Veterinary Surgery Deep Dive: Equine Ortho — November 2025 Edition

In this episode of the Simini Equine Surgery Podcast, we explore the orthopedic research from the November 2025 issue (Issue 8) of Veterinary Surgery, where two studies focus on a shared objective: identifying orthopedic injuries earlier and treating them more effectively to maximize athletic performance and long-term soundness. 

One study demonstrates how early arthroscopic intervention can prevent incomplete third carpal bone slab fractures from progressing into career-ending injuries, while the second presents the largest multicenter case series to date evaluating plate fixation for proximal splint bone fractures in horses.

In this episode:

✅ Garcia-Collao et al. evaluated arthroscopic debridement of incomplete third carpal bone slab fractures (ISFs) in Thoroughbred and Standardbred racehorses. Reviewing 33 horses, the authors reported that 66.7% successfully returned to racing following early surgical intervention, with a median rehabilitation period of 247 days. The study emphasizes the importance of recognizing these lesions before progression to complete slab fractures or advanced osteoarthritis. During arthroscopy, surgeons observed medial palmar intercarpal ligament (MPIL) injury in every horse, raising important questions about whether ligament pathology may contribute to the development of these fractures rather than simply occurring as a consequence of them. The findings strongly support early diagnosis using skyline radiographs followed by aggressive arthroscopic debridement to preserve athletic careers. 

✅ Melly et al. presented the largest published series evaluating plate fixation of proximal small metacarpal and metatarsal (splint bone) fractures in horses. Among 27 cases, 76% returned to their previous level of work or higher, while more than 90% of racehorses returned to racing following surgery. The study provides valuable technical guidance on implant selection, emphasizing the importance of maximizing screw purchase in relatively soft splint bone while avoiding penetration into the cortex of the third metacarpal or metatarsal, where stress risers may lead to catastrophic fractures during anesthetic recovery. The authors also discuss intraoperative screw stripping, postoperative complications, and practical considerations that can significantly influence surgical success. 

Together, these studies reinforce a central principle of equine orthopedic surgery: successful outcomes often depend on recognizing injuries before they become catastrophic and executing meticulous surgical technique that respects both anatomy and biomechanics.

🎓 Journal Articles Discussed

• Garcia-Collao et al. — Outcome of arthroscopic debridement for the treatment of incomplete third carpal bone slab fractures in racehorses
• Melly et al. — Plate fixation of small metacarpal and metatarsal bone fractures in 27 horses

📚 From the November 2025 Issue (Issue 8) of Veterinary Surgery

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Transcript

SPEAKER_00 0:04

Hi, I'm Carl Damiani, and this is the Simene Equine Surgery Podcast, your fast focused update on what matters most from the latest equine surgical literature. In each episode, we break down key articles from the veterinary journals and translate them into practical surgical insight you can use. Today, not someday. This episode covers the orthopedic section from the November 2025 issue of Veterinary Surgery, featuring two studies focused on improving outcomes after equine orthopedic injury from early intervention in racehorses to advanced fracture fixation techniques. First, we'll look at Garcia Kalau et al., who evaluate arthroscopic debridement for incomplete third carpal bone slab fractures in racehorses. We'll discuss why recognizing these injuries before they progress to complete fractures may dramatically improve the likelihood of returning horses to competition and how early surgical intervention could change the way we approach these challenging carpal lesions. Then we'll review Melly et al. who present the largest multi-center series to date on plate fixation of proximal small metacarpal and metatarsal fractures. We'll explore the surgical techniques, postoperative complications, and return to work outcomes that help clarify when plate fixation offers the greatest advantage and what factors surgeons should keep in mind when selecting cases. Two studies. One common goal identifying orthopedic injuries earlier and treating them more effectively to maximize athletic performance and long-term soundness. Let's dive in.

SPEAKER_01 1:43

If you

Garcia-Collao et al. Study: Evaluating Arthroscopic Debridement for Incomplete Third Carpal Bone Slab Fractures (ISFs) in Racehorses.

SPEAKER_01 1:44

uh if you leave an incomplete carpal slab fracture alone in a racehorse, I mean you aren't just resting them. You are essentially guaranteeing a career-ending injury.

SPEAKER_02 1:53

Right, yeah. It's basically a ticking time bomb.

SPEAKER_01 1:55

Exactly. Think of this like catching a crack in your car's windshield before it, you know, spiderweds all the way across. We are looking at stopping a catastrophic fracture before it happens.

SPEAKER_02 2:04

Absolutely.

SPEAKER_01 2:05

Welcome to today's clinical deep dive. Our mission today is to extract actionable surgical intelligence that you can use in the OR tomorrow, specifically focusing on a new retrospective study, Garcia Calau et al. 2025.

