Horses with distal phalanx fracture typically recover with rest
MedWire News: Horses who suffer a distal phalanx fracture are best managed with complete stall rest and generally make a good recovery, according to study results published in The Veterinary Journal.
Equine fractures of the distal phalanx are relatively common and occur in all breeds; however, the optimal management and prognosis of this injury is not well defined.
In this study, Astrid Rijkenhuizen (Utrecht University, The Netherlands) and colleagues approached multiple sources to obtain reports of horses who had suffered a distal phalangeal fracture. A total of 285 cases were identified and included in the analysis.
The mean age of the horses was 7.3 years and the majority were either Warmbloods (n=157) or Thoroughbreds (n=81). The most common cause of fracture was slipping or stepping on solid objects or kicking an unyielding object.
In 101 horses the fracture was acute and in 146 horses it was chronic. Around 40% of fractures were classified as articular while around one-third were classified as nonarticular fractures of the palmar or plantar process.
Nearly three-quarters of cases were treated conservatively, 13.2% were treated surgically, and 12.9% of cases received no treatment whatsoever. Conservative management typically involved box rest with or without immobilizing the hoof.
Long-term outcomes were reported for 223 horses. Of these, 77.1% were considered to have a "successful" outcome, with a return to original or expected level of functioning.
Involvement of the distal interphalangeal joint was a major determinant of outcome, Rijkenhuizen and co-authors found.
Non-articular fractures were associated with the best chance of a successful outcome, with 91.7% of horses returning to their pre-fracture levels of use. By contrast, success rates were around 70% for horses with articular fractures.
Other predictors for a successful outcome included younger age and involvement of the hindlimb. Interestingly, neither hoof immobilization nor the development of a contracted heel influenced outcome.
In addition, radiologic findings were not correlated with clinical healing, leading the authors to recommend that the recommencement of training should be based on clinical rather than X-ray findings.
The team concludes: "For horses with a distal phalanx fracture (types I-III), conservative management, consisting of complete stall rest, is indicated.
"The prognosis is good and is not improved by the application of an immobilising shoe/cast or internal fixation."
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By Joanna Lyford