Tuning and validation of a virtual mechanical testing pipeline for condylar stress fracture risk assessment in Thoroughbred racehorses

Condylar stress fracture of the third metacarpal/metatarsal bone (MC3/MT3) in Thoroughbred racehorses is a common catastrophic injury, putting both the racehorse and the jockey at risk. Microdamage forms in the distal MC3 and may result in strain elevation and higher risk of stress fracture, directly and through focal osteolysis resulting from the associated damage repair by remodelling in the condylar parasagittal grooves (PSG). Standing computed tomography (sCT) is a practical screening tool for detecting fatigue-induced structural changes, but clinical interpretation remains subjective. The goal of this study was to develop and validate an sCT-based, subject-specific finite element analysis pipeline for virtual mechanical testing of the distal MC3. Twelve (n = 12) MC3 condyles with available ex vivo strain were selected. Half of the specimens were used for tuning Young's modulus in fatigue sites, and the other half were used to evaluate the validity of the pipeline in predicting PSG strain. The tuned model improved the prediction of strain and predicted higher strain in bones with PSG lysis over the untuned model, which is an essential feature for a diagnostic screening tool. The presented pipeline can assist clinicians with the interpretation of sCT-detectable structural changes and, ultimately, with the assessment of condylar fracture risk in racing Thoroughbreds.

Equine Nuclear Medicine in 2024: Use and Value of Scintigraphy and PET in Equine Lameness Diagnosis

Scintigraphy and Positron Emission Tomography (PET) are both nuclear medicine imaging techniques, providing functional information of the imaged areas. Scintigraphy is a two-dimensional projected imaging technique that was introduced in equine imaging in the late 1970s. Scintigraphy allows imaging of large body parts and can cover multiple areas, remaining the only technique commonly used in horses for whole body imaging. PET is a cross-sectional imaging technique, first used in horses in 2015, allowing higher resolution three-dimensional functional imaging of the equine distal limb. This manuscript will cover current use and values of these two modalities in equine lameness diagnosis.

Subchondral bone fatigue injury in the parasagittal condylar grooves of the third metacarpal bone in thoroughbred racehorses elevates site-specific strain concentration

Condylar stress fracture of the distal end of the third metacarpal/metatarsal (MC3/MT3) bones is a major cause of Thoroughbred racehorse injury and euthanasia worldwide. Functional adaptation to exercise and fatigue damage lead to structural changes in the subchondral bone that include increased modeling (resulting in sclerotic bone tissue) and targeted remodeling repair (resulting in focal resorption spaces in the parasagittal groove). Whether these focal structural changes, as detectable by standing computed tomography (sCT), lead to elevated strain at the common site of condylar stress fracture has not been demonstrated. Therefore, the goal of the present study was to compare full-field three-dimensional (3D) strain on the distopalmar aspect of MC3 bone specimens with and without focal subchondral bone injury (SBI). Thirteen forelimb specimens were collected from racing Thoroughbreds for mechanical testing ex vivo and underwent sCT. Subsequently, full-field displacement and strain at the joint surface were determined using stereo digital image correlation. Strain concentration was observed in the parasagittal groove (PSG) of the loaded condyles, and those with SBI in the PSG showed higher strain rates in this region than control bones. PSG strain rate in condyles with PSG SBI was more sensitive to CT density distribution in comparison with condyles with no sCT-detectable injury. Findings from this study help to interpret structural changes in the subchondral bone due to fatigue damage and to assess risk of incipient stress fracture in a patient-specific manner.

Fractures in Thoroughbred racing and the potential for pre-race identification of horses at risk

Risk rates for and predisposing factors to fractures occurring in Thoroughbred racing that have been published in peer reviewed journals are documented. The potential for currently available techniques to identify horses at increased risk for fracture is discussed on the bases of principles, practicalities, advantages, disadvantages and current data. All are reviewed in light of justifiable decision making and importance of fractures to horseracing's social license.

