A review of equine tibial fractures.

Equine tibial fractures are relatively infrequent in racing and non-racing sport horses, but limitations in successful treatment of tibial fractures in adult horses result in relatively high mortality compared with other musculoskeletal injuries. The aetiology of tibial fracture can be classified into two general categories: traumatic impact or fatigue failure. Tibial stress fractures, also known as fatigue fractures, are often rated as the second most common stress fracture in racing Thoroughbreds; young age, early stage in race training, and initiation of training after a period of rest are the reported risk factors. Both impact and fatigue fracture propagation are dependent on the magnitude of force applied and on the local composition/alignment of mineralised collagen in the tibial lamella. Extensive research has characterised the pattern of strain distribution and stress remodelling within the equine tibia, but in vivo measurement of load and angular moments are currently not feasible. Further research is warranted to correlate biomechanical theory of tibia fatigue fracture propagation with current histopathological data. Preventative measures for fatigue fractures aim to optimise diagnostic efficiency, reduce the interval between injury and diagnosis and modify racing and training conditions to reduce non-specific fracture risk. Treatment options for complete tibial fractures in adult horses are limited, but with careful case selection, successful outcomes have been reported after open reduction and internal fixation. On the other hand, tibial stress fractures and minimally displaced incomplete fractures are typically treated conservatively and have good prognosis for athletic recovery. This review aims to describe the current literature regarding tibial fracture aetiology, prevalence, risk factors, fracture biomechanics, treatment, prognosis and prevention.

Bone stress injuries and fatigue fractures of the pelvis in endurance horses.

BACKGROUND: Bone stress injuries and fatigue fractures of the pelvis are reported in only a small number of endurance horses. OBJECTIVES: To describe bone stress injuries and fatigue fracture of the pelvis in endurance horses trained and competing on the deep sand surfaces. STUDY DESIGN: Retrospective case series. METHODS: Medical records of horses used for endurance and diagnosed with bone stress injuries and/or fatigue fractures of the pelvis by ultrasound were reviewed. The bone stress injuries and fatigue fractures were classified as affecting the iliac wing, the iliac shaft, the tuber ischiadicum, the rest of the ischium or the pubis and subdivided into four fracture configurations: isolated iliac fracture, isolated fracture of the floor of the pelvis, isolated tuber ischiadicum fracture and multiple fractures. Descriptive statistics were performed overall and on fracture configurations for age, sex, breed, level of activity, affected limbs, previous injuries, development of the injury, seasons in the UAE, physical and dynamic findings and outcome. For each fracture configuration and the outcome, multivariable logistic regression models were developed after univariable logistic regression and collinearity analyses. Significance was set at P ≤ .05. RESULTS: Sixty endurance horses were included; 48% (95% CI: 36%-61%) had isolated iliac fracture, 17% (7%-26%) isolated fracture of the floor of the pelvis, 15% (6%-24%) isolated tuber ischiadicum fracture and 20% (10%-30%) had multiple fractures. Breed (OR, 4.42; 95%CI, 1.02-19.57) was significantly associated with isolated iliac fracture and asymmetry of bone landmarks (OR, 7.42; 95% CI, 1.47-37.45) with isolated tuber ischiadicum fracture. Degree of lameness (OR, 3.08; 95% CI, 1.07-8.9) and trotting on three tracks (OR, 8.62; 95% CI, 1.43-51.9) were significantly associated with the diagnosis of isolated fracture of the floor of the pelvis. MAIN LIMITATIONS: Data acquired in a single country. CONCLUSIONS: Bone stress injuries and fatigue fractures of the pelvis can affect endurance horses trained and competing on deep sand. Isolated bone stress injuries and/or fatigue fractures of the ileum were the commonest followed by multiple pelvic bones involvement. The presence of lameness and trotting on three tracks suggest the presence of bone stress injuries and/or fatigue fractures of the floor of the pelvis; asymmetry of bony landmarks is more commonly detected in horses with bone stress injuries and/or fatigue fractures of the tuber ischiadicum.

