Race-start characteristics and risk of catastrophic musculoskeletal injury in Thoroughbred racehorses

Evaluation of catastrophic musculoskeletal injuries in Thoroughbreds and Quarter Horses at three Midwestern racetracks

OBJECTIVE

To determine the incidence of and compare the types of catastrophic musculoskeletal injuries (CMIs) sustained in Thoroughbreds and Quarter Horses during racing at 3 Midwestern racetracks from 2000 to 2006.

DESIGN

Retrospective cohort study.

ANIMALS

139 Thoroughbred and 50 Quarter Horse racehorses euthanized because of CMIs.

PROCEDURES

Veterinary officials from 3 Midwestern racing jurisdictions provided injury reports for Thoroughbreds and Quarter Horses that sustained CMIs (which required euthanasia) and the total number of race starts for each year. The number of CMIs/1,000 starts was determined for each racetrack. Past performance reports for each horse with a CMI were evaluated.

RESULTS

The total number of race starts (both breeds) at the 3 racetracks from 2000 through 2006 was 129,460, with an overall incidence of 1.46 CMIs/1,000 race starts. Incidences of CMIs among racetracks were similar. Of horses that sustained a CMI, the median age of Thoroughbreds at first race was 3 years, compared with a median age of 2 years for Quarter Horses. A larger proportion of Thoroughbreds sustained a CMI in a claiming race than did Quarter Horses, and a larger proportion of Quarter Horses sustained a CMI in a futurity trial than did Thoroughbreds. The most common site for CMIs in Thoroughbreds was the left forelimb (69/124 [55.6%]), whereas most CMIs in Quarter Horses involved the right forelimb (18/30 [60.0%]).

CONCLUSIONS AND CLINICAL RELEVANCE

Differences identified between CMIs in Thoroughbred and Quarter Horse racehorses should allow veterinarians to focus on horses and anatomic regions of greatest risk of CMI during racing.

Use of a global positioning and heart rate monitoring system to assess training load in a group of Thoroughbred racehorses

REASONS FOR PERFORMING STUDY

Training is an important variable for determining athletic success. Nonetheless, there has been minimal scientific evaluation of racehorse training programmes. Training of racehorses focuses on running the horses at certain speeds using a combination of a stopwatch and rider's 'feel' for a horse's work intensity. Consequently, actual work intensity for individual horses is not clearly defined.

OBJECTIVES

To 1) utilise a combined global positioning system (GPS) and heart rate monitor system to quantify training intensity and physiological responses of a group of racehorses undergoing training and racing; and 2) compare the workload measured by the GPS to that timed and recorded daily by a racehorse trainer.

METHODS

Nineteen racehorses age 3 years were followed through a traditional training and racing programme over a 4 month period. Daily GPS and heart rate data together with the trainer's timing and distance data were collected while the horses were trained. Data were analysed using an ANOVA for repeated measures.

RESULTS

The combined GPS/heart rate monitoring system detected different heart rate responses in individual horses subjected to the same training workouts. The average speeds detected with the GPS system were in agreement with average speeds timed by the trainer. However, peak speeds reached during training were significantly greater (P<0.05) than those estimated with stopwatch timing. The horses average training speeds increased significantly over the duration of the training period.

CONCLUSIONS AND POTENTIAL RELEVANCE

The results from this study show that a GPS/heart rate monitor system provides a reliable measure of daily workload in horses during training. This technology provides a detailed picture of horses' training sessions and has the potential to provide a greater insight into the types of training that may predispose horses to injury.

Horse-level risk factors for fatal distal limb fracture in racing Thoroughbreds in the UK

REASONS FOR PERFORMING STUDY

Fractures below the level of the radius or tibia (distal limb fractures) are the most common cause of equine fatality on UK racecourses; however, little is known about their epidemiology or aetiology. Identification of risk factors could enable intervention strategies to be designed to reduce the number of fatalities.

OBJECTIVES

To identify horse-level risk factors for fatal distal limb fracture in Thoroughbreds on UK racecourses.

METHODS

A case-control study design was used. Fractures in case horses were confirmed by post mortem examination and 3 matched uninjured controls were selected from the race in which the case horse was running. One hundred and nine cases were included and information was collected about previous racing history, horse characteristics and training schedules. Conditional logistic regression was used to identify the relationship between a number of independent variables and the likelihood of fracture.

