Abstract
PICO question
 In young Thoroughbreds with osteochondral fragments of the proximo-plantar aspect of the proximal phalanx, does pre-emptive surgical removal of the fragments compared to conservative (non-surgical) management reduce the incidence of subsequent lameness?
 Clinical bottom line
 There is currently insufficient data to determine the impact, on subsequent lameness, of conservative versus surgical management of proximo-plantar osteochondral fragments in young Thoroughbreds. Indeed, only three relevant studies were found, which include one retrospective study and two smaller case series. Since there are no substantive studies that have specifically focused on the treatment of plantar osteochondral fragmentation in Thoroughbred racehorses, the strength of evidence currently available is low.
 
Highlights
Intervention details: All horses were divided into two groups: Surgical removal in 10 horses Conservative treatment in nine horses
O Follow-up information was acquired by examination or telephone conversation with the owner or the trainer
Of the nine horses treated conservatively, 8 (89%) were unable to perform at pre-lameness levels: o The five horses treated with intra-articular polysulphated glycosaminoglycans (PSGAGs) had some temporary relief of clinical signs o One horse received PSGAGs 3 times, at weekly interval, swam instead of training and returned at higher racing level o The two horses treated with intra-articular corticosteroids showed relief from lameness for 2 months o One of the two horses not treated was retired immediately and the other one was sold as failing to train as required speed
Summary
Julia Dubuc DMV, DÉS, DACVS-LA, M.Sc, MRCVS 1* Christopher Akkari BVMedSci (Hons), BVM BVS (Hons), MRCVS2. In young Thoroughbreds with osteochondral fragments of the proximo-plantar aspect of the proximal phalanx, does pre-emptive surgical removal of the fragments compared to conservative (non-surgical) management reduce the incidence of subsequent lameness?. There is currently insufficient data to determine the impact, on subsequent lameness, of conservative versus surgical management of proximo-plantar osteochondral fragments in young Thoroughbreds. Clinical Scenario You are required to perform prepurchase radiographs (including both stifles, tarsi and carpi as well as all four fetlocks) on a young racing thoroughbred. All joints radiographed are unremarkable aside from the left metatarsophalangeal joint, which presents a proximo-plantar osteochondral fragment (PlOF) of the medial aspect of the proximal phalanx. The trainer asks if surgical removal is advised at this stage
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