Changes in Thoroughbred speed and stride characteristics over successive race starts and their association with musculoskeletal injury

BACKGROUND

Certain stride characteristics have been shown to affect changes in biomechanical factors that are associated with injuries in human athletes. Determining the relationship between stride characteristics and musculoskeletal injury (MSI) may be key in limiting injury occurrence in the racehorse.

OBJECTIVES

This study aimed to determine whether changes in race day speed and stride characteristics over career race starts are associated with an increased risk of MSI in racehorses.

STUDY DESIGN

Case-control study.

METHODS

Speed, stride length, and stride frequency data were obtained from the final 200 m sectional of n = 5660 race starts by n = 584 horses (case n = 146, control n = 438). Multivariable joint models, combining longitudinal and survival (time to injury) analysis, were generated. Hazard ratios and their 95% confidence intervals (CI) are presented.

RESULTS

The risk of MSI increased by 1.18 (95% CI 1.09, 1.28; P < 0.001) for each 0.1 m/s decrease in speed and by 1.11 (95% CI 1.02, 1.21; P = 0.01) for each 10 cm decrease in stride length over time (career race starts). A more marked rate of decline in speed and stride length was observed approximately 6 races prior to injury. Risk of MSI was highest early in the horse's racing career.

MAIN LIMITATIONS

Only final sectional stride characteristics were assessed in the model. The model did not account for time between race starts.

CONCLUSIONS

Decreasing speed and stride length over multiple races is associated with MSI in racehorses. Monitoring stride characteristics over time may be beneficial for the early detection of MSI.

Metacarpophalangeal Joint Pathology and Bone Mineral Density Increase with Exercise but Not with Incidence of Proximal Sesamoid Bone Fracture in Thoroughbred Racehorses

Proximal sesamoid bone (PSB) fracture is the leading cause of fatal musculoskeletal injury in Thoroughbred racehorses in Hong Kong and the US. Efforts are underway to investigate diagnostic modalities that could help identify racehorses at increased risk of fracture; however, features associated with PSB fracture risk are still poorly understood. The objectives of this study were to (1) investigate third metacarpal (MC3) and PSB density and mineral content using dual-energy X-ray absorptiometry (DXA), computed tomography (CT), Raman spectroscopy, and ash fraction measurements, and (2) investigate PSB quality and metacarpophalangeal joint (MCPJ) pathology using Raman spectroscopy and CT. Forelimbs were collected from 29 Thoroughbred racehorse cadavers (n = 14 PSB fracture, n = 15 control) for DXA and CT imaging, and PSBs were sectioned for Raman spectroscopy and ash fraction measurements. Bone mineral density (BMD) was greater in MC3 condyles and PSBs of horses with more high-speed furlongs. MCPJ pathology, including palmar osteochondral disease (POD), MC3 condylar sclerosis, and MC3 subchondral lysis were greater in horses with more high-speed furlongs. There were no differences in BMD or Raman parameters between fracture and control groups; however, Raman spectroscopy and ash fraction measurements revealed regional differences in PSB BMD and tissue composition. Many parameters, including MC3 and PSB bone mineral density, were strongly correlated with total high-speed furlongs.

Comparison of skeletal scintigraphy and standing 18 F-NaF positron emission tomography for imaging of the fetlock in 33 Thoroughbred racehorses

This retrospective, methods comparison study aimed to compare skeletal scintigraphy and ¹⁸ F-NaF positron emission tomography (PET) for the detection of abnormalities in the fetlocks of Thoroughbred racehorses. Thirty-three horses (72 limbs) imaged with both scintigraphy and ¹⁸ F-NaF PET, for investigation of lameness or poor performance related to the fetlock, were included. Seven observers, including experienced racetrack practitioners, surgery and imaging residents, and a board-certified veterinary radiologist, independently reviewed all data for evidence of increased radiopharmaceutical uptake in 10 different regions of interest. The interobserver agreement was higher for PET (Kappa-weighted (K-w) 0.73 (0.51-0.84)) (median (range)) than for scintigraphy (0.61 (0.40-0.77)) (P < 0.0001). When scintigraphy and PET were compared, the agreement was fair (K-w 0.29). More sites of increased uptake were identified using PET compared with scintigraphy. Agreement between the two modalities was higher for the palmar/plantar metacarpal/metatarsal condylar regions (K-w 0.59) than for the proximal sesamoid bones (K-w 0.25). Increased radiopharmaceutical uptake was detected in the medial proximal sesamoid bone in 6.9% and 22.2% of limbs with scintigraphy and PET, respectively. The high interobserver agreement for PET, despite the recent introduction of this technique, demonstrates the ease of clinical interpretation of PET scans. The higher number of lesions detected with PET compared with scintigraphy can be explained by the higher spatial resolution and cross-sectional nature of this modality. Study findings supported using PET in a clinical population of racehorses, in particular for the assessment of the proximal sesamoid bones.

