehorse catastrophic musculoskeletal injury in flat racing.. Vet J 2019;245:29–40.
  3. Johnson BJ, Stover SM, Daft BM, Kinde H, Read DH, Barr BC. Causes of death in racehorses over a 2 year period.. Equine Vet J 1994;26:327–330.
  4. Zekas LJ, Bramlage LR, Embertson RM, Hance SR. Characterisation of the type and location of fractures of the third metacarpal/metatarsal condyles in 135 horses in central Kentucky (1986‐1994).. Equine Vet J 1999;31:304–308.
  5. Muir P, McCarthy J, Radtke CL, Markel MD, Santschi EM, Scollay MC. Role of endochondral ossification of articular cartilage and functional adaptation of the subchondral plate in the development of fatigue microcracking of joints.. Bone 2006;38:342–349.
  6. Ramzan PHL, Palmer L, Powell SE. Unicortical condylar fracture of the Thoroughbred fetlock: 45 cases (2006‐2013).. Equine Vet J 2015;47:680–683.
  7. Stewart BD, Lam KH. Racing injury risk assessment at official pre‐race veterinary inspections in Hong Kong Jockey Club.. Proceedings of the 18th international conference of racing analysts and veterinarians New Zealand; 2010:296–297.
  8. Jacklin BD, Wright IM. Frequency distribution of 174 fractures of the distal condyles of the third metacarpal and metatarsal bones in 167 Thoroughbred racehorses (1999‐2009).. Equine Vet J 2012;44:707–713.
  9. Moulin N, Francois I, Cote N, Alford C, Clearly O, Desjardins MR. Surgical repair of propagating condylar fractures of the third metacarpal/metatarsal bones with cortical screws placed in lag fashion in 26 racehorses (2007–2015).. Equine Vet J 2018;50:629–635.
  10. Colgate VA, Carpenter R, Kawcak C, Muir P, Palmer S, Parkin T. Risk assessment for reducing injuries of the fetlock bones in Thoroughbred racehorses.. Equine Vet J 2020;52:482–488.
  11. Wong ASM, Morrice‐West AV, Whitton RC, Hitchens PL. Changes in Thoroughbred speed and stride characteristics over successive race starts and their association with musculoskeletal injury.. Equine Vet J 2023;55:194–204.
  12. 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;47:65–73.
  13. Riggs CM, Whitehouse GH, Boyde A. Structural variation of the distal condyles of the third metacarpal bone and third metatarsal bone in the horse.. Equine Vet J 1999;31:130–139.
  14. Boyde A, Firth EC. Musculoskeletal responses of 2‐year‐old Thoroughbred horses to early training. 8. Quantitative back‐scattered electron scanning electron microscopy and confocal fluorescence microscopy of the epiphysis of the third metacarpal bone.. N Z Vet J 2005;53:123–132.
  15. Boyde A, Firth EC. High resolution microscopic survey of third metacarpal articular calcified cartilage and subchondral bone in the juvenile horse: possible implications in chondro‐osseous disease.. Microsc Res Tech 2008;71:477–488.
  16. Boyde A, Haroon Y, Jones SJ, Riggs CM. Three‐dimensional structure of the distal condyles of the third metacarpal bone of the horse.. Equine Vet J 1999;31:122–129.
  17. Currey JD. How well are bones designed to resist fracture?. J Bone Miner Res 2003;18:591–598.
  18. Muir P, Peterson AL, Sample SJ, Scollay MC, Markel MD, Kalscheur VL. Exercise‐induced metacarpophalangeal joint adaptation in the Thoroughbred racehorse.. J Anat 2008;213:706–717.
  19. Firth EC, Doube M, Boyde A. Changes in mineralised tissue at the site of origin of condylar fracture are present before athletic training in Thoroughbred horses.. N Z Vet J 2009;57:278–283.
  20. Whitton RC, Trope GD, Ghasem‐Zadeh A, Anderson GA, Parkin TDH, Mackie EJ. Third metacarpal condylar fatigue fractures in equine athletes occur within previously modelled subchondral bone.. Bone 2010;47:826–831.
  21. Davis AM, Fan X, Shen L, Robinson P, Riggs CM. Improved radiological diagnosis of palmar osteochondral disease in the Thoroughbred racehorse.. Equine Vet J 2017;49:454–460.
  22. Cianci JM, Wulster KB, Richardson DW, Stefanovski D, Ortved KF. Computed tomographic assessment of fracture characteristics and subchondral bone injury in Thoroughbred racehorses with lateral condylar fractures and their relationship to outcome.. Vet Surg 2022;51:426–437.
  23. Cresswell EN, Ruspi BD, Wollman CW, Peal BT, Deng S, Toler AB. Determination of correlation of proximal sesamoid bone osteoarthritis with high‐speed furlong exercise and catastrophic sesamoid bone fracture in Thoroughbred racehorses.. Am J Vet Res 2021;82:467–477.
  24. Barr ED, Pinchbeck GL, Clegg PD, Boyde A, Riggs CM. Post‐mortem evaluation of palmar osteochondral disease (traumatic osteochondrosis) of the metacarpo/metatarsophalangeal joint in Thoroughbred racehorses.. Equine Vet J 2009;41:366–371.
  25. Morgan JW, Santschi EM, Zekas LJ, Scollay‐Ward MC, Markel MD, Radtke CL. Comparison of radiography and computed tomography to evaluate metacarpo/metatarsophalangeal joint pathology of paired limbs of Thoroughbred racehorses with severe condylar fracture.. Vet Surg 2006;35:611–617.