SPEAKER_02 2:19

Aaron Powell Right. So this paper it tackles incomplete slab fractures or ISFs of the third carpal bone, specifically in thoroughbreds and standard breads.

SPEAKER_01 2:28

Aaron Powell Okay, so if the fracture is incomplete and let's say the horse is just showing mild lameness, why jump straight to surgery? I mean, why not just rest them?

SPEAKER_02 2:35

Well, historically, that conservative weight and see management was, you know, the default. But we know now that the immense compressive force

The Ticking Time Bomb Dilemma: Analyzing why conservative management fails due to immense cyclic compressive loads on sclerotic bone, mandating early intervention.

SPEAKER_02 2:44

of uh cyclic loading on that sclerotic bone, it just doesn't work out.

SPEAKER_01 2:48

Aaron Powell Because it almost always leads to a complete fracture, right? Or just severe osteoarthritis.

SPEAKER_02 2:53

Exactly. It ignores the biomechanical reality of the joint. And that is why this study looked at 33 race horses that underwent early arthroscopic debridement instead.

SPEAKER_01 3:02

Aaron Powell And the data from that is pretty striking.

SPEAKER_02 3:04

Aaron Powell It really is. I mean 66.7% of those horses returned to racing postoperatively.

SPEAKER_01 3:10

Wow. Two-thirds.

SPEAKER_02 3:12

Yeah. It's a massive improvement over historical data. And uh for your pre-operative discussions with owners, you should know the median convalescent period was about 247 days.

SPEAKER_01 3:22

247. Okay, so roughly eight months.

SPEAKER_02 3:24

Aaron Ross Powell Right. And interestingly, the data showed no statistically significant difference in outcomes whether the patient was a thoroughbred or standard bread.

SPEAKER_01 3:34

Oh really?

SPEAKER_02 3:35

Yeah. Or even whether the fracture plane was dorsal or sagittal.

SPEAKER_01 3:38

Aaron Powell Okay. Well, 66.7% returning to racing is a highly favorable prognosis. But I'm I I have to look at the other side of that data.

SPEAKER_02 3:47

Aaron Powell The third that don't make it back.

SPEAKER_01 3:49

Exactly. Is that a limitation of the surgical technique itself, or are we just, you know, catching the underlying subchondral sclerosis too late?

SPEAKER_02 3:55

Aaron Powell It mostly comes down to the progression of that sclerosis before you actually intervene. Makes sense. When you go in arthroscopically and aggressively to bride

Altering Joint Mechanics: Aggressively debriding brittle subchondral bone down to healthy bleeding margins to arrest fracture progression and generate fibrocartilage mapping.

SPEAKER_02 4:04

that brittle abnormal subchondral bone down to healthy bleeding margins, you are fundamentally altering the joint's mechanics. You need enough healthy surrounding tissue to support that repair.

SPEAKER_01 4:15

Aaron Powell So you're essentially removing a crumbling, load-bearing pillar and letting it fill in with like reinforced concrete. Right, to better distribute that compressive shock. Trevor Burrus, Jr.

SPEAKER_02 4:28

That is a perfect way to look at it. You stop the opposing radiocarpal dome from grinding against a painful brittle surface.

SPEAKER_01 4:34

Aaron Powell Which halts the progression of the fracture.

SPEAKER_02 4:35

Aaron Powell Yes, and allows the joint to handle training loads again.

SPEAKER_01 4:38

Aaron Powell But let's look at the actual closure, because there is a major clinical hurdle here.

SPEAKER_02 4:43

Oh, definitely.

SPEAKER_01 4:44

You do this incredibly

Simini Protect Lavage Study: Overcoming the 42% bacterial remainder of standard saline with a 60-second surfactant rinse to clear high-load joints at closure.

SPEAKER_01 4:45

precise debridement, you map out an eight-month rehab, and then you know you rely on a standard saline flush before suturing. But what about the invisible risks when you actually close the joint?

SPEAKER_02 4:56

Aaron Powell Right. Is standard saline really enough to protect that massive investment?

SPEAKER_01 5:01

Well, head-to-head studies show saline leaves 42% of bacteria behind. I mean, for a joint meant to bear race level loads, leaving nearly half the bacterial load in the joint space is a massive blind spot.

SPEAKER_02 5:13

It is a huge blind spot. And the reason for that 42% delta really comes down to mechanism.

SPEAKER_01 5:19

Right, because saline only provides a mechanical flush.

SPEAKER_02 5:22

Exactly. It literally slips right over the extracellular matrix of a biofilm without actually penetrating it.