Catastrophic musculoskeletal injuries in Thoroughbred racehorses in Uruguay, 2011-2017

Catastrophic musculoskeletal injuries (CMI) pose a major welfare concern to horses and their riders, yet limited data is available describing their occurrence in South America. Using a retrospective cohort and case-control design, the objective of the study was to determine the incidence of CMI for Thoroughbreds in training and racing, and associated horse-level risk factors in Uruguay. Seventy-seven Thoroughbreds sustained a CMI; 37 of which were age- and sex-matched to 111 control horses in the same race. Training and racing data from 2011-2017 were collected. Incidence of race day CMI per 1000 race starts and training CMI incidence per 100 horse months were calculated using Poisson regression. Univariable logistic regression was used to assess relationships between race history and occurrence of CMI by fracture location, and multivariably for all fracture locations. Overall race day incidence of CMI was 0.42 per 1000 race starts (95% CI 0.29, 0.60). The incidence of CMI in training was 0.059 per 100 horse months. Most fractures were of the forelimbs (80.3%). There were 32 (41.5%) distal and 39 (50.6%) proximal limb fractures. The risk of CMI was greater for horses with fewer places (P = 0.001), and greater time between the previous race and the race in which CMI occurred (P = 0.020). The rate of race day CMI was low, despite Uruguay being a racing jurisdiction with policies and risk factors associated with higher CMI rates compared to other jurisdictions. Lightly raced horses with long periods since their previous race start should be monitored closely.

Proximal sesamoid bone microdamage is localized to articular subchondral regions in Thoroughbred racehorses, with similar fracture toughness between fracture and controls

OBJECTIVE

To determine whether proximal sesamoid bone (PSB) microdamage and fracture toughness differ between Thoroughbred racehorses sustaining PSB fracture and controls.

STUDY DESIGN

Cadaveric case-control.

ANIMALS

Twenty-four Thoroughbred racehorses (n = 12 PSB fracture, n = 12 control).

METHODS

Proximal sesamoid bones were dissected, and gross pathological changes and morphological measurements were documented. High-speed exercise history data were evaluated. Microdamage was assessed in fracture, fracture-contralateral limb (FXCL) and control PSBs using whole bone lead uranyl acetate (LUA) staining with micro-CT imaging or basic fuchsin histological analysis. Fracture toughness mechanical testing was carried out in 3-point-bending of microbeams created from PSB flexor cortices. Data were analyzed using ordinal logistic and linear regression models.

RESULTS

Microdamage was detected most commonly in the articular subchondral region of PSBs via LUA micro-CT and basic fuchsin histology. There were no differences in microdamage between FXCL and control PSBs. Fracture toughness values were similar for FXCL (1.31 MPa√m) and control (1.35 MPa√m) PSBs. Exercise histories were similar except that horses sustaining fracture spent a greater percentage of their careers in rest weeks.

CONCLUSION

Microdamage was detected in the articular region of PSBs but was not greater in horses sustaining catastrophic PSB fracture. Fracture toughness of PSB flexor cortices did not differ between FXCL and control PSBs.

CLINICAL SIGNIFICANCE

Although uncommon, microdamage is localized to the articular region of Thoroughbred racehorse PSBs. Catastrophic PSB failure is not associated with lower PSB flexor cortex fracture toughness.

