Non-surgical and surgical management of chip fractures of the fetlock

Equine Vet J. 2019 Sep 12.
Non-surgical and surgical management of metacarpo/metatarsophalangeal joint dorsal chip fracture in the Thoroughbred racehorse.
Ramzan PHL1, Wylie CE1,2.

Author information:
1. Rossdales LLP, Beaufort Cottage Stables, High Street, Newmarket, Suffolk, UK.
2. Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia.
Abstract
BACKGROUND:

Arthroscopy is considered the treatment of choice for dorsal osteochondral chip fractures of the metacarpo/metatarsophalangeal (MCP/MTP) joints in the racehorse; however, there is no published research on non-surgical management of this injury.
OBJECTIVES:

To compare clinical features, intra-articular medication use and return to racing in Thoroughbred racehorses with non-surgically (non-SX) or surgically (SX) managed MCP/MTP dorsal chip fracture.
STUDY DESIGN:

Retrospective observational study conducted between 2006 and 2014.
METHODS:

Radiographs of Thoroughbred racehorses were reviewed to identify MCP/MTP dorsal osteochondral chip fractures. Clinical and intra-articular medication data were obtained from veterinary records and return to racing data from a public online resource.
RESULTS:

A total of 98 MCP/MTP horses with dorsal chip fractures were identified (70 non-SX, 28 SX). Median age was 2 years (range 2-7 years). Osteochondral chip fractures predominantly involved the forelimbs (n = 92, 93.9%) and the majority were considered by the treating clinician to be clinically active (n = 85, 86.7%). Significantly more SX horses had a reported ongoing problem associated with the affected joint than non-SX horses (P = 0.002), however there was no significant difference between non-SX and SX horses in the number of intra-articular medications of affected joint per month of follow-up (P = 0.22). The proportion of horses racing post-diagnosis was not significantly different between non-SX (55/70; 78.6%, 95%CI 69.0, 88.2%) and SX horses (24/28; 85.7%, 95%CI 72.8, 98.73%) (P = 0.57). Median time to first start following diagnosis for non-SX (106 days, range 1-326) was significantly shorter than for SX horses (203 days, range 9-559) (P = 0.002).
MAIN LIMITATIONS:

Management technique was not randomised or blinded, with few surgically managed horses.
CONCLUSIONS:

The results contribute to the current evidence base used to guide management of osteochondral chip fractures of the metacarpo/metatarsophalangeal (MCP/MTP) joints in the racehorse, and indicate that non-surgical management may be a valid treatment option for some injuries.