Stress fracture of the palmar, distal cortex of the third metacarpal bone: A diagnostic challenge with a good prognosis.

BACKGROUND: Transverse stress fracture of the palmar cortex of the distal aspect of the third metacarpal bone (TSF PCD McIII) is poorly documented. OBJECTIVES: To describe the typical signalment of this injury, the common clinical and radiological signs and prognosis. STUDY DESIGN: A retrospective hospital-based case series with follow-up of racing records. METHODS: All cases of TSF PCD McIII diagnosed among racehorses in training at the Hong Kong Jockey Club between 2011 and 2019 were identified. Clinical records were reviewed and documented signs were recorded for each case. Findings from a predefined list of radiological features were listed. Descriptive statistics were used to describe the age and training profile of horses, the clinical and radiological findings and time to return to ridden exercise. RESULTS: Twenty-three cases (n = 23) were identified. The majority (57%) had recently started or returned to training from a break and 35% (n = 8) of cases had not yet undertaken timed gallops at the time of injury. Most cases (20/23; 87%) were lame; in nine (39%), lameness was severe. Localised swelling of superficial soft tissues was reported in 15/23 (65%) cases. Pain on palpation of the distal McIII was present in 15/23 (65%) cases and in response to fetlock flexion in 12/23 (52%). Diffuse, localised increase in radiopacity, disruption to the outline of the bone periosteal surface and outward displacement of the button of the splint bone were common radiological features in early cases (70%, 67% and 67% of all cases). Sixty-one per cent of cases (14/23) were initially misdiagnosed. Most horses (n = 18/23) resumed training and racing after a median of 83 and 246 days. MAIN LIMITATIONS: Clinical notes were not consistent between cases. Radiographs were taken at different times. CONCLUSIONS: Horses commencing training are at risk of TSF PCD McIII, which presents with confusing clinical signs and subtle radiological findings. The long-term outlook is favourable.

The effect of stress fracture occurring within the first 12 months of training on subsequent race performance in Thoroughbreds in Hong Kong.

BACKGROUND: Racehorses are at an increased risk of stress fracture within the first 12 months of racing and when resuming training after a break. Research in these high-risk periods and on the effect of performance post-recovery is limited. OBJECTIVES: To describe the occurrence of stress fractures, diagnosed by nuclear scintigraphy (NS), in racehorses' first 12 months training in Hong Kong, and their impact on racing performance and career length. STUDY DESIGN: Retrospective 1:2 matched case-control study. METHODS: Clinical records of horses with NS-diagnosed stress fractures within 365 days of import between 2006 and 2018 were collated. Cases and controls were matched on import date. Univariable conditional logistic regression compared signallment, pre-fracture training and post-recovery racing performance between cases and matched controls. Shared Frailty Cox regression analysed time from import to fracture and total career length. RESULTS: Eighty-seven horses sustained a NS-diagnosed fracture within their first year in Hong Kong (incidence risk 1.7% [95% confidence interval (CI) 1.4%-2.1%; N = 5180]). The humerus (42.0%; 95% CI 31.8%-52.6%; n = 39) and tibia (28.0%; 95% CI 19.1%-38.2%; n = 26) were the most common stress fracture sites. Cases missed a median of 63 days (Interquartile range (IQR) 49-82) of training because of fracture. Within the 12 months following diagnosis, case horses had a median of four (IQR 2-4, P < .0001) fewer race starts and were down HK$ 206 188 (IQR HK$ 0-436 800, P = .007) in race earnings compared to controls. Career length did not significantly differ between cases and controls (median 2 years and 3 months; IQR 15.3-39.1 months; P = .2). MAIN LIMITATIONS: Only stress fractures diagnosed by NS were included, hence, the study is not representative of all stress fractures occurring in racehorses in Hong Kong. CONCLUSIONS: Racehorses sustaining a stress fracture within 1 year of entering Hong Kong lost significant time in training, earnings and race starts. However, overall career length was unaffected.

