A case‐matched controlled retrospective performance indexed analysis of Thoroughbred racehorses that underwent surgical repair of proximal phalanx and third meta‐carpal/tarsal condylar fractures

Background Standing fracture repair has become established as an acceptable technique with a good long‐term prognosis. However, no study has compared racing outcomes with case‐matched controls. Objectives To compare racing outcomes between a large dataset of horses undergoing standing fracture repair against case‐matched controls. Study Design Retrospective case‐matched controlled comparative study. Methods Thoroughbred racehorses undergoing standing repair of distal limb fracture(s) over 10 years (2012–2022) at five hospital centres across North America and Europe were included. Data retrieved included age, sex, fracture type, pre‐ and post‐operative racing status, days elapsed between repair and first start, and number of starts and places (1–3), which were used to generate a performance index (PI) and a performance index per start (PI/S). Two case‐matched controls were assigned and used for post‐operative comparison of racing performance. Results 185/265; 69.8% (confidence interval (CI): 63.9%–75.4%) of horses raced post‐surgery. No significant difference in the proportion of cases and case‐matched controls (260/342; 76% (CI: 71.3%–80.4%)) that returned to racing was observed. No significant difference in post‐operative performance indicators (N starts, PI, PI/S) between cases ((9, inter‐quartile‐range (IQR): 14) (7, IQR: 14) (0.64, IQR: 1)) respectively, and case‐matched controls ((9, IQR: 17) (5, IQR: 14.8) (0.6, IQR: 0.66)) respectively, was observed. Fracture type, limb, sex, or pre‐operative racing experience did not affect the proportion of horses returning to racing. Main Limitation The retrospective nature of this study may lead to the omission of data for analysis. Conclusion Horses undergoing standing internal fixation of select proximal phalanx and third metacarpal/tarsal condylar fractures have a good prognosis for return to racing and comparable performance with case‐matched controls. Horses that undergo standing fracture repair have good longevity, outweighing surgical costs and loss of training.