When radiography and ultrasonography are not enough: the use of computed tomography and magnetic resonance imaging for equine lameness cases

MRI and CT have enhanced our diagnostic abilities for equine lameness beyond what is available using radiography and ultrasonography. This has allowed veterinarians to better prognosticate and treat lameness conditions, improving patient outcomes. This article discusses the basic principles behind MRI and CT, their advantages and disadvantages, the different types of equipment available for clinical use in horses, the typical diagnostic workup prior to pursuing advanced imaging, and common regions where MRI and CT are used clinically. The companion Currents in One Health by Spriet, AJVR, July 2022, discusses even more advanced equine imaging in the form of positron emission tomography. Combined, these future directions of MRI, CT, and positron emission tomography may include improved ability to image standing horses or screen for injury prevention.

Imaging and Gross Pathological Appearance of Changes in the Parasagittal Grooves of Thoroughbred Racehorses

Simple Summary

Early detection of racehorses at risk of stress fracture is key to reducing the number of horses with catastrophic fractures while racing. Bone changes are often visible in the limbs of Thoroughbred racehorses in work, particularly in the fetlock region. However, it is currently unknown whether some of these changes indicate an impending fracture or are a healthy adaptation to high-speed exercise. This study looks at imaging and gross changes in a specific area (parasagittal grooves (PSGs) of the cannon bone) and the utility of X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) to detect the changes. All fetlock joints were assessed from twenty horses that died during racing or training, including horses with and without fetlock fracture. Overall, X-ray was poor for detecting PSG changes. Some PSG changes on CT and MRI were common in Thoroughbred racehorses and possibly represent normal bone adaptation when seen in clinical cases. However, certain CT and MRI findings were more prevalent in horses with a fracture, possibly indicating microdamage accumulation and increased risk of fracture. Bilateral advanced imaging is recommended in clinical cases of suspected fetlock pathology.

Abstract

(1) Background: Parasagittal groove (PSG) changes are often present on advanced imaging of racing Thoroughbred fetlocks and have been suggested to indicate increased fracture risk. Currently, there is limited evidence differentiating the imaging appearance of prodromal changes in horses at risk of fracture from horses with normal adaptive modelling in response to galloping. This study aims to investigate imaging and gross PSG findings in racing Thoroughbreds and the comparative utility of different imaging modalities to detect PSG changes. (2) Methods: Cadaver limbs were collected from twenty deceased racing/training Thoroughbreds. All fetlocks of each horse were examined with radiography, low-field magnetic resonance imaging (MRI), computed tomography (CT), contrast arthrography and gross pathology. (3) Results: Horses with fetlock fracture were more likely to have lateromedial PSG sclerosis asymmetry and/or lateral PSG lysis. PSG lysis was not readily detected using MRI. PSG subchondral bone defects were difficult to differentiate from cartilage defects on MRI and were not associated with fractures. The clinical relevance of PSG STIR hyperintensity remains unclear. Overall, radiography was poor for detecting PSG changes. (4) Conclusions: Some PSG changes in Thoroughbred racehorses are common; however, certain findings are more prevalent in horses with fractures, possibly indicating microdamage accumulation. Bilateral advanced imaging is recommended in racehorses with suspected fetlock pathology.

Factors Associated with Fatality in Ontario Thoroughbred Racehorses: 2003-2015

Simple Summary

Ontario’s Alcohol and Gaming Commission records equine racing fatalities through its Equine Health Program. This study examines the 695 Thoroughbred occurrences from 2003 to 2015 with the aim of identifying associations. Deaths occurred within 60 days of a horse racing or being entered or qualified to race. Calculated on the most commonly adopted basis, rates for Ontario Thoroughbreds are high—2.94/1000 starts (all fatalities) and 1.96/1000 (breakdowns only), compared with a global industry breakdown range of 0.29–2.36/1000 starts. The study revealed several significant risk factors, including workload, stage of training, age, sex, stage of career, finish position, race field size, and day of week. Among fatalities were groups where combinations of these risk factors were important, such as being a two-year-old male, un-castrated, and in early training. Probability of fatality fell over the study period in response to increasing awareness through existence of the Program and adoption of new regulations, but remains of concern. All identified associations represent aspects of management and industry structure that are amenable to change with a view to reducing fatalities. A link between fatality and cumulative, non-fatal outcomes should also be considered. An overall approach might view associated factors as sources of physical and psychological stress that, acutely and cumulatively, may influence the liability for adverse outcomes in training and racing.