Characteristics of complete tibial fractures in California racehorses.

BACKGROUND: Tibial fractures cause ~3% of racehorse deaths. Pre-existing stress fractures have been associated with multiple racing and training fractures, but not complete tibial fractures. OBJECTIVES: To describe racehorse tibial fractures and compare signalment and exercise histories of affected and control racehorses. STUDY DESIGN: Retrospective analysis of necropsy reports. METHODS: Racehorses that had a complete tibial fracture (1990-2018) were retrospectively reviewed. Signalment and exercise histories of affected horses were compared to 1) racehorses that died because of non-tibial musculoskeletal injuries or 2) non-musculoskeletal cause and 3) age, sex, event-matched control racehorses. Tibial fracture prevalence was described relative to California racehorses that had at least one official work or race. Age, sex and limb distributions were compared between affected and control horses (Chi-square, Fisher's Exact test). Exercise history data were reduced to counts and rates of official high speed works, races and layups (periods without an official high speed work or race >60 days). Variables were compared among groups using matched logistic regression (P ≤ .05). RESULTS: Tibial fractures in 115 horses (97% unilateral; 50% left, 47% right) occurred most commonly during training (68%) and in 2- to 3-year-old horses (73%). Fractures were predominantly comminuted (93%), diaphyseal (44%) and oblique (40%). Of 61 cases examined for callus, 64% had periosteal callus associated with fracture, most commonly in proximal (65%) and distal diaphyseal (27%) locations. Of 28 racehorses with known exercise history, 57% never raced and 36% had a layup. Affected horses had fewer official-timed works and events (official high speed works and races), number of active days and accumulated less distance in events and works (P < .05) than control horses. MAIN LIMITATIONS: Retrospective review of necropsy reports by multiple pathologists over 28 years. CONCLUSIONS: Tibial fractures were associated with pre-existing stress fracture early in career. Most fractures were associated with proximolateral stress fractures.

Postinjury performance for differing humeral stress fracture locations in the racing thoroughbred.

OBJECTIVE: To assess the influence of humeral stress fracture location on the time to return to racing and postinjury performance of thoroughbred racehorses. STUDY DESIGN: Retrospective study (1992-2015). SAMPLE POPULATION: Thoroughbred racehorses (n = 131) that presented for lameness with the sole diagnosis of humeral stress fractures in the lame limb, as determined by scintigraphy or radiology. METHODS: Sex, fracture site, age, starts, earnings, and average earnings per race were examined for differences in pre-stress and post-stress fracture diagnosis for the entire population as well as individual stress fracture locations (general linear model, χ2 tests). Pre-stress and post-stress fracture performance for the three stress fracture locations were assessed: (1) earnings pre-stress and post-stress fracture (Kruskal-Wallis one-way analysis of variance), (2) average earnings per start prefracture, and (3) average earnings per start postfracture (Wilcoxon signed-rank tests). RESULTS: Stress fracture locations were caudodistal (n = 36), craniodistal (n = 43), and caudoproximal (n = 52). One hundred ten of 131 horses raced postfracture, and 54 of 131 horses raced prefracture. Age at injury was 43.61 months caudodistal, 33.48 months caudoproximal, and 36.65 months craniodistal. Horses returned to race at a median of 244 days (range, 218-272). Postfracture earnings per start were greater for caudodistal vs caudoproximal (P = .04). CONCLUSION: There were no differences in prefracture earnings or fracture site and sex or limb affected. Return-to-race time varied by location but not significantly. Differences in earnings preinjury and postinjury were not significant. Horses with a stress fracture at the caudodistal location earned significantly more compared with horses with a stress fracture at the caudoproximal location after they returned to race. CLINICAL SIGNIFICANCE: Thoroughbred racehorses have a good prognosis for return to racing regardless of fracture location.

