Management and outcome of fractures of the distal phalanx: a retrospective study of 285 horses with a long term outcome in 223 cases.

The research discusses the management and outcomes of fractures in the distal phalanx, the bone in the tip of a horse’s foot. The study shows that horses with a non-articular type I fracture had better prognosis compared to other types of fractures, and that a conservative treatment approach and focusing on clinical findings rather than radiological ones yield better results.

Methodology

• The researchers conducted a multicentre retrospective study involving 285 horse cases with distal phalangeal fractures.
• They analysed the outcomes of different treatment methods and correlated it with various fracture types, locations (hindlimb or forelimb), horse age, time to start treatment, etc.
• The follow-up results were available for 223 of the cases, which allowed the researchers to review the long-term effectiveness of the treatment methods used.

Key Findings

• Horses with a non-articular type I fracture had a better prognosis for returning to their original level of performance or expected level of use than those with an articular type II or III fracture.
• The prognosis for types IV and V fractures was deemed fair while it was good for type VI fractures.
• Horses with a hindlimb fracture had a significantly better chance of a successful outcome than those with forelimb fractures.
• There was no significant correlation observed between the age of the horse or the time to initiate treatment and the success rate of the treatment.

Best Treatment Options and Observations

• For types I-III fractures, the best treatment option was a conservative approach which involved rest (box rest).
• Type IV fractures were best treated by arthroscopic removal of the fracture fragment.
• Hoof immobilisation did not seem to influence the overall outcome.
• Radiological findings and clinical healing were found to be not accurately correlated. The study suggests that the decision to recommence training should be based on clinical findings rather than radiological ones.
• The research also pointed out that complete osseous union, or bone healing, of the fracture was not essential for a successful return to athletic activity.