Abstract

Ontario’s Alcohol and Gaming Commission records equine racing fatalities through its Equine Health Program. The present study examined all Thoroughbred fatalities from 2003 to 2015, inclusive, to identify associations. Official records and details of fatalities were combined in multivariable logistic regression modelling of 236,386 race work-events (433 fatalities), and 459,013 workout work-events (252 fatalities). Fatality rates were 2.94/1000 race starts (all fatalities) and 1.96/1000 (breakdowns only) with an overall rate of 2.61% or 26.1 fatalities/1000 horses. Comparison with published reports reveals rates to be high. Musculoskeletal injury was the predominant complaint and there was a high incidence of horses dying suddenly. Liability was high for young horses early in the season with a differential according to sex and whether a male horse was gelded. Horses undertaking repeated workouts had a higher liability and liability was higher in workouts for horses switching from dirt/synthetic to turf racing and for young horses in sprints. Race distance was not significant but high fatality rates in some large field, distance races combined with effects of age and workload identified groups at particular risk. As field size increased, fatality liability increased for early-finishing horses. Findings suggest jockey strategy could be an important factor influencing fatalities. Probability of fatality declined over the study period. Findings indicate that rapid accumulation of workload in animals early in their preparation is likely to be damaging. Fatality fell toward the end of a season and for horses with a long career history of successful performance; however, horses not exhibiting this robustness and staying power represent the population of greatest concern. Associations may be characterised as representing sources of stress, current or cumulative, and identifying at-risk animals on this basis may be as productive as targeting specific, discrete mechanisms suspected to contribute to individual fatalities.

Determination of correlation of proximal sesamoid bone osteoarthritis with high-speed furlong exercise and catastrophic sesamoid bone fracture in Thoroughbred racehorses

OBJECTIVE

To examine whether proximal sesamoid bone (PSB) articular cartilage and bone osteoarthritic changes or palmar osteochondral disease (POD) scores were associated with exercise history and catastrophic PSB fracture in Thoroughbred racehorses.

SAMPLES

PSBs from 16 Thoroughbred racehorses (8 with and 8 without PSB fracture).

PROCEDURES

Exercise history was collected, and total career high-speed furlongs was used as the measure of total exercise per horse. At necropsy, medial and lateral condyles of the third metacarpus from each forelimb were assigned a POD score, followed by imaging with micro-CT for evaluation of osteophyte size. Three investigators that were blinded to the type of PSB (fracture or no fracture) used the Osteoarthritis Research Society International (OARSI) scoring system to evaluate acellularity, chondrocyte necrosis, cartilage fibrillation, chondrone formation, safranin O stain uptake, and tidemark advancement of 1 central sagittal tissue section/PSB (4 PSBs/horse). Cartilage thickness and bone necrosis were scored on the basis of histologic examination.

RESULTS

POD score, osteophyte size score, percentage of bone necrosis, tidemark advancement, chondrone formation, and total OARSI score were greater in horses with more accrued total career high-speed furlongs. Scores for POD, osteophyte size, fibrillation, acellularity, chondrone formation, and total OARSI were greater for horses with PSB fracture.

CONCLUSIONS AND CLINICAL REVELANCE

OARSI scoring revealed that more advanced osteoarthritic changes strongly correlated with total career high-speed furlongs and PSB fracture. However, the effect of exercise was dominant, suggesting that exercise history will be important to include in future models that aim to assess risk factors for catastrophic PSB fracture.

Expression of select mRNA in Thoroughbreds with catastrophic racing injuries

BACKGROUND

The ability to identify horses at risk for catastrophic injuries continues to be a pressing issue for the racing industry, especially given recent events in North America.