RESULTS

Horses doing no gallop work during training and those in their first year of racing were at significantly increased risk of fracture on the racecourse. Case horses were also more likely to have trained on a sand gallop, i.e. a gallop described by trainers as being primarily composed of sand.

CONCLUSIONS

Modifications to training schedules, specifically within the first year of racing, may have a large impact on the risk of fatal distal limb fracture on the racecourse. Horses should do some gallop work in training and our results suggest that the minimum distance galloped should be between 805-2012 m (4-10 furlongs)/week.

POTENTIAL RELEVANCE

The information from this study can be used to alter training schedules in an attempt to reduce the incidence of fatal distal limb fracture in Thoroughbred racehorses. Training should include some gallop work, and further studies, recording the exact level of work, will help to identify an optimum range of training speeds and distances which will reduce the liklihood of catastrophic fracture on the racecourse.

Risk factors for fatal lateral condylar fracture of the third metacarpus/metatarsus in UK racing

REASONS FOR PERFORMING STUDY

Lateral condylar fractures of the third metacarpus/metatarsus are the most common cause of equine fatality on UK racecourses. Identification of risk factors for such injuries and the subsequent implementation of intervention strategies could significantly reduce the total number of racecourse fatalities.

OBJECTIVES

To identify horse-, race- and course-level risk factors for fatal lateral condylar fracture in Thoroughbreds on UK racecourses.

METHODS

Case-control study designs were used. Case horses were defined as those that were subjected to euthanasia having sustained an irreparable lateral condylar fracture while racing at any of the 59 UK racecourses. Case races were defined as those in which one or more horses sustained a fatal lateral condylar fracture. Three controls for each case horse were selected at random from the race in which the case was running. Three controls for each case race were selected at random from all races of the same type held in the same year. Ninety-eight cases were included in the study. Conditional logistic regression was used to identify the relationship between a number of independent variables and the likelihood of fracture.

RESULTS

Horses doing no gallop work during training and those in their first year of racing were at significantly increased risk of fracture on the racecourse. Case horses were also more likely to have started racing as 3- or 4-year-olds. Fractures were found to be more likely in longer races with a larger number of runners, races in which professional jockeys were not permitted to ride and races in which the going was described as firm or hard.

CONCLUSIONS AND POTENTIAL RELEVANCE

Modifications to training schedules, specifically within the first year of racing, may have a large impact on the risk of fatal lateral condylar fracture on the racecourse. Horses should do some gallop work in training and our results suggest that the minimum distance galloped should be between 201 m (1 furlong) and 1609 m (8 furlongs) per week. The association with age at first race requires further investigation for flat and National Hunt racing separately. A reduction in the number of races taking place on very firm going could have an impact on the number of lateral condylar fractures.

Epidemiology of racetrack injuries in racehorses

This article describes the development of epidemiologic analyses of racetrack injury in racehorses. The risk or rate of fatal and nonfatal injury in racing and training around the world is examined. The focus is on the importance of global collaboration and the identification of modifiable risk factors. In particular, exercise-related risk factors for injury are evaluated and the potential impact of interventions discussed.

Risk factors for Thoroughbred racehorse fatality in flat starts in Victoria, Australia (1989-2004)

REASONS FOR PERFORMING STUDY

Research into risk factors specific for fatality in flat racing should be focused at a regional level as the risk factors may differ among countries and even regions within countries.

OBJECTIVE

To identify risk factors for fatality of Thoroughbred racehorses in flat starts on all racecourses in Victoria, Australia between 1989 and 2004.

METHODS

Fatalities comprised all horses that died during or immediately after a flat race or official flat trial, and all horses that were subjected to euthanasia within 24 h of an event in which an injury was sustained. The retrospective study involved 283 case starts and 3307 control starts. Univariable and multivariable backward stepwise logistic regression was used to identify risk factors for fatality at any one start.

RESULTS

In the final multivariable model, horse gender, prior racing history, race length, racing year, racecourse location and track rating were associated with fatality.

CONCLUSIONS

This study identified specific risk factors for fatality. The findings are consistent with the hypothesis that horses accumulating high speed exercise are predisposed to catastrophic injury. The study has also highlighted the need to investigate further the adverse effects of different track ratings on the incidence of injury and subsequent fatality.

RELEVANCE

The results will facilitate the development of effective strategies to improve overall safety of horses and jockeys in flat racing in Victoria, Australia.