Treatment of humeral condylar fractures and humeral intracondylar fissures in cats with patellar fracture and dental anomaly syndrome.

OBJECTIVES: The aim of this study is to describe the treatment and outcome of humeral condylar fractures and humeral intracondylar fissures in cats with patellar fracture and dental anomaly syndrome (PADS) and to provide advice on how to manage these cases in practice. METHODS: Data were collated on cats with PADS that were reported to have sustained humeral fractures or had fractures or fissures of the humerus identified on radiographs. The details of the fractures were recorded in addition to any treatment and outcome information. RESULTS: Of the 207 cases reported with PADS, 18 cats (8.7%) were found to have humeral condylar fractures, none of which was known to have resulted from significant trauma. Where treatment occurred, it involved the placement of transcondylar positional or lag screws. In some cases additional implants, including supracondylar bone plates and screws or Kirschner wires (K-wires), were used. Follow-up data revealed that only two cats were euthanased owing to the presence of the humeral fractures, with at least eight achieving some degree of recovery of function. CONCLUSIONS AND RELEVANCE: These humeral fractures all have the characteristics of stress insufficiency fractures, being simple isolated fractures that are short oblique, with increased radio-density at the fracture line and occurring following minimal or no trauma. Humeral intracondylar fissures were identified in two cats and it is possible that some of the other fractures may have occurred secondary to pre-existing fissures. To our knowledge, no prior reports exist of fissures in cats that do not meet the criteria for PADS. Surgical repair primarily consisted of the placement of transcondylar lag or positional screws with, in some cases, adjunct implants such as bone plates and screws or K-wires. Though there were insufficient data to determine the prognosis for these fractures in the long term, unlike patellar fractures, many of these fractures will heal if treated appropriately.

Bone marrow oedema-type signal in the proximal phalanx of Thoroughbred racehorses.

This study focused on 8 Thoroughbred racehorses showing bone marrow oedema-type signal in the proximal sagittal groove of the proximal phalanx, with the aim of understanding its clinical significance. Standing magnetic resonance imaging played an important role in assessing osseous abnormalities that were not radiographically identifiable. Further, a histopathological result from one of the cases showed there was oedema surrounding adipose tissues with increase in density of trabecular scaffolding. This may indicate presence of osseous injury within the area of decreased elasticity due to subchondral bone modeling. This study suggests that detection of osseous abnormality based on bone marrow oedema-type signal, and application of appropriate care following injury would contribute to prevent deterioration of stress-related fractures of the proximal phalanx.

Bilateral calcaneal stress fractures in two cats.

Two cats that developed bilateral calcaneal stress fractures are reported. One cat developed lameness associated with incomplete fractures at the base of both calcanei, both of which progressed to acute, complete fractures 2 months later. The second cat presented with acute complete calcaneal fracture, with evidence of remodelling of the contralateral calcaneus, which subsequently fractured two years later. The calcaneal fractures were successfully stabilised with lateral bone plates in each case. Stress fractures were suspected because of the bilateral nature, the simple and similar configuration, the consistent location of the fractures, the absence of other signs of trauma in both cases and the suspected insidious onset of the lameness. The feline calcaneus is susceptible to stress fracture, and cats presenting with calcaneal fractures without evidence of trauma should be evaluated for concurrent skeletal pathology.

Analysis of stress fractures associated with lameness in Thoroughbred flat racehorses training on different track surfaces undergoing nuclear scintigraphic examination.

