Observations and management of fractures of the proximal phalanx in young Thoroughbreds

Ellis, David R.; Simpson, David J.; Greenwood, R. E. S.; Crowhurst, James

doi:10.1111/j.2042-3306.1987.tb02579.x

Cited by 50 publications

(70 citation statements)

References 2 publications

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“…This result coincides with the cli-nical evidence that fracture of the trabecular region is the most common in the proximal phalanx (Nixon 2012). In this study post-fracture CT images revealed that most fracture lines were located in the sagittal plane at the proximal or distal trabecular regions, similarly to an earlier retrospective study (Ellis et al 1987). Thus, it would be important to focus on this region in further studies, as the trabecular region appears to be the key component in sagittal proximal phalanx fractures.…”

Section: Discussionsupporting

confidence: 78%

“…Thus, it would be important to focus on this region in further studies, as the trabecular region appears to be the key component in sagittal proximal phalanx fractures. Proximal phalanx fractures are categorized as sagittal or transverse, the latter extends across the bone and does not involve articular surfaces (Ellis et al 1987). Sagittal proximal phalanx fractures are categorized as incomplete or complete.…”

Section: Discussionmentioning

confidence: 99%

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Bone mineral density (BMD) and computer tomographic measurements of the equine proximal phalanx in correlation with breaking strength

Tóth¹,

Horváth²,

Ferencz³

et al. 2013

Polish Journal of Veterinary Sciences

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Despite the fact that bone mineral density (BMD) is an important fracture risk predictor in human medicine, studies in equine orthopedic research are still lacking. We hypothesized that BMD correlates with bone failure and fatigue fractures of this bone. Thus, the objectives of this study were to measure the structural and mechanical properties of the proximal phalanx with dual energy X-ray absorptiometry (DXA), to correlate the data obtained from DXA and computer tomography (CT) measurements to those obtained by loading pressure examination and to establish representative region of interest (ROI) for in vitro BMD measurements of the equine proximal phalanx for predicting bone failure force.DXA was used to measure the whole bone BMD and additional three ROI sites in 14 equine proximal phalanges. Following evaluation of the bone density, whole bone, cortical width and area in the mid-diaphyseal plane were measured on CT images. Bones were broken using a manually controlled universal bone crusher to measure bone failure force and reevaluated for the site of fractures on follow-up CT images. Compressive load was applied at a constant displacement rate of 2 mm/min until failure, defined as the first clear drop in the load measurement.The lowest BMD was measured at the trabecular region (mean ± SD: 1.52 ± 0.12 g/cm 2 ; median: 1.48 g/cm 2 ; range: 1.38-1.83 g/cm 2 ). There was a significant positive linear correlation between trabelcular BMD and the breaking strength (P=0.023, r=0.62). The trabecular region of the proximal phalanx appears to be the only significant indicator of failure of strength in vitro. This finding should be reassessed to further reveal the prognostic value of trabecular BMD in an in vivo fracture risk model.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Bone mineral density (BMD) and computer tomographic measurements of the equine proximal phalanx in correlation with breaking strength

Tóth¹,

Horváth²,

Ferencz³

et al. 2013

Polish Journal of Veterinary Sciences

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“…Most P1 fractures in the Thoroughbred racehorse occur in a predictable configuration, along a sagittal plane through the proximal sagittal groove (Ellis et al. ; Stover, ; Murray et al. ).…”

Section: Introductionmentioning

confidence: 99%

“…One theory of aetiology for sagittal fractures of P1 is that the rotary movement between the sagittal groove of the proximal P1 and the distal third metacarpal bone (McIII) sagittal ridge, induces compressive and torsional forces that ultimately lead to fracture as an acute biomechanical event or monotonic overload (Markel & Richardson, ; Ellis et al. ; Holcombe et al. ).…”

Section: Introductionmentioning

confidence: 99%

Does subchondral bone of the equine proximal phalanx adapt to race training?