OBJECTIVES

Since most catastrophic injuries occur in areas of existing pathology and this pathology is likely to elicit an inflammatory response, it was hypothesised that analysis of messenger RNA (mRNA) expression would detect significant changes in select genes in horses at risk for a catastrophic injury.

STUDY DESIGN

Prospective cohort study.

METHODS

Five racing jurisdictions across the United States participated in this study. A total of 686 Tempus^® RNA Blood Tube samples were collected for mRNA analysis from 107 catastrophically injured horses, as well as from noninjured horses sampled either prerace (n = 374) or postrace (n = 205). A subset of horses (n = 37) were sampled both prerace and postrace for analysis of expression changes during the postrace period.

RESULTS

Of 21 genes analysed via RT-qPCR, the expression of 12 genes (ALOX5AP, CD14, IL-10, IL-1β, IL-6, IL-8, MMP1, PTGS2, TLR4, TNFα, TNFSF13B and VEGFA) changed significantly within 45 minutes after a race and were excluded. Of the remaining nine genes (BMP-2, IGF-1, IL1RN, MMP2, MMP9, Osteoprotegrin, RANKL, SAA1 and TGFβ), three genes (IGF-1, IL1RN and MMP2) were found to be significantly different between catastrophically injured and noninjured horses using multiple logistic regression modelling. Receiver operating characteristic analysis of models, which included mRNA expression, demonstrated sensitivities from 76%-82% (95% CI: 67%-93%) and specificities from 84%-88% (95% CI: 71%-94%) at the Youden Index.

MAIN LIMITATIONS

Samples were collected as soon as possible postinjury (within 30 minutes).

CONCLUSIONS

Analysis of mRNA expression of specific genes in the future may be considered as an economical, accessible and noninvasive means by which horses at risk for catastrophic injury can be identified.

Warmblood fragile foal syndrome type 1 mutation (PLOD1 c.2032G>A) is not associated with catastrophic breakdown and has a low allele frequency in the Thoroughbred breed

Background

Catastrophic fractures are among the most common cause of fatalities in racehorses. Several factors, including genetics, likely contribute to increased risk for fatal injuries. A variant in the procollagen‐lysine, 2‐oxoglutarate 5‐dioxygenase1 gene (PLOD1 c.2032G>A) was shown to cause Warmblood fragile foal syndrome type 1 (WFFS), a fatal recessive defect of the connective tissue. Screening of multiple horse breeds identified the presence of the WFFS allele in the Thoroughbred. PLOD1 is involved in cross‐linking of collagen fibrils and thus could potentially increase the risk of catastrophic breakdown.

Objectives

Estimate the frequency of the WFFS allele (PLOD1 c.2032G>A) and determine if it is a risk factor for catastrophic breakdown in the Thoroughbred.

Study design

Case–control genetic study.

Methods

Genomic DNA from hair and/or tissue samples was genotyped for the WFFS allele. Fisher’s Exact tests were performed to compare allele and carrier frequencies between the case cohort (catastrophic breakdown, n = 22) and several cohorts with no record of injury (n = 138 raced/trained at same track and season and n = 185 older than 7 years and raced during same season), nonracers (n = 92), and a random sample without consideration for racing history (n = 279).

Results

The frequency of the PLOD1 c.2032G>A variant in the Thoroughbred breed is low (1.2%). Seventeen of 716 Thoroughbreds tested were carriers (2.4%) and no WFFS homozygotes were detected. Only one catastrophic breakdown case carried the WFFS allele. No statistically significant difference in allele or carrier frequency was identified between case and control cohorts (P>0.05 in all comparisons performed).

Main limitations

This study evaluated cases from one single track.

Conclusions

This study demonstrated that the PLOD1 c.2032G>A associated with WFFS is present at very low frequency in Thoroughbreds and is not a genetic risk factor for catastrophic breakdown.

Standing MRI for surgical planning of equine fracture repair

OBJECTIVE

To report the feasibility of standing MRI (sMRI) and document the value of sMRI in surgical planning for surgical repair of limb fractures in the horse.

STUDY DESIGN

Retrospective case series.

ANIMALS

Thirty-one horses with preoperative sMRI.