SPEAKER_01 5:29

It just washes over the top.

SPEAKER_02 5:30

Yeah. That is why many orthopedic surgeons are upgrading their closure protocols with Semini Protect Livage. Trevor Burrus, Jr.

SPEAKER_01 5:37

Because it isn't just flushing. It actually disrupts the lipid bonds of that biofilm matrix. Trevor Burrus, Jr.

SPEAKER_02 5:42

Right. It breaks it down. And in those same independent head-to-head studies, it takes that remaining bacterial load down to zero percent. Trevor Burrus, Jr.

SPEAKER_01 5:50

Zero. That's incredible.

SPEAKER_02 5:52

It actively removes those resistant pathogens and biofilms, and it does it without relying on antibiotics.

SPEAKER_01 5:58

Aaron Powell I mean from a workflow perspective, it takes under 60 seconds, right at the point of closure, right?

SPEAKER_02 6:02

Trevor Burrus Exactly. It takes under a minute and doesn't disrupt your existing protocols at all.

SPEAKER_01 6:06

Aaron Powell So the core clinical takeaway for your workflow tomorrow is this Early diagnosis of a third carpal bone ISF using a skyline radiograph,

The 100% Ligament Damage Mystery: Identifying a universal 100% incidence rate of medial palmar intercarpal ligament (MPIL) damage that potentially acts as the underlying driver of the bone slab fracture.

SPEAKER_01 6:15

followed by aggressive arthroscopic debridment.

SPEAKER_02 6:19

And using a disrupted biofilm closure like Semini Protect Livage?

SPEAKER_01 6:22

Right. That offers a highly viable treatment plan with a very favorable prognosis for getting them back to racing.

SPEAKER_02 6:28

Absolutely. But uh there is one fascinating surgical mystery hidden in this data that I do want to leave you with.

SPEAKER_01 6:35

Oh, lay it on me.

SPEAKER_02 6:36

So during these arthroscopies, the surgeons noted a 100% incidence of medial palmar intercarpal ligament damage.

SPEAKER_01 6:43

Wait, 100%. Every single horse.

SPEAKER_02 6:46

Every single one had MPIL damage.

SPEAKER_01 6:48

Wow. So we are treating the bone, but does that soft tissue damage actually shift the joint loading first?

SPEAKER_02 6:55

That's the big question.

SPEAKER_01 6:56

Are we looking at a ligament injury that biomechanically causes the subchondral bone to fracture in the first place?

SPEAKER_02 7:02

It's entirely possible.

SPEAKER_01 7:03

But that is definitely a provocative thought to mull over before you make your next incision.

SPEAKER_00 7:11

Here's the next article.

Melly et al. Study: Multi-Center Retrospective Evaluation of Plate Fixation for Proximal Small Metacarpal and Metatarsal (Splint Bone) Fractures

SPEAKER_02 7:17

Today we are looking at a really challenging clinical scenario.

SPEAKER_01 7:21

Right. Managing proximal small metacarpal and metatarsal bone fractures, those splint bones. I mean, think about the immense tensile force dragging across the carpal and tarsal joints of a galloping thoroughbred.

SPEAKER_02 7:34

It is a staggering amount of force. Those bones act as a critical lever arm, and well, when that lever snaps, repairing it is just a clinical nightmare.

SPEAKER_01 7:41

It really is. Historically, if you chose plate fixation, you were essentially flipping a coin. The return to work rate hovered somewhere between uh 33 and 60 percent. But we have a new retrospective study, Melly et al. 2025, that suggests those odds have fundamentally changed.

SPEAKER_02 7:56

Aaron Powell They absolutely have. So this study looked at 27 horses. Um the vast majority were thoroughbreds, and they found that 76 percent returned to their previous level of work or higher after plate fixation.

SPEAKER_01 8:07

Aaron Powell Wow, 76%? That is a huge jump. Trevor Burrus, Jr.

SPEAKER_02 8:10

Right. And for racehorses specifically, it was actually over 90% that made it back to the track.

SPEAKER_01 8:15

Aaron Powell Okay, wait. How are they achieving that? Is it just the hardware functioning as a like a more effective tension band against all those joint forces?

SPEAKER_02 8:22

Aaron Powell Essentially, yes. I mean, the plate restores the joint alignment and preserves the splint bone's integrity. Because it is placed on the tension side of the bone,

The Elite Performance Earnings Drop: Analyzing the postoperative catch where racehorses saw median earnings per start drop from $5,000 down to $2,700 due to altered gait mechanics and a 33% complication rate.

SPEAKER_02 8:31

it neutralizes that massive pull from the collateral ligaments.