REASONS FOR PERFORMING STUDY: There is limited information regarding the impact of training track surface on the occurrence of stress fractures. OBJECTIVES: To evaluate the impact of training track surface on the proportion of long bone and pelvic stress fractures associated with lameness in Thoroughbred horses in flat race training undergoing nuclear scintigraphic examination. STUDY DESIGN: Retrospective study. METHODS: Scintigraphic examinations of Thoroughbred flat racehorses were evaluated from 2 hospitals (hospital A [Toronto Equine Hospital], 2003-2009, and hospital B [George D. Widener Hospital for Large Animals, School of Veterinary Medicine, University of Pennsylvania], 1994-2006). Horses admitted to hospital A trained at a single track, at which the main training surface changed from dirt to synthetic on 27 August 2006. Two distinct populations existed at hospital B: horses that trained on dirt (numerous trainers) and those that trained on turf (single trainer). All scintigraphic images were evaluated by a blinded reviewer. Fisher's exact test and logistic regression were used when appropriate, and significance was set at P<0.05. RESULTS: When reviewing 528 scintigraphic examinations from hospital A (257 dirt and 271 synthetic, numerous trainers), there was a greater proportion of stress fractures detected in scintigraphic examinations from horses training on a synthetic surface (31.7%) in comparison to scintigraphic examinations from horses training on a dirt surface (23.0%) at an earlier point in time (P = 0.03). There was a greater proportion of hindlimb/pelvic and tibial stress fractures diagnosed in horses from the synthetic surface-trained group than from the dirt-trained group at hospital A (P<0.04 and P = 0.03, respectively). CONCLUSIONS: This study provides evidence that training surface may affect the proportion of stress fractures diagnosed, but other factors, such as training philosophy, appear to be important. Future prospective investigations to fully elucidate the relationship between training track surface and the proportion of stress fractures and other nonfatal musculoskeletal injuries are warranted.

Bone fatigue and its implications for injuries in racehorses.

Musculoskeletal injuries are a common cause of lost training days and wastage in racehorses. Many bone injuries are a consequence of repeated high loading during fast work, resulting in chronic damage accumulation and material fatigue of bone. The highest joint loads occur in the fetlock, which is also the most common site of subchondral bone injury in racehorses. Microcracks in the subchondral bone at sites where intra-articular fractures and palmar osteochondral disease occur are similar to the fatigue damage detected experimentally after repeated loading of bone. Fatigue is a process that has undergone much study in material science in order to avoid catastrophic failure of engineering structures. The term 'fatigue life' refers to the numbers of cycles of loading that can be sustained before failure occurs. Fatigue life decreases exponentially with increasing load. This is important in horses as loads within the limb increase with increasing speed. Bone adapts to increased loading by modelling to maintain the strains within the bone at a safe level. Bone also repairs fatigued matrix through remodelling. Fatigue injuries develop when microdamage accumulates faster than remodelling can repair. Remodelling of the equine metacarpus is reduced during race training and accelerated during rest periods. The first phase of remodelling is bone resorption, which weakens the bone through increased porosity. A bone that is porous following a rest period may fail earlier than a fully adapted bone. Maximising bone adaptation is an important part of training young racehorses. However, even well-adapted bones accumulate microdamage and require ongoing remodelling. If remodelling inhibition at the extremes of training is unavoidable then the duration of exposure to high-speed work needs to be limited and appropriate rest periods instituted. Further research is warranted to elucidate the effect of fast-speed work and rest on bone damage accumulation and repair.

Does periosteal scraping of the third metacarpal bone reduce the incidence of 'bucked shins' in young Thoroughbred racehorses?

