Comminuted fractures of the proximal phalanx in horses: A multicentre retrospective review

Summary Background Comminuted fractures of the proximal phalanx (CFPP), defined as the presence of three or more major fracture fragments, present difficult management challenges. Feedback from practitioners and long‐term follow‐up can be helpful to reassess evidence‐based treatment strategies and improve clinical outcomes. Objectives To collect and analyse CFPP data from equine veterinary practices and hospitals, evaluate the long‐term outcome and propose a modified radiographic classification system to aid treatment selection and refine the prognosis. Study design A multicentre retrospective review. Methods Medical records were reviewed and fractures classified as moderately (MCFPP), severely (SCFPP) or highly (HCFPP) CFPP categories. HCFPP was defined by the absence of a continuous cortical fragment between joints, along with extensive osseous fragmentation in the central part of the diaphysis of the proximal phalanx. Results Between 2002 and 2024, 154 horses were evaluated. Survival rates were 64% for MCFPP, 59% for SCFPP and 39% for HCFPP. Lag screw fixation (SF) of MCFPP achieved the highest surgical survival rate (78%). Seven of eight horses (87.5%) managed conservatively with a simple cast survived to 1‐year follow‐up (2 MCFPP, 5 SCFPP, 1 HCFPP). The major complication was transfixation pin tract infection (43%), followed by pin breakage (40%), discomfort (35%) and contralateral laminitis (19%). Among 55 horses with long‐term follow‐up information (>1 year), 9% were euthanised after 1 year, and 10% resumed riding activity. Main limitations Retrospective design, incomplete data, reliance on the accuracy of medical records and potential reporting bias caused by the possible reluctance of some veterinarians to report unfavourable outcomes. Conclusions This study represents the most comprehensive review of CFPP and introduces a new fracture classification that appears to be correlated with survival outcome. SF of MCFPP offers the best prognosis, and simple cast immobilisation may offer a valid treatment when surgical treatment methods are not an option.