SPEAKER_01 8:35

Aaron Powell That makes sense. But diving into the data, there is a pretty glaring caveat here, right? Over 90% went back to racing, but their median earnings per start just plummeted.

SPEAKER_02 8:47

Aaron Powell Yeah, that is the catch. The earnings dropped from over $5,000 down to about uh 2,700.

SPEAKER_01 8:53

Aaron Powell So they are running, but they aren't winning like they used to. Why the drop? Is the sheer rigidity of the plate altering their gait mechanics? Or is there, I don't know, lingering subclinical pain keeping them from fully expending?

SPEAKER_02 9:05

Aaron Powell Well, the study does not definitively pinpoint the exact biomechanical cause of that earnings drop. But it is highly likely a mix of those altered gait mechanics and just the physical toll of the surgical reality itself.

SPEAKER_01 9:19

Aaron Powell Which brings us to a crucial finding. Despite the high return rates, this procedure comes with a 33% complication rate.

SPEAKER_02 9:26

Exactly. And that drop in elite performance often correlates directly with the trauma of those underlying complications.

SPEAKER_01 9:33

Aaron Powell And as a surgeon, you know that awful sinking feeling in the OR, you know, when you are driving a screw into a splint bone and suddenly you just lose purchase because the bone is too soft.

SPEAKER_02 9:43

Oh, it is the worst. And thread stripping was a really frequent intraoperative reality in this study.

SPEAKER_01 9:48

Aaron Powell So how do we adapt to that?

SPEAKER_02 9:50

Well, because the bone of the small metacarpals and metatarsals is relatively soft, the actionable takeaway here is to always have self-tapping 3.5 millimeter screws on hand.

SPEAKER_01 10:00

Right, or bone fasteners just to optimize your implant purchase.

SPEAKER_02 10:03

Exactly. You must match your hardware

The Main Cortex Stress Riser Pitfall: Highlighting the critical rule to stay out of metacarpal 3 (MC3) and metatarsal 3 (MT3) to avoid creating catastrophic fracture planes during violent anesthesia recoveries.

SPEAKER_02 10:05

to the tissue reality you are actually facing in the moment.

SPEAKER_01 10:08

Aaron Powell So adapt to the soft bone, but you have to be incredibly careful not to overcompensate by anchoring into the harder bone nearby.

SPEAKER_02 10:16

Right. That is a huge pitfall. If you drill into the Palmar or Plantar cortex of metacarpal three or metatarsal three just to get better purchase, well, you are asking for trouble.

SPEAKER_01 10:26

Aaron Ross Powell You are essentially scoring glass, aren't you? Like creating a massive stress racer.

SPEAKER_02 10:31

That is spot on. I mean, unless you have absolutely zero proximal bone purchase and it is totally unavoidable, you must stay out of metacarpal three and metatarsal three.

SPEAKER_01 10:41

Because a drill hole in that main cortex acts as a focal point for stress. And when that horse wakes up from anesthesia and scrambles to stand up, experiencing all those violent, uncontrolled biomechanical forces, that stress riser can just snap.

SPEAKER_02 10:55

Which is exactly what happened in the study. They documented a catastrophic metatarsal three fracture right during anesthesia recovery.

SPEAKER_01 11:02

Wow, that is literally the ultimate worst-case scenario.

SPEAKER_02 11:04

It really is. So the clinical mandate from Melly et al. 2025 is clear. Plate fixation for proximal SMCT fractures works incredibly well for getting horses back to work.

SPEAKER_01 11:14

But clinical success demands meticulous screw selection to prevent stripping and extreme anatomical discipline to avoid engaging metacarpal III and metatarsal III.

SPEAKER_02 11:25

Exactly. It highlights how the surgery itself might be flawless, but the sheer physics of a thousand-pound animal waking up from anesthesia can undo everything in seconds.

SPEAKER_01 11:35

Which leaves you wondering, you know, considering the severe trauma of recovery and that catastrophic fracture we just talked about, could standing plate fixation eventually become the new gold standard for these repairs?

SPEAKER_02 11:45

That is a fascinating thought. I mean, if we can eliminate the anesthesia recovery entirely, maybe we eliminate the biggest risk factor.

SPEAKER_01 11:52

It is definitely something for you to weigh before your next case. The link to Melly et al. 2025 is in the show notes for you to review.

SPEAKER_00 12:04

That's it for this episode of the Simony Surgery Podcast. This show is brought to you by Semini Protect Livage, our interoperative lavage developed to target resistant bacteria and biofilms where traditional solutions of saline and post op antibiotics fall short. If you're interested in learning more or trying out your own procedures, you'll find information and links in the show notes. Listening, and we'll see you in the next episode.