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Fetlock chips at the front of the joint vs at the back of the joint

If your horse must fracture something, cross your fingers it is a chip fracture. Outcomes for chip removal are very good to excellent in most cases. And with the continued development of surgical techniques, such as standing chip removals and the use of progressively smaller endoscopic cameras, we can hope that outcomes might become even more successful and complication-free.

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Most horse owners would be aware of the term 'bone chip' or osteochondral fragments and have come accross such terms perhaps during a pre-purchase of a horse or a routine checkup. One may immediately be allerted as a 'red flag' situation however not all osteochondral fragments are alike nor are they all the same level of significance.

 

Bone chips or osteochondral fragments are seen via radiographs, a diagnostic modality commonly used when lameness/pain/swelling is detected in a joint or during a thorough veterinary exam during a pre-purchase. Such findings at the time of exam may be causing nil to low level of significance to performance and overall joint health. However on the other hand bone chips can be graded as a 'high level' of risk and may already be detromental to athletes performance, due to lameness, postive reactions during flexion tests of joint swelling.

 

Such findings on radiographs have a variation of meanings that effect prognosis and treatment moving forward. Most of the time it is hard to determine if the cause if from trauma or exercise however this generally doesn't effect the outcome moving forward. Unfortunately due to the high level of motion and loading of the joint the fetlock is the most common joint where a vet will dicover such bone fragments. Some good idicating points to recognise when such findings are discovered is the age of the equine athlete and the level of work this horse is in. An older horse in heavy work with NO signs of lameness compared to a younger horse in light work with signs of lameness will make a significant difference to how such 'bone chips' make be looked at.

 

The two main areas bone chips or osteochondral fragments are found are at the FRONT of the joint or at the BACK of the joint. Both locations have different impacts on potential joint health/risks moving forward and different treatment plans. So lets jump in.......

Fragments at the FRONT of the joint

(dorsal proximal P1 osteochondral fragments)

 

These are generally due to trauma and are significant regarding possible contributing to lameness. What is seen on radiographs can be deceiving as the cartilage damage under the bone cannot be visualised. Generally, there is damage to the weight bearing surface of the joint and there is associated cartilage damage.

 

In most instances it is recommended that these fragments be removed via arthroscopy. Thankfully surgery is usually very successful, and these animals can return to full athletic performance a few months after surgery.

 

Arthroscopy (surgery) for this specific fragment can wither be performed under general anaesthetic (see image 3) or done standing (videos below). Doing this procedure standing is extremely safe for the horse, and decrease risks associated with recovery from anaesthetics.

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Fragments at the BACK of the joint

(palmar/plantar P1 fragments)

 

These are VERY common incidental findings in lameness and pre-purchase exams. The “bone chips” are the back of the fetlock joints are usually NOT associated with lameness or poor performance. They are thought to be of a developmental/genetic origin and a usually present from a very young age.

 

In my opinion, they should only be considered significant and of “high risk” if there is swelling and lameness associated with the joint. We do not commonly suggest removal of these fragments if no lameness or joint swelling is occurring.

 

 

These are many top level performance horses with these fragments in their joints that have never had a lame step in their life.

Ready to Ride

Joint health plays such a major role in keeping our horses sound and performing at their best. Whether you have a racehorse, jumping horse or pleasure horse the importance of understanding our animal's anatomy and function is very important. This allows us to provide the best ongoing care for a long healthy performance career well into our horses teens. 

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