FREE SHIPPING over $40
OVER 10000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
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.
Get Full Text
Publication Date: 2025-08-29 PubMed ID: 40883227DOI: 10.1111/evj.70077Google 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
  • Review

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 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.

References

This article includes 54 references
  1. Murad MH, Asi N, Alsawas M, Alahdab F. New evidence pyramid. Evid Based Med 2016;21:125–127.
    doi: 10.1136/ebmed-2016-110401google scholar: lookup
  2. Caspers MK, Gier CJ, Reesink HL. Equine non‐septic tenosynovitis: a systematic literature review of site‐specific pathological lesions, outcomes and surgical complications. Equine Vet J 2023;56(5):842–857.
    doi: 10.1111/evj.14000google scholar: lookup
  3. Kraus BM, Richardson DW, Nunamaker DM, Ross MW. Management of comminuted fractures of the proximal phalanx in horses: 64 cases (1983–2001). J Am Vet Med Assoc 2004;224(2):254–263.
    doi: 10.2460/javma.2004.224.254google scholar: lookup
  4. Nunamaker DM, Nash RA. A tapered‐sleeve transcortical pin external skeletal fixation device for use in horses: development, application, and experience. Vet Surg 2008;37(8):725–732.
    doi: 10.1111/j.1532-950x.2008.00461.xgoogle scholar: lookup
  5. Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Baldini SC. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc 2015;13:141–146.
  6. Tricco AC, Lillie E, Zarin W, O'Brien K, Colquhoun H, Kastner M. A scoping review on the conduct and reporting of scoping reviews. BMC Med Res Methodol 2016;16:15.
  7. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int Surg J 2021;372(71):1–9.
    doi: 10.1136/bmj.n71google scholar: lookup
  8. Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and incidence data. Int J Evid Based Healthc 2015;13(3):147–153.
    doi: 10.1097/xeb.0000000000000054google scholar: lookup
  9. Chaisemartin C, Farfan M, Dal Cero B, Martens A, Rossignol F, Kalinovskiy A. Comminuted fractures of the proximal phalanx in horses: a multi‐center retrospective review of 159 cases with long‐term outcome (2002–2024) [Abstract]. Vet Surg 2025;54(1):2.
  10. Joyce J, Baxter GM, Sarrafian TL, Stashak TS, Trotter G, Frisbie D. Use of transfixation pin casts to treat adult horses with comminuted phalangeal fractures: 20 cases (1993–2003). J Am Vet Med Assoc 2006;229(5):725–730.
    doi: 10.2460/javma.229.5.725google scholar: lookup
  11. Ammann L, Fürst AE, Jackson MA. Complete fractures through osseous cyst‐like lesions of the proximal phalanx in three horses. Equine Vet Educ 2024;36(9):e223–e231.
    doi: 10.1111/eve.13965google scholar: lookup
  12. Redden RF. Preventing laminitis in the contralateral limb of horses with nonweight‐bearing lameness. Clin Tech Equine Pract 2004;3(1):57–63.
    doi: 10.1053/j.ctep.2004.07.005google scholar: lookup
  13. Chernigova SV, Suchkov MV, Zubkova NV. Efficiency of the screw fixation method in the treatment of horses with proximal phalanx fractures. Vestn Omsk Gos Agrar Univ 2022;1(45):111–120.
  14. de Chaisemartin C, Arnauld-des-Lions J, Gouzer V, Santinelli Y, Normand T, Vandeweerd JM. Publication bias: reflection on a case of comminuted fracture of the proximal phalanx. Prat Vet Equine 2019;51(201):56–61.
  15. Verheyen KLP, Wood JLN. Descriptive epidemiology of fractures occurring in British thoroughbred racehorses in training. Equine Vet J 2004;36(2):167–173.
    doi: 10.2746/0425164044868684google scholar: lookup
  16. Prado LG, Anacleto TP, Santos IF, Dias APM, Barboza LC. Osteossíntese por fixação externa em fratura cominutiva de falange proximal em um equino: Relato de caso.. Rev Cienc Univ 2018;5(1):69–75.
  17. Heilès PH, Orange F. New therapeutical approach for a case of closed comminuted bi‐articular first phalanx fracture on the hindlimb.. Prat Vet Equine 1997;29:59–66.
