title: Management of comminuted fractures of the proximal phalanx in horses: 64 cases (1983-2001).
abstract: OBJECTIVE
  To report the outcome of surgical treatment of comminuted fractures of the proximal phalanx in horses.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  64 horses.
  
  
  METHODS
  Medical records and radiographs were reviewed to obtain information regarding signalment, fracture classification, and treatment. Follow-up information was obtained by telephone conversation or evaluation of production records.
  
  
  RESULTS
  Thirty-eight horses had moderately comminuted fractures of the proximal phalanx. Two horses were euthanatized immediately. Fractures of the proximal phalanx in 36 horses were repaired with open reduction and internal fixation with a successful outcome in 33 (92%) horses. Reconstruction of the fracture was performed in most horses by use of a long curved incision, transection of the collateral ligament of the metacarpophalangeal or metatarsophalangeal joint, and open exposure of the proximal articular surface of the proximal phalanx. Twenty-six horses had severely comminuted fractures of the proximal phalanx. Six horses were euthanatized immediately. One horse was euthanatized after 9 days of treatment with a cast alone. Severely comminuted fractures of the proximal phalanx in 13 horses were treated with an external skeletal fixation device, and fractures healed in 8 of those horses. Six horses with severely comminuted fractures of the proximal phalanx were treated with transfixation pins incorporated into a fiberglass cast, and fractures healed in 4 horses.
  
  
  CONCLUSIONS
  Moderately comminuted fractures of the proximal phalanx can be successfully repaired; however, fractures that are too severe to permit accurate reconstruction of the fragments remain difficult to treat and horses have only a fair prognosis for survival.
authors.affiliation: Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA 19348, USA.
authors.forename: Beth M
authors.initials: BM
authors.lastname: Kraus
authors.forename: Dean W
authors.initials: DW
authors.lastname: Richardson
authors.forename: David M
authors.initials: DM
authors.lastname: Nunamaker
authors.forename: Michael W
authors.initials: MW
authors.lastname: Ross
mesh_terms: D000818:Animals; D005500:Follow-Up Studies; D005552:Forelimb / Q000293:injuries* / Q000601:surgery; D005592:Fracture Fixation / Q000379:methods / Q000662:veterinary; D005593:Fracture Fixation, Internal / Q000379:methods / Q000662:veterinary; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000601:surgery / Q000662:veterinary*; D006614:Hindlimb / Q000293:injuries* / Q000601:surgery; D006736:Horses / Q000293:injuries* / Q000601:surgery; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D014034:Toes / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome