A retrospective study comparing conservative and surgical treatments of open comminuted fractures of the fourth metatarsal bone in horses

Abstract

Summary The proximal third of metatarsal IV is predisposed to open comminuted fractures due to its superficial and prominent position and controversy exists regarding the most appropriate management for this type of fracture. Fifty‐three horses treated for open comminuted fractures of the proximal third of metatarsal IV were selected for study from 6 equine hospitals across England. Comparisons were made between the 21 horses treated conservatively and the 32 horses treated surgically. Horses treated conservatively at referral centres had comparable rates of survival, rates of return to full work and convalescent periods but a significantly lower cost than those treated surgically. The results of this study suggest that aggressive conservative therapy may be indicated in open comminuted fractures of the proximal third of metatarsal IV.

Internal fixation of proximal fractures of the 2nd and 4th metacarpal and metatarsal bones using bioabsorbable screws

“…Another study suggested that conservative therapy of open comminuted fractures of the proximal one-third of MT4 had comparable rates of survival, return to full work and convalescent period to those of surgically managed patients. 24 In that study, 80% of the horses were acutely injured (< 3 weeks since the injury) and conservative management offered a better prognosis. They also reported that horses that did not respond to conservative therapy developed exuberant callus formation, which led to longer convalescence times.…”

“…In the current series, most of the included subjects had undergone conservative therapy for 3–5 months without improvement and thus surgical intervention was the alternative option. Another study suggested that conservative therapy of open comminuted fractures of the proximal one‐third of MT4 had comparable rates of survival, return to full work and convalescent period to those of surgically managed patients . In that study, 80% of the horses were acutely injured (< 3 weeks since the injury) and conservative management offered a better prognosis.…”

“…In that study, 80% of the horses were acutely injured (< 3 weeks since the injury) and conservative management offered a better prognosis. They also reported that horses that did not respond to conservative therapy developed exuberant callus formation, which led to longer convalescence times …”

“…Because of the small MT4–tarsal bones articulation surfaces, there is minimal weight transfer and fewer proximal soft tissue attachments, so MT4 can be completely removed . No horses in this report had complete extirpation of MT4.…”

“…They also reported that horses that did not respond to conservative therapy developed exuberant callus formation, which led to longer convalescence times. 24 Another possible complication of conservative therapy is instability resulting from the amount of bone remaining and the integrity of its attachment to MC3/MT3, which could develop arthrosis of the distal carpal/tarsal joints. 7,23 Internal fixation of the proximal fragment to MC3/MT3 with the help of a small plate is suggested to maintain axial support.…”