Computed tomographic‐planned repair of short incomplete sagittal fractures of the proximal phalanx

Abstract

SummaryBackgroundShort incomplete sagittal fractures of the proximal phalanx are common in racehorses. Configurations vary; surgical planning has been performed using radiography which has limited ability to differentiate between common configurations. Computed tomographic (CT) imaging accurately maps fracture configuration and may be contributory to case management.Objectives(i) Describe a surgical technique for CT‐planned repair of short incomplete sagittal fractures of the proximal phalanx and (ii) report case outcomes.Study designRetrospective case series (2019–2023).MethodsCT‐planned surgical repair of short incomplete sagittal fractures of the proximal phalanx was performed under radiographic control. Following repair, screw position was assessed with CT. Case records, radiographic and CT images were reviewed. Follow‐up information was obtained from referring veterinarians, race records and owner/trainers.ResultsTen fractures were confined to the dorsal cortex and subchondral bone. One fracture extended the full dorsoplantar depth of the bone. One fracture was confined to the subchondral bone centrally. Screw repair was planned using CT, to cross the fracture, or to position as close as possible while avoiding penetration of the articular surface. Surgery was performed under radiographic control, and subsequent CT examination confirmed screw placement as planned. Fractures healed radiographically in all 10 imaged cases. All horses were sound at follow‐up examination. One horse was retired to stud after surgery. Eleven horses returned to full training and 10 raced.Main limitationsThe case outcomes reported are only relevant to similar populations of Thoroughbred racehorses. The lack of a cohort of control horses limits conclusions that can be drawn relating to the contribution of this surgery to case management.ConclusionsCT planned repair of short incomplete sagittal fractures of the proximal phalanx, with screws positioned according to fracture location, can be reliably performed and is associated with good outcomes.