  26. Brounts SH, Lund JR, Whitton RC, Ergun DL, Muir P. Use of a novel helical fan beam imaging system for computed tomography of the distal limb in sedated standing horses: 167 cases (2019‐2020).. J Am Vet Med Assoc 2022;260:1351–1360.
  27. Trope GD, Ghasem‐Zadeh A, Anderson GA, Mackie EJ, Whitton RC. Can high‐resolution peripheral quantitative computed tomography imaging of subchondral and cortical bone predict condylar fracture in Thoroughbred racehorses?. Equine Vet J 2015;47:428–432.
  28. Peloso JG, Cohen ND, Vogler JB, Marquis PA, Hilt L. Association of catastrophic condylar fracture with bony changes of the third metacarpal bone identified by use of standing magnetic resonance imaging in forelimbs from cadavers of Thoroughbred racehorses in the United States.. Am J Vet Res 2019;80:178–188.
  29. Dubois M‐S, Morello S, Rayment K, Markel MD, Vanderby R Jr, Kalscheur VL. Computed tomographic imaging of subchondral fatigue cracks in the distal end of the third metacarpal bone in the Thoroughbred racehorse can predict crack micromotion in an ex‐vivo model.. PLoS One 2014;9:e101230.
  30. Irandoust S, Whitton RC, Muir P, Henak CR. Subchondral bone fatigue injury in the parasagittal condylar grooves of the distal end of the third metacarpal bone in Thoroughbred racehorses elevates site‐specific strain concentration.. J Mech Behav Biomed Mater 2024;155:106561.
    doi: 10.1016/j.jmbbm.2024.106561google scholar: lookup
  31. Ramzan PHL. The BEVA Field Guide to the flexed dorsopalmar radiographic projection of the fetlock. 2019.
  32. Ramzan PHL. Letter to the editor: validation of standing cone beam computed tomography for diagnosing subchondral fetlock pathology in the Thoroughbred racehorse.. Equine Vet J 2021;53:628–629.
  33. Johnston GCA, Ahern BJ, Palmieri C, Young AC. Imaging and gross pathological appearance of changes in the parasagittal grooves of Thoroughbred racehorses.. Animals 2021;11:3366.
  34. Whitton RC, Ayodele BA, Hitchens PL, Mackie EJ. Subchondral bone microdamage accumulation in distal metacarpus in Thoroughbred racehorses.. Equine Vet J 2018;50:766–773.
  35. Holmes JM, Mirams M, Mackie RC, Whitton RC. Thoroughbred horses in race training have lower levels of subchondral bone remodeling in highly loaded regions of the distal metacarpus compared to horses resting from training.. Vet J 2014;202:443–447.
  36. Hornof WJ, O'Brien TR, Pool RR. Osteochondritis dissecans of the distal metacarpus in the adult racing Thoroughbred horse.. Vet Radiol 1981;22:98–106.
  37. Pool RR. Pathologic manifestations of joint disease in the athletic horse.. Joint disease in the horse Philadelphia: W.B. Saunders; 1996. p. 87–104.
  38. Radtke CL, Danova NA, Scollay MC, Santschi EM, Markel MD, Da Costa Gómez T. Macroscopic changes in the distal ends of the third metacarpal and metatarsal bones of Thoroughbred racehorses with condylar fractures.. Am J Vet Res 2003;64:1110–1116.
  39. Arash Salarian. Intraclass Correlation Coefficient (ICC), MATLAB central file exchange.. 2023.
  40. Tranquille CA, Murray RA, Parkin TDH. Can we use subchondral bone thickness on high‐field magnetic resonance images to identify Thoroughbred racehorses at risk of catastrophic lateral condylar fracture?. Equine Vet J 2017;49:167–171.
  41. Malekipour F, Hitchens PL, Whitton RC, Lee PV‐S. Effects of in vivo fatigue‐induced subchondral bone microdamage on the mechanical response of cartilage‐bone under a single impact compression.. J Biomech 2020;100:109594.
  42. Irandoust S, Henak CR, Muir P. Sensitivity of subchondral bone strain to softening in osteolytic and sclerotic regions: a finite element study of a Thoroughbred racehorse with extensive adaptive structural change and fatigue damage.. Orthopaedic Research Society Annual Meeting 2024.
  43. Pauwels FE, Van der Vekens E, Christan Y, Koch C, Schweizer D. Feasibility, indications, and radiographically confirmed diagnoses of standing extremity cone beam computed tomography in the horse.. Vet Surg 2021;50:365–374.

Citations

This article has been cited 2 times.
  1. Irandoust S, Whitton C, Henak C, Muir P. Tuning and validation of a virtual mechanical testing pipeline for condylar stress fracture risk assessment in Thoroughbred racehorses. R Soc Open Sci 2025 May;12(5):241935.
    doi: 10.1098/rsos.241935pubmed: 40370600google scholar: lookup
  2. Morrice-West AV, Thomas M, Wong ASM, Flash M, Whitton RC, Hitchens PL. Linkage of jockey falls and injuries with racehorse injuries and fatalities in Thoroughbred flat racing in Victoria, Australia. Front Vet Sci 2024;11:1481016.
    doi: 10.3389/fvets.2024.1481016pubmed: 40018508google scholar: lookup
Subscribe to our newsletter
Join 99,727 horse owners like you who receive our email updates on horse health and nutrition.