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Home / Equine Research Bank / Equine Vet J / Scoping review of comminuted fractures of the proximal phala...
Equine veterinary journal2025; doi: 10.1111/evj.70077

Scoping review of comminuted fractures of the proximal phalanx in horses.

Abstract: Comminuted fractures of the proximal phalanx (CFPP) occur in adult horses. Various treatments have been described. It remains uncertain which is the best therapeutic option. Objective: This study aims to review systematically the existing literature on CFPP in horses, evaluate treatment modalities, synthesise outcomes to assess treatment efficacy and survival rates, and identify knowledge gaps for future research. Methods: Scoping review. Methods: A literature search was conducted using online databases. The bias quality of each article was evaluated. Chi-squared analysis was used to detect differences between types of CFPP in each paper (based on the presence [moderately comminuted, MCFPP] or absence [severely comminuted, SCFPP] of an intact cortical strut between both adjacent joints). Results: Thirty-nine papers met the criteria for inclusion in this review. In total, 409 cases were identified. The survival rate (SR) was 77% for MCFPP and 51% for SCFPP with a significant difference between fracture types (odds ratios [OR]: 3.16; 95% confidence interval [CI]:1.64-6.24; p < 0.001). For MCFPP, the SR was 85% following lag screw fixation (SF). SF yielded significantly better outcomes compared to SF with transfixation cast (TFC) (SF vs. SF + TFC: p = 0.02). Cast immobilisation (CI) alone was associated with a SR of 50% (1/2) and 85% (11/13) for MCFPP and SCFPP, respectively. For SCFPP fractures, treatment with Ci showed significantly superior results compared to SF and TFC (CI vs. SF + TFC: OR: 6.65; 95% CI: 1.11-73.96; p = 0.04) and plate fixation with arthrodesis of two joints (PF2) (CI vs. PL2: OR: 9.60; 95% CI: 1.54-110.23; p = 0.006). Conclusions: All reviewed studies were retrospective. Fracture definitions, data collection periods, follow-up time and methods varied between studies. Conclusions: This study showed that SRs between 35% and 85% may be expected for CFPP. In MCFPP, SF appears to be a good treatment option. The merits of cast immobilisation alone should be discussed with owners if surgery is not an option in MCFPP or SCFPP.
© 2025 The Author(s). Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
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Publication Date: 2025-08-29 PubMed ID: 40883227DOI: 10.1111/evj.70077Google Scholar: Lookup
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Summary

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Overview

  • This study systematically reviews available research on comminuted fractures of the proximal phalanx (CFPP) in horses.
  • It evaluates different treatment methods, compares outcomes and survival rates, and identifies areas needing further research.

Background

  • Comminuted fractures involve a bone breaking into several pieces; in this case, the proximal phalanx bone in horses’ limbs.
  • These fractures commonly occur in adult horses and present significant treatment challenges.
  • Several treatments exist, but the best approach remains unclear due to variability in case types and outcomes reported.

Objectives

  • To systematically collect and review current literature on CFPP in horses.
  • To analyze treatment methods utilized and synthesize survival outcomes.
  • To identify differences between fracture types and treatment efficacies.
  • To highlight gaps in knowledge to guide future studies.

Methods

  • A scoping review methodology was employed, gathering eligible studies via comprehensive online database searches.
  • Each article’s potential bias was assessed to evaluate the quality of evidence.
  • Cases were categorized based on fracture type:
    • Moderately Comminuted Fractures (MCFPP): Presence of an intact cortical bone “strut” between adjacent joints.
    • Severely Comminuted Fractures (SCFPP): Absence of the cortical strut, indicating more fragmentation.
  • Statistical analysis, specifically Chi-squared tests, measured differences in survival rates across fracture types and treatments.

Results

  • Total of 39 studies included, covering 409 individual CFPP cases in horses.
  • Survival Rates (SR) observed:
    • MCFPP: 77% overall survival.
    • SCFPP: 51% overall survival — significantly lower than MCFPP (p < 0.001).
  • Treatment outcomes for MCFPP:
    • Lag screw fixation (SF) achieved an 85% survival rate.
    • SF combined with transfixation cast (SF + TFC) had worse outcomes than SF alone (p = 0.02).
    • Cast immobilization (CI) alone showed a 50% survival in MCFPP (though data were limited: 1/2 cases).
  • Treatment outcomes for SCFPP:
    • Cast immobilization (CI) showed 85% survival (11/13 cases), significantly outperforming SF + TFC (p = 0.04) and plate fixation with arthrodesis of two joints (PF2) (p = 0.006).
    • This suggests conservative cast treatment may be preferable for severely comminuted fractures.

Conclusions

  • Existing literature consists exclusively of retrospective studies, with variable definitions, follow-up durations, and data quality.
  • Survival rates for CFPP vary widely between 35% and 85%, depending on fracture type and treatment.
  • For moderately comminuted fractures, lag screw fixation appears to be an effective treatment choice.
  • For both fracture types, cast immobilization alone offers a viable treatment alternative, particularly when surgery is not feasible or desired by horse owners.
  • These results point to a need for more standardized, prospective studies to better determine optimal treatments.

Cite This Article

APA
de Chaisemartin C, Vandeweerd JM, Schramme M. (2025). Scoping review of comminuted fractures of the proximal phalanx in horses. Equine Vet J. https://doi.org/10.1111/evj.70077

Publication

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

Researcher Affiliations

de Chaisemartin, Charles
  • Center for Equine Health, École Nationale Vétérinaire de Lyon, VetAgro Sup, University of Lyon, Marcy l'Etoile, France.
Vandeweerd, Jean-Michel
  • Omnibus Animalibus Studia Sanitatis (Oasis)-Namur Research Institute for Life Sciences (Narilis), Université de Namur (UNamur), Namur, Belgium.
Schramme, Michael
  • Center for Equine Health, École Nationale Vétérinaire de Lyon, VetAgro Sup, University of Lyon, Marcy l'Etoile, France.
  • Research Unit ICE, Campus Vétérinaire de Lyon, Marcy l'Étoile, France.

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