METHODS

Medical records were reviewed for fracture type, application of a polyester cast, sMRI sequences performed, technical variables, and image quality. Fracture geometry and concomitant lesions were compared between sMRI and radiography. The relative value of sMRI with regard to surgical planning was classified as minor (sMRI did not provide additional findings), intermediate (additional lesions found or slight modification to surgical plan), or major (sMRI led to significant alternations in surgical plan).

RESULTS

Standing MRI provided good studies in all horses. Standing MRI was classified as having major relevance in 12 of 31 horses, intermediate relevance in 14 of 31 horses, and minor relevance in 5 of 31 horses.

CONCLUSION

Preoperative sMRI produced good studies in all horses and influenced the surgical planning in the majority of fractures in this study. Application of a polyester cast seemed to improve comfort without appreciable loss of image quality.

CLINICAL SIGNIFICANCE

Standing MRI can be considered as an adjunct to plan the repair of equine fractures, and a polyester cast does not impair image quality.

Association of catastrophic condylar fracture with bony changes of the third metacarpal bone identified by use of standing magnetic resonance imaging in forelimbs from cadavers of Thoroughbred racehorses in the United States

OBJECTIVE To compare bony changes of the third metacarpal bone (MC3) of Thoroughbred racehorse cadavers with (cases) or without (controls) catastrophic condylar fracture by use of standing MRI. SAMPLE 140 forelimbs from 26 case horses (both forelimbs) and 88 control horses (single forelimb). PROCEDURES Bone marrow lesions (BMLs), identified as a decrease in T1-weighted (T1W) signal and increases in T2*-weighted (T2*W) and short tau inversion recovery (STIR) signals, and dense bone volume percentage (DBVP), identified as decreases in T1W, T2*W, and STIR signals, in the distopalmar aspect of MC3 were recorded. Logistic regression was used to compare fractured and nonfractured limbs of cases and fractured limbs of cases with randomly selected limbs of controls. RESULTS Among cases, fractured limbs were significantly more likely to have BMLs (26/26 [100%]) than were nonfractured limbs (7/26 [27%]). Fractured limbs of cases were significantly more likely to have BMLs (26/26 [100%]) than were limbs of controls (6/88 [7%]). Among cases, there was no significant difference in DBVP between fractured and nonfractured limbs in lateral (26% vs 21%, respectively) or medial (25% vs 20%, respectively) condyles. However, DBVP was significantly greater in fractured limbs of cases than in limbs of controls for lateral (26% vs 16%, respectively) and medial (25% vs 18%, respectively) condyles. CONCLUSIONS AND CLINICAL RELEVANCE Standing MRI revealed a significantly greater degree of bone change in racehorses with condylar fracture when comparing fractured and nonfractured limbs of case horses and fractured limbs of case horses with randomly selected limbs of control horses.

Meta-analysis of risk factors for racehorse catastrophic musculoskeletal injury in flat racing

Studies of racehorse injury or fatality in various countries have identified common, and in some cases conflicting, risk factors. We conducted a systematic search of the relevant literature published from 1990 to 2017. Peer-reviewed articles were included if they reported the incidence of fatal or catastrophic musculoskeletal injury (CMI) in Thoroughbred flat races (n=21) or risk factors for CMI (n=65). Pooled effect sizes were estimated using the random-effects DerSimonian-Laird model. The pooled incidence of CMI was 1.17 (95% confidence interval 0.90, 1.44) per 1000 race starts. Almost 300 factors have been investigated in epidemiological studies for potential associations with CMI. Factors found to have consistent evidence of increasing risk of CMI are: (1) Horse-level factors such as older horse age and age at first start, male sex, and higher race class or lower claiming price; (2) Race-level factors such as firmer track conditions on turf and wetter conditions on dirt, longer race distance, and a greater number of starters; and (3) Management-related factors including more time since previous start, greater number of starts, longer career length, issues identified at pre-race examination, previous injury, and recent administration of medication or injections. Studies investigating recent cumulative distance of high-speed exercise were conflicting and suggestive of at least two mechanisms of injury related to the accumulation of bone damage: (1) In well adapted bone following a period of intense training; and (2) In poorly adapted bone at relatively low levels of training intensity. Future studies should evaluate success of interventions and mechanisms for injury.

