Plate fixation of small metacarpal and metatarsal bone fractures in 27 horses.

Overview

• This study examined the use of plate fixation (PF) to treat small metacarpal and metatarsal bone fractures in horses, analyzing surgical methods, complications, and how well horses returned to their prior levels of work or racing.
• The research found that most horses successfully returned to their previous activity levels after surgery, despite a notable rate of postoperative complications, with outcomes better than those reported in earlier studies.

Study Objective and Design

• The primary goal was to evaluate the effectiveness of plate fixation as a treatment method for small metacarpal and metatarsal (SMCT) fractures in horses.
• The study aimed to describe surgical techniques used, assess the frequency and nature of postoperative complications, and determine factors influencing successful return to intended use (work or racing).
• A retrospective multicenter approach was utilized, reviewing veterinary cases from three hospitals spanning 2008 to 2023.
• Data sources included medical records, imaging studies, follow-up hospital visits, telephone interviews with horse owners/trainers, and race records to assess long-term outcomes.

Patient Population and Fracture Characteristics

• Total of 27 horses treated with plate fixation for SMCT fractures were included.
• All fractures were located in the proximal segment of the small metacarpal or metatarsal bones.
• Fracture-specific details:
  • 74.1% (20/27) were articular fractures, meaning they involved the joint surface.
  • 96.3% (22/27) were comminuted fractures, indicating the bone was broken into multiple pieces.
  • 81.5% (24/27) were displaced fractures, meaning the broken bone ends were misaligned.

Surgical Technique and Follow-up

• Plate fixation involved surgical stabilization of the fractured bone segments using metal plates designed for small fractures.
• The surgical method was tailored for the proximal SMCT fractures considering their location and complexity.
• Long-term follow-up was conducted through:
  • Monitoring hospital readmissions for complications or re-evaluation.
  • Telephone interviews with caretakers to assess recovery and use.
  • Reviewing official race records to determine if racehorses returned to competitive work.

Outcomes and Complications

• Return to previous work level:
  • Out of 25 horses with follow-up data, 19 (76%) successfully returned to their prior level of work or activity.
• Postoperative complications:
  • Complications occurred in 9 out of 27 cases (approximately 33.3%).
  • Details of specific complications were not provided, but this rate indicates that such issues are relatively common after PF in these fractures.
• Effect on racing performance:
  • For racehorses, earnings per start post-surgery were statistically significantly lower than preoperative earnings (p = .02), indicating some reduction in economic performance after surgery.

Statistical Analysis and Factors Affecting Outcome

• Univariable and multivariable regression models were used to explore factors that might predict return to intended use.
• No individual explanatory variable (such as fracture type, displacement, or comminution) was found to be significantly associated with successful return to use.
• This suggests that return to work is likely influenced by multiple factors or that the sample size limited detection of significant predictors.

Conclusions and Significance

• Plate fixation for proximal SMCT fractures is a viable and effective surgical option in horses, providing a high rate of return to prior work activity.
• The study’s outcomes demonstrate improved success compared to earlier case series, indicating advancements in surgical technique or case selection.
• Despite the relatively high frequency of postoperative complications, the majority of horses recovered functionally.
• The lack of clear predictive factors for return to work highlights the complexity of fracture healing and recovery in equine patients and suggests further research is needed.
• Overall, PF should be considered a strong treatment choice for complex small metacarpal/metatarsal fractures in horses, especially for those intended to return to athletic use.