Plate fixation of equine splint bone fractures: 76% return to work in a multicenter series

Plate fixation of small metacarpal and metatarsal bone fractures in 27 horses

Virginia Melly, MVB; Kyla F. Ortved, DVM, PhD, DACVS (Large Animal), DACVSMR; Holly L. Stewart, VMD, PhD, DACVS (Large Animal); Darko Stefanovski, PhD; Dean W. Richardson, DVM, DACVS (Large Animal); Kirstin A. Bubeck, DVM, DACVS (Large Animal), DACVSMR; Patricia M. Hogan, VMD, DACVS (Large Animal); José M. García-López, VMD, DACVS (Large Animal), DACVSMR

Background

Proximal fractures of the small metacarpal and metatarsal bones (SMCT; splint bones) in horses can compromise carpometacarpal and tarsometatarsal joint stability due to altered lever arm mechanics. While plate fixation (PF) is recommended for unstable proximal fractures, existing literature is limited to small case series with variable outcomes. The authors aimed to describe fracture characteristics, surgical techniques, complications, and return-to-work outcomes in a larger multicenter cohort of horses undergoing PF for SMCT fractures.

Methods

This multicenter retrospective study reviewed medical records from three referral hospitals (2008–2023) and included 27 horses with SMCT fractures treated with PF and a minimum of 10 months of follow-up. Pre- and postoperative radiographs (and CT when available) were reviewed for fracture characteristics. Surgical variables, postoperative management, complications, and outcomes were recorded. Univariable and multivariable regression analyses were used to evaluate associations between explanatory variables and return to intended use. Racing performance before and after surgery was assessed in racehorses using official race records.

Results

All fractures were located in the proximal third of the SMCT; 96.3% were comminuted, 81.5% displaced, and 74.1% articular. Thoroughbred racehorses predominated, with medial splint bone (MC2) fractures most common. Postoperative complications occurred in 9/27 horses (33.3%), including surgical site infection, wound dehiscence, incomplete healing, implant-related issues, osteoarthritis, and two catastrophic outcomes resulting in euthanasia. Of horses with follow-up, 19/25 (76%) returned to their previous level of work or higher, including 10/11 (90.9%) racehorses and 9/14 (64.3%) non-racehorses. No individual explanatory variable was significantly associated with return to use. Racehorses had significantly lower earnings per start postoperatively compared to preoperatively, despite returning to racing.

Limitations

The retrospective design, small sample size, heterogeneous fracture configurations, and variability in surgical technique and postoperative management limit the ability to identify prognostic factors or compare PF with conservative management. Incomplete records and lack of a control group further restrict causal inference.

Conclusions

Plate fixation of proximal SMCT fractures resulted in a high rate of return to work in this cohort, exceeding outcomes reported in earlier case series. Although postoperative complications were relatively common, PF appears to be an effective treatment option for selected proximal splint bone fractures. Careful case selection and surgical technique remain critical, and larger prospective studies are needed to better define indications and prognostic factors for PF in equine SMCT fractures.

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