The Importance of Subchondral Bone in the Pathophysiology of Osteoarthritis

Subchondral bone plays a critical role in the pathogenesis of osteochondral disease across veterinary species. The subchondral bone is highly adaptable, with the ability to model and remodel in response to loading stresses experienced by the joint. Repetitive stress injuries within the joint can result in primary or secondary pathologic lesions within the subchondral bone, which have been recognized to contribute to the development and progression of osteoarthritis. Recent advances in diagnostic imaging, particularly volumetric imaging modalities have facilitated earlier identification of subchondral bone disease. Despite these advancements, limitations in our knowledge about subchondral bone makes treatment and prevention of these conditions challenging. The purpose of this report is to review our current understanding of subchondral bone and its relationship to osteoarthritis across veterinary species, with a specific focus in the research that has been performed in horses. It can be concluded that our current understanding of subchondral bone is advancing, and future experimental, clinical and pathologic studies will provide additional insight about subchondral bone and its relationship to joint disease.

Common lesions of the distal end of the third metacarpal/metatarsal bone in racehorse catastrophic breakdown injuries

Equine catastrophic skeletal breakdown injury is a serious issue within the racing industry, given the impact on equine and human health. The metacarpo- and metatarso-phalangeal (fetlock) joints are common sites of catastrophic injury. However, lesions involving articular cartilage, subchondral bone, and synovium are commonly identified within the fetlock of the contralateral limb; hence, it is imperative that lesions in both limbs are evaluated and characterized during postmortem examination. Bone and articular cartilage changes typically occur in specific locations, related to cyclic fetlock load and overextension during high-speed exercise. Associations between preexisting degenerative fetlock lesions and catastrophic injury are a focus of continued research. These lesions often occur because of adaptive failure related to cumulative damage. Further investigation of these lesions is imperative to determine their impact on equine performance or injury. Ultimately, consistent documentation of catastrophic versus non-catastrophic osteochondral lesions provided by pathologists, in the context of training history, diagnostic imaging, and the presence or absence of catastrophic injury, will contribute to further understanding of skeletal responses associated with catastrophic failure.

Thoroughbred fatality and associated jockey falls and injuries in races in New South Wales and the Australian Capital Territory, Australia: 2009-2014

Monitoring racehorse fatality and associated jockey falls provides benchmarks for intervention strategies. The aims of this study were to describe the incidence of and reasons for fatalities in Thoroughbred horses during flat races in the Australian Capital Territory and New South Wales (NSW), Australia, and to describe reported jockey falls and injuries associated with racehorse fatalities. A cohort study identified all racehorse fatalities reported through Racing NSW for the 2009-2010 to 2013-2014 racing seasons. Risks of racehorse fatality, fatal musculoskeletal injury, spontaneous death (as distinct from euthanasia) and racehorse fatality associated jockey falls and injuries were calculated using Poisson regression. A total of 167 horse fatalities were reported, with an overall incidence of 0.59 deaths/1000 starts. Forty-nine reasons for horse fatality were reported, although post-mortem examinations were conducted on only 52/165 (31.5%) horses. Musculoskeletal injury accounted for 144/167 (86.2%) fatalities, with an incidence of 0.52/1000 starts. Fractures comprised 96/167 (57.5%) fatalities, with the fetlock or proximal sesamoid bones being the most common fracture location, comprising 36/96 (37.5%) fractures. Only 22/166 (13.3%) racehorse fatalities were due to spontaneous death, representing an incidence of 0.08/1000 starts. A total of 50 racehorse fatality associated jockey falls were reported (incidence of 0.18/1000 starts), with 32 reported jockey injuries (incidence of 0.12/1000 starts). Most racehorse fatality associated jockey injuries occurred to the limbs (17/32, 53.1%), particularly the upper limb. The estimates for both horse fatality and associated jockey injury were comparable with previous estimates from other jurisdictions internationally.