  18. Niimura del Barrio MC, David F, Hughes JL, Clifford D, Wilderjans H, Bennett R. A retrospective report (2003–2013) of the complications associated with the use of a one‐man (head and tail) rope recovery system in horses following general anaesthesia.. Ir Vet J 2018;71:1–9.
    doi: 10.1186/s13620-018-0117-1google scholar: lookup
  19. McClure SR, Honnas CM, Watkins JP. Managing equine fractures with external skeletal fixation.. Compend Contin Educ Pract Vet 1995;17:1054–1063.
  20. Keller SA. The problem of pin breakage in equine transfixation pin casting: a retrospective clinical study and biomechanical testing of four different transfixation pin designs.. Doctoral Thesis, University of Zurich. 2018.
  21. Nemeth F, Back W. The use of the walking cast to repair fractures in horses and ponies.. Equine Vet J 1991;23(1):32–36.
    doi: 10.1111/j.2042-3306.1991.tb02709.xgoogle scholar: lookup
  22. Smith MRW, Corletto FC, Wright IM. Parasagittal fractures of the proximal phalanx in thoroughbred racehorses in the UK: outcome of repaired fractures in 113 cases (2007–2011).. Equine Vet J 2017;49(6):784–788.
    doi: 10.1111/evj.12707google scholar: lookup
  23. Jann HW, Collier MA, Fackelman GE. Adjustable brace for the fetlock joint.. J Equine Vet Sci 1990;10:141–143.
  24. Rossignol F, Vitte A, Boening J. Use of a modified transfixation pin cast for treatment of comminuted phalangeal fractures in horses.. Vet Surg 2014;43(1):66–72.
    doi: 10.1111/j.1532-950x.2013.12075.xgoogle scholar: lookup
  25. Valverde A, Little CB, Dyson DH, Motter CH. Use of epidural morphine to relieve pain in a horse.. Can Vet J 1990;31(3):211–212.
  26. Amer MSM. Clinical and educational studies on some equine fractures.. Doctoral dissertation, Cairo University. 2013.
  27. Crawley GR, Grant BD, Krpan MK, Major MD. Long‐term follow‐up of partial limb amputation in 13 horses.. Vet Surg 1989;18(1):52–55.
    doi: 10.1111/j.1532-950x.1989.tb01043.xgoogle scholar: lookup
  28. Perrin RAR, Launois MT, Brogniez L, Clegg PD, Coomer RPC, Desbrosse FG. The use of computed tomography to assist orthopaedic surgery in 86 horses (2002–2010).. Equine Vet Educ 2011;23(6):306–313.
    doi: 10.1111/j.2042-3292.2010.00159.xgoogle scholar: lookup
  29. Barr ARS, Denny HR, Waterman AE, Weaver BM. Proximal phalangeal fractures in the horse.. Vet Comp Orthop Traumatol 1988;1(2):86–90.
    doi: 10.1055/s-0038-1633170google scholar: lookup
  30. Misheff MM, Alexander GR, Hirst GR. Management of fractures in endurance horses.. Equine Vet Educ 2010;22(12):623–630.
    doi: 10.1111/j.2042-3292.2010.00150.xgoogle scholar: lookup
  31. Yovich JV, Turner AS, Stashak TS, McIlwraith CW. Luxation of the metacarpophalangeal and metatarsophalangeal joints in horses. Equine Vet J 1987;19(4):295–298.
    doi: 10.1111/j.2042-3306.1987.tb01414.xgoogle scholar: lookup
  32. Kuemmerle JM, Auer JA, Rademacher N, Lischer CJ, Bettschart‐Wolfensberger R, Fürst AE. Short incomplete sagittal fractures of the proximal phalanx in ten horses not used for racing. Vet Surg 2008;37:193–200.
    doi: 10.1111/j.1532-950x.2007.00359.xgoogle scholar: lookup
  33. Ellis DR, Simpson DJ, Greenwood RES, Crowhurst JS. Observations and management of fractures of the proximal phalanx in young thoroughbreds. Equine Vet J 1987;19(1):43–49.
    doi: 10.1111/j.2042-3306.1987.tb02579.xgoogle scholar: lookup
  34. Turek B. Comminuted fractures of the proximal phalanx in a horse: a case report. Medycyna Wet 2008;64(5):713–716.
  35. Nunamaker DM, Richardson DW, Butterweck DM, Provost MT, Sigafoos RD. A new external skeletal fixation device that allows immediate full weightbearing application in the horse. Vet Surg 1986;15(5):345–355.
    doi: 10.1111/j.1532-950x.1986.tb00242.xgoogle scholar: lookup
  36. Markel MD, Richardson DW, Nunamaker DM. Comminuted first phalanx fractures in 30 horses: surgical vs. nonsurgical treatments. Vet Surg 1985;14(2):135–140.
    doi: 10.1111/j.1532-950x.1985.tb00843.xgoogle scholar: lookup
