Equis ISSN 2398-2977

Proximal phalanx: fracture

Synonym(s): Split pastern

Contributor(s): Steve Adair, Vetstream Ltd, Chris Whitton

Introduction

Pathogenesis

Etiology

  • Performance horses   →   repetitive concussive forces   →   fatigue fracture.
  • Stepped on by dam.
  • Pasture accident.

Specific

Pathophysiology

  • Chip fractures:
    • Racing and other performance horses.
    • Intra-articular fracture.
  • Major fractures:
    • Mid-sagittal groove of proximal joint surface   →   distally.
    • Compressive and torsional forces.
    • Forelimb > hindlimb.
    • More commonly a racing injury, but can occur at pasture.
    • Unfused fragment   →   palmar or plantar wing fractures (young horses).
    • Medial collateral ligament avulsion fractures (young horses).
    • Dorsal frontal (high speed injury) and dorsal (low impact injury) fractures: Deceleration of the metacarpus/metatarsus against the proximal phalanx while the metacarpo/metatarsophalangeal joint is extended or slightly flexed.
    • Short sagittal fractures - about 1 cm long; in hindlimb subjected to more stress on rising from ground   →   displacement more likely.
    • Comminuted fractures.
  • Severely comminuted fractures - release of substantial internal energy   →   multiple fragmentation of the phalanx.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references fromPubMed andVetMedResource
  • Smith M R W & Wright I M (2014)Are there radiologically identifiable prodromal changes in Thoroughbred racehorses with parasagittal fractures of the proximal phalanx?Equine Vet J46(1), 88-91PubMed.
  • Smith M R W & Wright I M (2014)Radiographic configuration and healing of 121 fractures of the proximal in 120 Thoroughbred racehorses (2007-2011).Equine Vet J46(1), 81-87PubMed.
  • Ramzan P H L & Powell S E (2010)Clinical and imaging features of suspected prodromal fracture of the proximal phalanx in three Thoroughbred racehorses.Equine Vet J42(2), 164-169PubMed.
  • Cullimore A M, Finnie J W, Marmion W J & Booth T M (2009)Severe lameness associated with an impact fracture of the proximal phalanx in a filly.Equine Vet Educ21(5), 247-251VetMedResource.
  • Dechant J Eet al(1998)Repair of complete dorsal fracture of the proximal phalanx in two horsesVet Surg27(5), 445-449 (description of fracture type, and management)PubMed
  • Tetens Jet al(1997)Comparison of racing performance before and after treatment of incomplete, midsagittal fractures of the proximal phalanx in Standardbreds - 49 cases (1986-1992).JAVMA210(1), 82-86PubMed.
  • Holcombe S Jet al(1995)Lag screw fixation of noncomminuted sagittal fractures of the proximal phalanx in racehorses - 59 cases (1973-1991).JAVMA206(8), 1195-1199PubMed.
  • McClure S Ret al(1995)Managing equine fractures with external skeletal fixation.Comp Contin Educ Pract Vet17, 1054-1063VetMedResource.
  • Nemeth F,et al(1991)The use of the walking cast to repair fractures in horses and ponies.Equine Vet J23, 32-36PubMed.
  • Ellis D Ret al(1987)Observations and management of fractures of the proximal phalanx in young Thoroughbreds.Equine Vet J19(1), 43-49PubMed.
  • Nunamaker D Met al(1986)A new external skeletal fixation device that allows immediate full weightbearing application in the horse.Vet Surg15, 345-355VetMedResource.
  • Bukowiecki C Fet al(1986)Palmar/plantar process fractures of the proximal phalanx in 15 horses.Vet Surg15, 383-388VetMedResource.
  • Markel M Det al(1985)Noncomminuted fractures of the proximal phalanx in 69 horses.JAVMA186(6), 573-597PubMed.

Other sources of information

  • Richardson, D, W, (1996)Fractures of the proximal phalanx.In:Equine Fracture Repair.Ed. A , J, Nixon. W, B, Saunders, Philadelphia.


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