Noble

Singer²,

Jeffery

2016

Journal of Anatomy

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Sagittal fractures of the first phalanx are a common, potentially catastrophic injury in racehorses. These fractures are often linked to an acute, one time, biomechanical event; however, recent evidence implies that chronic exposure to stress can lead to the accumulation of bony changes that affect the structural integrity of the bone and increase the likelihood of fracture. The aim of the study was to compare variations of two common metrics of bone adaptation - subchondral bone density and thickness across the proximal articular surface of the first phalanx in Thoroughbred horses that (1) raced but never experienced a first phalanx fracture (Raced Control); (2) raced and had experienced fracture of the contralateral first phalanx (Contralateral to Fracture); (3) had never raced or experienced a first phalanx fracture (Unraced Control). A total of 22 first phalangeal bones were sampled post-mortem and imaged using micro-computed tomography calibrated for mineral density measures. Measurements of volumetric subchondral bone mineral density and thickness were taken from images at five sites from medial to lateral, in three coronal planes (25, 50 and 75% dorsal-palmar). At each of the 15 sites, measurements were repeated and averaged across 10 adjacent micro-computed tomography slices of bone, spanning 0.75 mm. The magnitude and variance of these measurements were compared between sites and between cohorts with non-parametric statistical tests. Across the proximal osteochondral surface of the first phalanx, the pattern of subchondral bone volumetric bone mineral density and thickness varied with each coronal section studied. The subchondral bone thickness was greater for the central and dorsal coronal sections, compared with the palmar section. For the race-fit groups (Raced Control and Contralateral to Fracture), the highest volumetric bone mineral density was in the central sagittal groove. The volumetric bone mineral density was significantly greater in the sagittal groove in the central coronal section in the raced than the unraced group. The Contralateral to Fracture group demonstrated significantly greater variance of volumetric bone mineral density compared with the Raced Control and Unraced Control (P < 0.0001), with no difference in variance noted between the Raced Control and Unraced Control groups. There was a small (R rank = 0.3) but significant correlation between subchondral bone volumetric bone mineral density and thickness in the Contralateral to Fracture group (P = 0.005). The findings demonstrate that differences exist in subchondral bone volumetric bone mineral density and thickness across the proximal osteochondral surface of the equine first phalanx in horses with different training histories. The findings also demonstrate that the subchondral bone of the sagittal groove of the equine first phalanx adapts to race-training in the race-fit groups (Raced Control and Contralateral to Fracture) with an increase in volumetric bone mineral density relative to unraced controls. Within the race-trained ...

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“…It is also suggested that the decrease in the bone tissue parameters in the vicinity of proximal metaphysic of the proximal phalanx can be conducive to this type of fractures. Bone fractures are more likely to occur in the context of low bone tissue parameters such as decrease in the number of bone trabeculae, their volume, density and width [2,3]. Unfortunately, there are few reports on the bone tissue parameters of the proximal phalanges.…”

Section: Introductionmentioning

confidence: 99%

The analysis of densitometric and geometric parameters of bilateral proximal phalanges in horses with the use of peripheral quantitative computed tompgraphy

Dzierzęcka

Charuta

2012

Acta Vet Scand

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BackgroundProximal phalanges in horses are among bones that are most prone to injuries. So far, the detailed analysis of densitometric and geometric parameters of both front legs proximal phalanges in horses has not been investigated. The aim of this study was to compare the densitometric and geometric parameters between proximal phalanges in equine both front legs with the use of peripheral quantitative computed tomography (pQCT).MethodsThe study material comprised isolated both front legs proximal phalanges derived from 22 horses. The structure analysis of the proximal phalanges was conducted with the pQCT. The following bone parameters were determined: bone mineral content, volumetric bone mineral density, total bone area, trabecular area, cortical area, cortical thickness, periosteal circumference, endocortical circumference, Strength Strain Index. Tomographic analysis of proximal phalanges was conducted at three levels: at 15%, 50% and 85% of the bone length.ResultsThe statistical analysis showed that both the densitometric and geometric parameters of the bone at 50% and 85% of its length, did not present any statistically significant differences for the left or right proximal phalanges of the forelimb. At the same time, all examined parameters measured at 15% of the bone length, in the vicinity of the proximal metaphysis revealed significant statistical differences between both front legs proximal phalanges.ConclusionsThe proximal phalanx parameters in the forelimbs are significantly different for the left and right proximal phalanx at 15% of the length and they indicate higher Strength Strain Index of the left bone in this location. The densitometric and geometric parameters of the bone at 50% and 85% of its length, did not present any statistically significant differences for the left or right proximal phalanges of the left and right forelimbs. The most serious changes caused by asymmetrical load of the thoracic limbs in horses occur near the proximal metaphysis, where the spongious substance is most abundant. This may happen because the metabolism of the spongious bone tissue is eight times faster compared to the compact bone tissue. Thus, any changes, including those caused by asymmetrical strain exerted on the right and left thoracic limbs, are the earliest to be observed.

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Observations and management of fractures of the proximal phalanx in young Thoroughbreds

Cited by 50 publications

References 2 publications

Bone mineral density (BMD) and computer tomographic measurements of the equine proximal phalanx in correlation with breaking strength

Bone mineral density (BMD) and computer tomographic measurements of the equine proximal phalanx in correlation with breaking strength

Does subchondral bone of the equine proximal phalanx adapt to race training?

The analysis of densitometric and geometric parameters of bilateral proximal phalanges in horses with the use of peripheral quantitative computed tompgraphy

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