REASONS FOR PERFORMING STUDY: The occurrence of bucked shins in young Thoroughbred racehorses in North America is high. Although an altered training regime has demonstrated a significant decrease in this condition, trainers can be opposed to altering something as fundamental as their training routine. Periosteal scraping of the third metacarpal bone (McIII) is a putative prophylactic technique used to prevent bucked shins; therefore, a study to investigate the validity of the procedure is warranted. OBJECTIVES: To investigate whether prophylactic McIII scraping: 1) reduces the incidence of bucked shins in juvenile Thoroughbred horses at race speeds (breeze); and 2) allows increased cumulative breeze miles before the onset of disease. STUDY DESIGN: Nonrandomised prospective clinical study. METHODS: One hundred and seventy yearling Thoroughbreds from one farm, under one trainer, were enrolled in this study over one training season; 85 horses were treated and 85 horses were control animals. Horses were observed for bucked shins over 5 cumulative breeze miles. The objectives were evaluated by comparing incidence rates and Kaplan-Meier plots. RESULTS: The incidence rate for bucked shins was 0.059 cases per breezed mile in the treatment group, compared with 0.103 cases per breezed mile in the control group. Comparison of Kaplan-Meier plots of breeze miles for the 2 groups demonstrated a significant difference between groups (P = 0.035). Horses that developed bucked shins following periosteal shin scraping breezed an average of 3.52 miles before the onset of disease, compared to 2.50 miles for horses not prophylactically treated (P = 0.005). CONCLUSIONS: Periosteal McIII scraping reduced the incidence rate of bucked shins. The procedure allowed treated horses to breeze greater cumulative distances before an incident but failed to prevent the disease over the long term. Further investigation into this commonly used prophylactic technique is required.

Days-lost to training and competition in relation to workload in 263 elite show-jumping horses in four European countries.

Orthopaedic, or other, injuries in sports medicine can be quantified using the 'days-lost to training' concept. Both the training regimen and the surface used in training and racing can affect the health of racehorses. Our aim was to associate 'days-lost to training' in elite-level show-jumpers to horse characteristics, training and management strategies, and the time spent working on various training and competition surfaces. We designed a longitudinal study of professional riders in four European countries. Data were recorded using training diaries. Reasons for days-lost were classified into non-acute and acute orthopaedic, medical, hoof-related, and undefined. We produced descriptive statistics of training durations, relative to type of training, surfaces used, and days-lost. We created zero-inflated negative-binomial random-effects models using the overall days-lost as outcome. In the whole dataset, duration variables related to training surfaces were analysed as independent. The Swedish data only were also used to test whether duration variables were related to competition surfaces. Thirty-one riders with 263 horses provided data on 39,028 days at risk. Of these, 2357 (6.0%) were days-lost (55% and 22% of these were due to non-acute and acute orthopaedic injuries, respectively) in 126 horses. In the all-country model, controlling for season, a significant variable was country. Switzerland and the UK had lower incidence-rate ratios (IR) compared to Sweden (IRs 0.2 and 0.03, respectively). Horses with previous orthopaedic problems had almost a doubled IR (1.8) of days-lost due to orthopaedic injury, compared to baseline. If the horse had jumping training more than 1 min per day at risk the IRs were 6.9-7 (compared to less than this amount of time); this was, however, likely an effect of a small baseline. Variation in training was a protective factor with a dose-response relationship; the category with the highest variation had an IR of 0.1. In the Swedish model, controlling for season, there was an association of year (IR 2.8 year 2010). Further, if the horse rested >17-25% of the days at risk, or >33% of the DAR2, had IRs 3.5 and 3.0, compared to less time. Horses ≥ 6 years had IRs of 1.8-2.0, compared to younger horses. Limited training use of sand surface was a risk-factor (IR 2.2; >4 ≤ 12 min/day at risk), compared to not training on sand. Training/competing on sand-wood was a protective factor (IRs 0.4-0.5) compared to not using this surface.

Exercise-induced inhibition of remodelling is focally offset with fatigue fracture in racehorses.