  37. Cherdchutham W, Laikul A. Application of the polyvinylchloride pipe as a splint for comminuted fracture of the proximal phalanx (P1) in a pony. Agric Nat Resour 2008;42(5):106–110.
  38. Dubs B, Nemeth F. Therapie und prognose der fesselbeinfrakturen. Schweiz Arch Tierheilk 1975;117(6):299–309.
  39. Lescun TB, McClure SR, Ward MP, Downs C, Wilson DA, Adams SB. Evaluation of transfixation casting for treatment of third metacarpal, third metatarsal, and phalangeal fractures in horses: 37 cases (1994–2004). J Am Vet Med Assoc 2007;230(9):1340–1349.
    doi: 10.2460/javma.230.9.1340google scholar: lookup
  40. Jones DGC. Short clinical communications: fracture of the first phalanx. Equine Vet J 1968;1(1):45–47.
  41. Zert Z, Mezerova J, Kabes R, Krisova S. Sagittal fracture of the proximal phalanx in a horse complicated during induction of anesthesia by complete fragmentation of the bone: a case report. Vet Med 2007;52(2):113–118.
  42. Bérubé R. Les fractures de la première phalange chez le cheval. Can J Comp Med Vet Sci 1962;26(7):167.
  43. Levine DG, Richardson DW. Clinical use of the locking compression plate (LCP) in horses: a retrospective study of 31 cases (2004–2006). Equine Vet J 2007;39:401–406.
    doi: 10.2746/042516407x196555google scholar: lookup
  44. Murphy E. A compound comminuted fracture in an Arabian stallion. Iowa State Univ Vet 1953;3(15):165–166.
  45. Sasaki N, Kikuchi T, Yamada K, Higuchi T, Sato M, Yamada H. Basic assessment of diagnosis by MDCT in horses. J Equine Sci 2007;18(1):33–38.
    doi: 10.1294/jes.18.33google scholar: lookup
  46. Smith MWR. Chapter 19: fractures of the proximal phalanx. 2022. In: Wright IM, editor. Fractures in the horse. 1st ed. Chichester: Wiley Blackwell, John Wiley and sons Ltd; p. 389–413.
    doi: 10.1002/9781119431749.ch19google scholar: lookup
  47. Rossignol, Campos. Distal radial fracture repair in adult horses. Equine Vet Educ 2014;36(3):117–120.
    doi: 10.1111/eve.13871google scholar: lookup
  48. Woon CYL, Wong MK, Howe TS. LCP external fixation – external application of an internal fixator: two cases and a review of the literature. J Orthop Surg Res 2010;5:19.
    doi: 10.1186/1749-799x-5-19google scholar: lookup
  49. Xiao C, Tang F, Zhou Y, Zhang W, Luo Y, Duan H. A locking compression plate as an external fixator for treating infected nonunion of the humeral diaphysis. BMC Surg 2016;16(1):53.
    doi: 10.1186/s12893-016-0167-9google scholar: lookup
  50. Singh S, Baghel PK, Rastogi D, Shantanu K, Sharma V. Distal femoral locked plating versus retrograde nailing for extra‐articular distal femur fractures: a comparative study. Int J Orthop Sci 2018;4(4):702–705.
    doi: 10.22271/ortho.2018.v4.i4i.82google scholar: lookup
  51. Farfan M, Zderic I, Gueorguiev B, Rossignol F. Biomechanical comparison of distal femoral plate, transfixation pin casting and standard casting on cadaver specimens with highly comminuted fracture of the proximal phalanx [Abstract]. Vet Surg 2025;54(Suppl 1):8.
    doi: 10.1111/vsu.14293google scholar: lookup
  52. McClure S, Watkins J, Bronson D, Ashman R. In vitro comparison of the standard short limb cast and three configurations of short limb transfixation casts in equine forelimbs. Am J Vet Res 1994;55(9):1331–1334.
    doi: 10.2460/ajvr.1994.55.09.1331google scholar: lookup
  53. Nixon AJ. Phalanges and the metacarpophalangeal and metatarsopha‐langeal joints. 2019. In: Auer JA, Stick JA, editors. Equine surgery. 5th ed. St. Louis, MO: Elsevier; p. 1587–1618.
  54. Richardson DW. Fractures of the Proximal Phalanx. 2019. In: Nixon AJ, editor. Equine fracture rThe authors declare no conflicts of interest.epair. Philadelphia, PA: Saunders; p. 295–319.
    doi: 10.1002/9781119108757.ch19google scholar: lookup

Citations

This article has been cited 0 times.
Subscribe to our newsletter
Join 99,911 horse owners like you who receive our email updates on horse health and nutrition.