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Proceedings of the 16th

Italian Association of Equine Veterinarians
Congress

Carrara, Italy
January 29-31, 2010

Next SIVE Meeting:

Feb. 4-6, 2011 – Montesilvano, Pescara, Italy

Reprinted in the IVIS website with the permission of the

Italian Association of Equine Veterinarians – SIVE

http://www.ivis.org
Published in IVIS with the permission of SIVE
Fractures of the metacarpal and metatarsal
condyles
Ian Wright
MA, VetMB, DEO, Dipl ECVS, MRCVS
Newmarket Equine Hospital, Newmarket, Suffolk, UK
Fractures of the distal condyles of third
metacarpal and third metatarsal bones are the
most common long bone fracture in racehors-
es throughout the world. They occur most fre-
quently in racing Thoroughbreds, less fre-
quently in Standardbreds and occasionally in
Quarterhorses. However, they are seen also in
polo ponies, endurance horses and occasion-
ally in other horse sports with animal’s mov-
ing at speed. They are considered to result
from fatigue damage at sites of perturbed
bone remodelling in the palmar/plantar sub-
chondral bone (Ellis, 1994; Stover et al, 1994;
Pool, 1999). The fractures propagate, for
varying distances, through bone that has un-
dergone, or is undergoing adaptation in re-
sponse to training (Riggs et al, 1999). Since
most occur in two and three year old, rather
than older, horses this is circumstantial sup-
port for failure of adaptation rather than cu-
mulative fatigue failure. Although most are
amenable to treatment they remain a frequent
catastrophic injury; in Great Britain they are
the most common catastrophic injury to occur
on racecourses while in the United States they
are second only to fractures of the proximal
sesamoid bones.
Fractures of the medial condyle are less com-
mon than lateral but are more likely to propa-
gate into the diaphysis (Ellis, 1994; Zekas et
al, 1999; Wright and Smith, 2009). The inci-
dence in forelimbs is approximately three
times that in hindlimbs (Meagher, 1976; Ellis,
1994; Bassage and Richardson, 1998; Zekas
et al, 1999; Martin, 2000). Although trends to
sidedness have been reported, metanalysis of
the principal series in the literature suggest
that right and left limbs appear to be affected
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Proceedings of the Annual Meeting of the Italian Association of Equine Veterinarians, Carrara, Italy 2010
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in approximately equal numbers and to be in-
dependent of track direction.
Incomplete fractures may involve only the pal-
mar/plantar subchondral bone or may be bicor-
tical. Fractures are classified as complete if
they extend through to the periosteal surface of
the metaphysis or diaphysis of the bone. Dis-
placement may be abaxial, proximodistal, dor-
sopalmar/plantar or rotational and frequently
there is a combination of these. Two types of
fracture may propagate into the metacarpal/
metatarsal diaphysis; the first remain in a sagit-
tal or parasagittal plane and the second begin in
this plane and then change orientation to
oblique or frontal planes – these generally are
referred to as spiral. Comminution is seen only
with complete fractures. Fractures of the later-
al condyle vary in their point of origin from the
sagittal groowes adjacent to the sagittal ridge,
to narrow fragments, less then 10 mm from the
abaxial margin of the bone. Fractures which
commence axially usually are longer than those
which arise abaxially (Zekas et al, 1999). Thus,
propagating fractures of the lateral condyle
usually originate close to the sagittal ridge and
fractures of the medial condyle almost invari-
ably commence immediately adjacent to the
sagittal ridge (James and Richardson, 2006;
Wright and Smith, 2009).
Most palmar/plantar fractures (Fig. 1) heal
spontaneously with rest (Kawcak et al, 1995)
and if horses are removed from training it is
rare for these fractures to progress. Some
may become delayed unions and others recur
on resumption of exercise. Such cases fre-
quently respond well to compression with a
single 4.5 mm AO/ASIF cortical screw in the
epicondylar fossa.
Published in IVIS with the permission of SIVE
Figure 1 - Flexed dorsopalmar projection of a fracture in
the palmar subchondral bone of the lateral condyle of the
third metacarpal bone.
Figure 2 - Radiologically incomplete fracture of the lateral condyle of the third metacarpal bone repaired with 2 x 4.5 mm
and 1 x 3.5 mm cortical screws.
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Proceedings of the Annual Meeting of the Italian Association of Equine Veterinarians, Carrara, Italy 2010
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Some bicortical incomplete fractures also will
heal satisfactorily without repair. However, ra-
diographic examination does not, at least in
the acute phase, reliably differentiate between
complete and incomplete fractures. Surgical
immobilisation and compression of the frac-
ture will minimise the articular deficit, im-
prove the quality of hyaline cartilage repair,
reduce the risk of fracture propagation and of-
fer the most effective and expedient analgesia
(Fig. 2). It also should minimise the period of
necessary immobilisation or confinement. A
reduced risk of re-fracture has been suggested
(Bertone, 2002). Thus, in most cases surgical
repair is the treatment of choice. This usually
is effected by radiographically guided, percu-
taneous insertion of 4.5 mm AO/ASIF cortical
screws in a lag technique. The first screw is
placed in the middle of the epicondylar fossa