UNLABELLED: Bone remodelling is inhibited by high repetitive loading. However, in subchondral bone of racehorses in training, eroded surface doubled in association with fatigue fracture and there was greater surrounding trabecular bone volume suggesting trabecular modelling unloads the bone focally, allowing damage repair by remodelling. INTRODUCTION: Remodelling replaces damaged bone with new bone but is suppressed during high magnitude repetitive loading when damage is most likely. However, in cortical bone of racehorses, at sites of fatigue fracture, focal porosity, consistent with remodelling, is observed in proportion to the extent of surrounding callus. Focal areas of porosity are also observed at sites of fatigue damage in subchondral bone. We hypothesised that fatigued subchondral bone, like damaged cortical bone, is remodelled focally in proportion to the modelling of surrounding trabecular bone. METHODS: Eroded and mineralizing surfaces and bone area were measured using backscattered scanning electron microscopy of post-mortem specimens of the distal third metacarpal bone in 11 racehorses with condylar fractures (cases) and eight racehorses in training without fractures (controls). RESULTS: Cases had a two-fold greater eroded surface per unit area at the fracture site than controls (0.81 ± 0.10 vs. 0.40 ± 0.12 mm(-1), P = 0.021) but not at an adjacent site (0.22 ± 0.09 vs. 0.30 ± 0.11 mm(-1), P = 0.59). Area fraction of surrounding trabecular bone was higher in cases than controls (81 ± 2 vs. 72 ± 2 %, P = 0.0020) and the eroded surface at the fracture site correlated with the surrounding trabecular area (adjusted R (2) = 0.63, P = 0.0010). CONCLUSION: In conclusion, exercise-induced inhibition of remodelling is offset at sites of fatigue fracture. Modelling of trabecular bone may contribute to unloading these regions, allowing repair by remodelling.

Fractures in regions of adaptive modeling and remodeling of central tarsal bones in racing Greyhounds.

OBJECTIVE: To evaluate and compare bone modeling and remodeling in fractured and non-fractured central tarsal bones (CTBs) of racing Greyhounds. SAMPLE: Paired cadaveric tarsi from 6 euthanized racing Greyhounds with right CTB fractures and 6 racing Greyhounds with other nontarsal injuries. PROCEDURES: CTBs were dissected and fractured CTBs were reconstructed. Central tarsal bones were evaluated through standard and nonscreen high-detail radiography, computed tomography, and histologic examination. The bone mineral density (BMD) was calculated adjacent to fracture planes and as a gradient on sagittal computed tomographic images. Sagittal and transverse plane sections of bone were obtained and submitted for subjective histologic assessment. Linear mixed-effects models were used to compare findings. RESULTS: Fractured right CTBs had greater BMD in the dorsal and midbody regions of the sagittal plane sections than did nonfractured CTBs. The BMD ratios from bone adjacent to the dorsal slab fracture planes were not different between fractured and nonfractured right CTBs. CONCLUSIONS AND CLINICAL RELEVANCE: Findings supported the existence of site-specific bone adaptation in CTBs of Greyhounds, with modeling and remodeling patterns that were unique to fractured right CTBs. The dorsal and midbody regions of fractured bones had greater BMD, and fractures occurred through these zones of increased BMD.

Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses: 55 cases (2000-2009).

OBJECTIVE: To evaluate the diagnostic features, results of free-choice exercise treatment, prognosis, and postinjury racing performance of Thoroughbred racehorses with cumulative stress-induced bone injury (CSBI) of the distal portion of the third metacarpal and third metatarsal bones (MC3/MT3). DESIGN: Retrospective case series. ANIMALS: 55 Thoroughbred racehorses with CSBI of the distal portion of MC3/MT3. PROCEDURES: Data on signalment, history, and radiographic, scintigraphic, and lameness examination findings were reviewed. Horses with lameness localized to the distal portion of MC3/MT3, and that did not have concurrent lameness but did have radiographic and nuclear scintigraphic changes consistent with CSBI, were included in the study. Information on pre-and postinjury racing performance was acquired from race records. RESULTS: Mean age was 3.2 years (median, 3 years [range, 2 to 6 years]). Ninety-five percent (52/55) of horses with CSBI raced after injury. Males were more commonly affected (75% [41/55]) than were females (25% [14/55]; odds ratio, 3.99 [95% confidence interval, 2.17 to 7.34]). There was no significant difference in postinjury total earnings, compared with total earnings before injury; horses had significantly more starts and less earnings per start after injury. Median time to first start after injury was 194 days. Of 45 horses that raced before and after injury, 31 % (14/45) had an increase in racing class, 31 % (14/45) had no change in class, and 38% (17/45) had a decrease in class. CONCLUSIONS AND CLINICAL RELEVANCE: Thoroughbred racehorses with CSBI of the distal portion of MC3/MT3 treated with free-choice exercise had a favorable prognosis with no appreciable decrease in class or performance.

