The Surgical Repair of a Salter-Harris Type-2 Physeal Fracture of the Proximal Phalanx in a Foal.

This study presents a case involving a young horse that had a type-2 physeal fracture in its pastern, which was initially treated with a cast but ultimately required surgical intervention for proper healing. The surgery proved successful, suggesting that internal fixation is a preferable treatment method for such fractures.

Background

• The subject of the study was a six-month-old thoroughbred colt foal that was brought to a private equine referral hospital for acute lameness in its left hind limb.
• The foal showed significant swelling in the pastern and fetlock region of its left hind limb, but no other concerning physical symptoms were noted.

Diagnostic Methods

• Digital radiography was used to identify the cause of the foal’s lameness. The images revealed a Salter-Harris type-2 physeal fracture of the proximal phalanx — essentially, a growth plate fracture in the pastern.

Initial Treatment

• The fracture was first treated conservatively with a cast to immobilize the injured limb and allow the fracture to heal.
• Despite this initial conservative treatment, the cast did not provide sufficient immobilization to achieve a satisfactory reduction — a necessary step in haemostasis that involves realigning the bone fragments to their original position.

Surgical Treatment

• Since conservative treatment was not sufficiently effective, surgical intervention was opted for. The surgical construct consisted of a cortical lag screw, four locking head screws, and a locking T-plate to adequately stabilize the fracture.
• The surgical procedure was successful, and the foal recovered uneventfully. At a two-year follow-up, the horse was found to be sound and in race training, indicating a full recovery.

Conclusion

• Based on the successful outcome of this case, the study suggests that surgical repair using internal fixation may be a more effective treatment route for proximal phalanx physeal fractures, as compared to conservative management with a cast.
• This single case outcome might not be applicable to all similar injuries, but it certainly provides valuable insights for equine practitioners dealing with similar fractures in horses.