at the junction of its proximal and middle one
thirds. Despite some suggestions in the litera-
ture, use of a countersink is recommended.
Published in IVIS with the permission of SIVE
Proximal screws are placed as the individual
fracture dictates at 20-30 mm intervals.
Complete, non-displaced fractures are inher-
ently unstable and should be repaired. If the
fracture configuration confidently can be de-
termined from preoperative radiographs then
percutaneous, radiographically controlled, lag
screw insertion is appropriate. However, if
there is uncertainty regarding the configura-
tion, particularly proximally where the frac-
ture may deviate in the lateral cortex, then an
open approach is recommended. At this mar-
gin, thin (≤10 mm) proximal “spikes” should
be repaired with smaller, usually 3.5 mm di-
ameter cortical screws. In non-displaced frac-
tures, palmar/plantar articular fragments can
be compressed with the principal fracture.
Figure 3 - Displaced fracture of the lateral condyle of the third metatarsal bone and its repair with 3 x 4.5 mm and 1 x 3.5 mm
cortical screws.
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Proceedings of the Annual Meeting of the Italian Association of Equine Veterinarians, Carrara, Italy 2010
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Displaced fractures may be simple or com-
minuted proximally or distally. There are no
circumstances under which displaced frac-
tures can satisfactorily be managed without
reduction and repair. The principal goal is re-
construction of articular congruency and
should be achieved and/or verified arthroscop-
ically. Screws generally are inserted by an
open approach in order to assess the extra ar-
ticular portion of the fracture (Fig. 3).
Some propagating fractures of the third
metacarpal/metatarsal bones can heal without
surgical intervention but it is associated with
sufficiently high morbidity and mortality
rates that it cannot generally be recommend-
ed. An open lateral approach allows the sur-
geon, in most cases, to see the fracture as it
Published in IVIS with the permission of SIVE
propagates in the dorsal cortex and, with spi-
ral fractures, from the palmar/plantar cortex
into the lateral cortex (Wright and Smith,
2009). Direct fracture observation enables the
surgeon to insert screws in a biomechanically
optimal position along the entire length of the
fracture (Fig. 4). Radiographic prediction of
fracture configurations is sufficiently inaccu-
rate to preclude safe percutaneous repair. Spi-
ral fractures which involve a mid-diaphyseal
“Y” configuration require the support of a
broad, limited contact or locking compression
plate which can be applied by an open ap-
proach or by a skin sparing technique follow-
ing the creation of a subcutaneous tunnel
(James and Richardson, 2006).
Figure 4 - Spirally propagating fracture of the medial condyle of the third metacarpal bone and repair with 8 x 4.5 mm cor-
tical screws from a lateral approach.
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REFERENCES
Bassage, L.H., Richardson, D.W. (1998) Longitudinal
fractures of the condyles of the third metacarpal
and metatarsal bones in racehorses: 224 cases
(1986-1995). J Am Vet Med Assoc 212, 1757-
1764.
Bertone, A.L. (2002) The metacarpus and metatarsus. In:
Adams’ Lameness in Horses 5th Edn, Ed: Stashak,
T.S., Lippincott, Williams & Wilkies, Baltimore, pp
800-830.
Ellis, D.R. (1994) Some observations on condylar frac-
tures of the third metacarpus and third metatarsus in
young Thoroughbreds. Equine Vet J 26, 178-183.
James, F.M., Richardson, D.W. (2006) Minimally inva-
sive plate fixation of lower limb injury in horses: 32
cases (1999-2003). Equine Vet J 38, 246-251.
Kawcak, C.E., Bramlage, L.R. and Embertson, R.M.
(1995) Diagnosis and management of incomplete
Published in IVIS with the permission of SIVE
fracture of the distal palmar aspect of the third
metacarpal bone in five horses. J Am Vet Med As-
soc 206, 335-337.
Martin, G.S. (2000) Factors associated with racing per-
formance of Thoroughbreds undergoing lag screw
repair of condylar fractures of the third metacarpal
or metatarsal bone. J Am Vet Med Assoc 217,
1870-1877.
Meagher, D.M. (1976) Lateral condylar fractures of the
metacarpus and metatarsus in horses. Proc 22nd
Am Assoc Equine Pract p147.
Pool, R.R. (1999) Multidisciplinary investigation of the
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oughbreds. Equine vet J 31, 96.
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Pathology of the distal condyles of the third
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Proceedings of the Annual Meeting of the Italian Association of Equine Veterinarians, Carrara, Italy 2010
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metacarpal and third metatarsal bones of the horse.
Equine vet J 31, 140-148.
Stover, S.M., Deryck, H., R., Johnson, B.J., Harrington,
T., Ardans, A., Anderson, M.L., Barr, C.B., Daft,
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L.W. (1994) Lateral condylar fracture histomor-
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Pract 40, 173.
Wright, I.M. and Smith, M.R.W. (2009) A lateral approach
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condyle of the third metacarpal and metatarsal bone
in 18 racehorses. Vet Surg 38, 689-695.
Zekas, L.J., Bramlage, L.M., Embertson, R.M. and Hance,
S.R. (1999a) Characterisation of the type and loca-
tion of fractures of the third metacarpal/metatarsal
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