ABSTRACT
BACKGROUND: Repair of sagittal proximal phalanx (P1) and parasagittal metacarpal/metatarsal III (MC/MTIII) fractures has evolved over recent decades from a procedure carried out solely under general anaesthesia, to one commonly performed under standing sedation. To date, standing fracture repair has not been evaluated for large cohorts. OBJECTIVES: To determine short-term (survival to discharge) and long-term (return to racing) outcomes of horses undergoing standing repair of MC/MTIII and P1 fractures, and to compare pre-surgical and post-surgical racing performance. STUDY DESIGN: Single-centre retrospective cohort study. METHODS: Retrospective clinical record review of 245 cases undergoing standing repair of MC/MTIII or P1 fractures, 1 January 2007-30 June 2021. Data on signalment, fracture configuration and complications were collected and full race records were retrieved from the Racing Post Database (wwww.racingpost.com). Chi-squared and Mann-Whitney U tests were used to determine any difference in variables between horses that raced after surgery compared to those that did not. McNemar change and Wilcoxon signed-rank tests were used to compare pre- and post-surgical racing performance, p ≤ 0.05. RESULTS: Ninety-eight percent [95% confidence interval (CI): 96.2%-99.7%] of horses survived hospital discharge, and 75.1% (95% CI: 68.9%-81.4%) raced after surgery, a median of 241 days later. Horses that raced post-surgery were significantly less likely to have suffered from complications during hospitalisation than those that did not race again [17.3% (95% CI: 11%-24%) vs. 36.5% (95% CI: 23%-50%), p = 0.005]. Comparing pre- and post-operative racing performance, there was no significant difference in earnings per start [median £628.00, interquartile range (IQR) 115.90-1934.80 vs. £653.20, 51.00-1886.40, p = 0.7] or proportion of horses winning [51% (95% CI: 41%-61%) vs. 54% (95% CI: 44%-64%), p = 0.8] or being placed first-third [77% (95% CI: 68%-85%) vs. 71% (95% CI: 62%-80%, p = 0.5] in at least one race. MAIN LIMITATIONS: Retrospective nature of study with reliance on clinical records and public databases, limiting data available for analysis. CONCLUSIONS: Standing fracture repair is a viable treatment option for MC/MTIII or P1 fractures that returns horses to the racetrack within an acceptable time frame and is capable of restoring pre-surgical athletic ability.
ABSTRACT
BACKGROUND: Forelimb extensor tendon rupture (ETR) in foals is sparsely documented. OBJECTIVES: To describe clinical and imaging findings, treatment details, and long-term outcome in foals with ETR. STUDY DESIGN: Multicentre retrospective case-series. METHODS: Clinical record review of foals with ETR, presented to Faculty of Veterinary Medicine at Ghent University (Belgium), the Clinic for Horses at the University of Veterinary Medicine Hannover (Germany), and Rossdales Equine Hospital (UK) between 2009-2021. Long-term outcome based on structured telephone interview with the owner at the university hospitals and on future ratings from a public racing results archive at Rossdales Equine Hospital. RESULTS: Eight foals (28%; 95%CI: 11.7%-44.3%) presented with ETR only, whereas 21 foals (72%; 95%CI: 55.7%-88.3%) presented with ETR and concurrent flexural limb deformity foals with ETR only were older (median 20 days; Interquartile range [IQR] 13-22) than foals with ETR and flexural limb deformity (median five days; IQR 3-11; p = 0.001). Treatment included medical support, immobilization, and box rest. Hospitalisation time was longer for foals with ETR and flexural limb deformity (median 26 days; IQR 16-44) than for ETR-only foals (median 11 days; IQR 6-16; p = 0.03). Total rehabilitation time was longer for foals with ETR and flexural limb deformity (median 58 days; IQR 42-91) than for foals without flexural limb deformity (median 32 days; IQR 12-39; p = 0.03). Six foals (21%; 95%CI: 6.3%-35.7%) were euthanased within seven months: three because of problems with limb protraction and progressive flexural limb deformity. Long-term follow-up (>18 months) was available for two cases with ETR only, and seven cases with ETR and flexural limb deformity. Both ETR-only foals had a positive cosmetic outcome but only one a positive functional outcome. Foals with ETR and concurrent flexural limb deformity suffered limitations regarding cosmetic appearance (5/7 negative) and limb function (7/7 negative). MAIN LIMITATIONS: Small sample size, retrospective study, and no clinical follow-up. CONCLUSIONS: ETR is a rare condition in this sample of foals treated under hospital conditions often requiring prolonged care, especially with concurrent flexural limb deformity. Further research should investigate potential associations with future athletic performance.