Lag screw fixation of dorsal cortical stress fractures of the third metacarpal bone in 116 racehorses.

REASONS FOR PERFORMING STUDY: The effectiveness and best method to manage dorsal cortical stress fractures is not clear. This study was performed to evaluate the success of lag screw fixation of such fractures in a population of Thoroughbred racehorses. HYPOTHESIS: Lag screw fixation of dorsal cortical stress fractures is an effective surgical procedure allowing racehorses to return to their preoperative level of performance. METHODS: The records of 116 racehorses (103 Thoroughbreds) admitted to Equine Medical Centre, California between 1986 and 2008 were assessed. Information obtained from medical records included subject details, limb(s) affected, fracture configuration, length of screw used in repair and presence of concurrent surgical procedures performed. Racing performance was evaluated relative to these factors using Fisher's exact test and nonparametric methods with a level of significance of P<0.05. RESULTS: Of 92 Thoroughbred horses, 83% raced preoperatively and 83% raced post operatively, with 63% having ≥5 starts. There was no statistically significant association between age, gender, limb affected, fracture configuration or presence of concurrent surgery and likelihood of racing post operatively or of having 5 or more starts. The mean earnings per start and the performance index for the 3 races following surgery were lower compared to the 3 races prior to surgery; however, 29 and 45% of horses either improved or did not change their earnings per start and performance index, respectively. CONCLUSIONS AND POTENTIAL RELEVANCE: Data show that lag screw fixation is successful at restoring ability to race in horses suffering from dorsal cortical stress fractures.

Clinical and imaging features of suspected prodromal fracture of the proximal phalanx in three Thoroughbred racehorses.

Sagittal fracture of the proximal phalanx (P1) is an important musculoskeletal injury of the performance horse. Although widely considered to be monotonic in nature, there is emerging evidence that some P1 fractures may have stress-injury aetiology. Three cases are described in which imaging features found were suggestive of prodromal bone injury. All cases returned to full performance use after a period of rest. The authors conclude that it is possible that some P1 fractures in the Thoroughbred racehorse may develop through stress/fatigue injury pathways. It is proposed that intervention prior to overt fracture may be possible in some cases.

Changes in mineralised tissue at the site of origin of condylar fracture are present before athletic training in Thoroughbred horses.

AIM: To show that changes are present at the site of origin of metacarpal condylar fracture in young Thoroughbred horses before they enter race training. METHOD: Bone slices, 2 mm thick, in three mediolateral planes through the centre of rotation of the metacarpo-phalangeal joint (MCPJ) of both distal third metacarpal bones (Mc3) of 12 Thoroughbred horses aged 17 months, were imaged using point-projection digital X-ray imaging (muXR). RESULTS: In some horses, linear or ovoid radiolucency was found in articular calcified cartilage (ACC) and subchondral bone of the palmaro-distal aspect of the sagittal groove, exactly at the site of more advanced stages of condylar fatigue fracture. An incidental finding was ovoid radiolucency in the apex of the dorso-distal aspect of the sagittal ridge, with or without fragmentation or disturbance of the subchondral mineralised tissue line, resembling equine osteochondrosis. CONCLUSIONS AND CLINICAL RELEVANCE: The findings imply that the aetiology of condylar fatigue fracture in young Thoroughbred horses includes abnormality in development of the bone and joint that is present before athletic activity occurs.