BACKGROUND Arthroscopy is considered the treatment of choice for dorsal osteochondral chip fractures of the metacarpo/metatarsophalangeal (MCP/MTP) joints in the racehorse; however, there is no published research on non-surgical management of this injury. OBJECTIVES To compare clinical features, intra-articular medication use and return to racing in Thoroughbred racehorses with non-surgically (non-SX) or surgically (SX) managed MCP/MTP dorsal chip fracture. STUDY DESIGN Retrospective observational study conducted between 2006 and 2014. METHODS Radiographs of Thoroughbred racehorses were reviewed to identify MCP/MTP dorsal osteochondral chip fractures. Clinical and intra-articular medication data were obtained from veterinary records, and return to racing data from a public online resource. RESULTS A total of 98 MCP/MTP horses with dorsal chip fractures were identified (70 non-SX, 28 SX). Median age was 2 years (range 2-7 years). Osteochondral chip fractures predominantly involved the forelimbs (n = 92, 93.9%) and the majority were considered by the treating clinician to be clinically active (n = 85, 86.7%). Significantly more SX horses had a reported ongoing problem associated with the affected joint than non-SX horses (P = 0.002), however there was no significant difference between non-SX and SX horses in the number of intra-articular medications of affected joint per month of follow-up (P = 0.22). The proportion of horses racing post-diagnosis was not significantly different between non-SX (55/70; 78.6%, 95% CI 69.0, 88.2%) and SX horses (24/28; 85.7%, 95% CI 72.8, 98.73%) (P = 0.57). Median time to first start following diagnosis for non-SX (106 days, range 1-326) was significantly shorter than for SX horses (203 days, range 9-559) (P = 0.002). MAIN LIMITATIONS Management technique was not randomised or blinded, with few surgically managed horses. CONCLUSIONS The results contribute to the current evidence base used to guide management of osteochondral chip fractures of the MCP/MTP joints in the racehorse, and indicate that non-surgical management may be a valid treatment option for some injuries.

中文翻译：

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纯种赛马掌骨/跖趾关节背侧芯片骨折的非手术和手术治疗。

背景 关节镜被认为是赛马掌骨/跖趾（MCP/MTP）关节背侧骨软骨碎片骨折的首选治疗方法。然而，没有关于这种损伤的非手术治疗的已发表研究。目的 比较非手术（非 SX）或手术（SX）管理的 MCP/MTP 背侧芯片骨折纯种赛马的临床特征、关节内药物使用和重返赛马。研究设计 回顾性观察研究于 2006 年至 2014 年间进行。方法 审查纯种赛马的 X 光片以确定 MCP/MTP 背侧骨软骨碎片骨折。临床和关节内用药数据来自兽医记录，并从公共在线资源返回赛车数据。结果 共鉴定出 98 匹 MCP/MTP 马背侧芯片骨折（70 匹非 SX，28 匹 SX）。中位年龄为 2 岁（范围 2-7 岁）。骨软骨碎片骨折主要累及前肢（n = 92, 93.9%），大多数被治疗临床医生认为具有临床活性（n = 85, 86.7%）。与非 SX 马相比，明显更多的 SX 马报告与受影响的关节相关的持续问题（P = 0.002），但是在每个受影响关节的关节内药物数量方面，非 SX 和 SX 马之间没有显着差异随访月（P = 0.22）。非SX (55/70; 78.6%, 95% CI 69.0, 88.2%)和SX马(24/28; 85.7%, 95% CI 72.8, 98.73%)诊断后赛马比例无显着差异) (P = 0.57)。非 SX 诊断后首次开始的中位时间（106 天，范围 1-326）明显短于 SX 马（203 天，范围 9-559）（P = 0.002）。主要限制管理技术不是随机的或盲法的，很少有手术管理的马。结论 该结果有助于建立当前用于指导赛马 MCP/MTP 关节骨软骨碎片骨折治疗的证据基础，并表明非手术治疗可能是某些损伤的有效治疗选择。