Risk factors for proximal sesamoid bone fractures associated with exercise history and horseshoe characteristics in Thoroughbred racehorses

OBJECTIVE

To assess individual and combined associations of high-speed exercise and horseshoe characteristics with risk of forelimb proximal sesamoid bone fractures and proximal sesamoid bone midbody fractures in Thoroughbred racehorses.

ANIMALS

269 deceased Thoroughbred racehorses.

PROCEDURES

A case-control study design was used to compare 121 horses with a fracture of at least 1 of 4 forelimb proximal sesamoid bones (75 horses had a midbody fracture) and 148 horses without a forelimb proximal sesamoid bone fracture. Univariable and multivariable logistic regression analyses were used to evaluate potential risk factors for association with proximal sesamoid bone fracture.

RESULTS

Compared with horses that died without proximal sesamoid bone fractures, horses that died with proximal sesamoid bone fractures were more likely to be sexually intact males, spend more time in active trainingand racing, complete more events, train and race longer since their last layup, have higher exercise intensities during the 12 months prior to death, and have greater cumulative distances for their career. Horses with proximal sesamoid bone midbody fractures were more likely to be sexually intact males, train and race longer since their last layup, and have higher exercise intensities during the 12 months prior to death.

CONCLUSIONS AND CLINICAL RELEVANCE

Limitingexercise intensity and the continuous time spent in activity duringa horse's career may decrease the frequency of forelimb proximal sesamoid bone fractures in Thoroughbred horses.

Relationship between stages of the estrous cycle and bone cell activity in Thoroughbreds

OBJECTIVE

To investigate the relationship between stage of estrous cycle and bone cell activity in Thoroughbreds.

SAMPLE POPULATION

Blood samples collected from forty-seven 2-year-old Thoroughbred mares in training for racing.

PROCEDURES

Blood samples were collected monthly (in April through September) from the mares. Stage of estrus was determined by assessing serum progesterone concentration. Bone cell activity was determined by measuring concentrations of 2 markers of bone formation (osteocalcin and the carboxy-terminal propeptide of type I collagen [PICP]) and a marker of bone resorption (the cross-linked carboxy-terminal telopeptide of type I collagen [ICTP]) in sera.

RESULTS

When the relationship between stage of the estrous cycle and markers of bone cell activity was examined, serum concentrations of both osteocalcin and ICTP were significantly higher in mares that were in the luteal phase, compared with mares that were at other stages of the estrous cycle. Stage of estrus did not affect serum PICP concentration.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicate that bone cell activity in Thoroughbred mares fluctuates during the estrous cycle; serum concentrations of markers of bone formation and bone resorption are increased during the luteal phase. Further studies are required to determine whether these changes are of clinical importance and increase the risk of injury for mares in training during the breeding season. As in humans, stage of estrus must be considered as a source of uncontrollable variability in serum bone marker concentrations in horses.

Association between findings on palmarodorsal radiographic images and detection of a fracture in the proximal sesamoid bones of forelimbs obtained from cadavers of racing Thoroughbreds

OBJECTIVE

To determine the distribution for limbs and bones in horses with fractures of the proximal sesamoid bones and relationships with findings on palmarodorsal radiographic images.

SAMPLE POPULATION

Proximal sesamoid bones obtained from both forelimbs of cadavers of 328 racing Thoroughbreds.

PROCEDURE

Osteophytes; large vascular channels; and fracture location, orientation, configuration, and margin distinctness were categorized by use of high-detail contact palmarodorsal radiographs. Distributions of findings were determined. Relationships between radiographic findings and fracture characteristics were examined by use of chi2 and logistic regression techniques.

RESULTS

Fractures were detected in 136 (41.5%) horses. Biaxial fractures were evident in 109 (80%) horses with a fracture. Osteophytes and large vascular channels were evident in 266 (81%) and 325 (99%) horses, respectively. Medial bones typically had complete transverse or split transverse simple fractures, indistinct fracture margins, > 1 vascular channel that was > 1 mm in width, and osteophytes in abaxial wing and basilar middle or basilar abaxial locations. Lateral bones typically had an oblique fracture and distinct fracture margins. Odds of proximal sesamoid bone fracture were approximately 2 to 5 times higher in bones without radiographic evidence of osteophytes or large vascular channels, respectively.

CONCLUSIONS AND CLINICAL RELEVANCE

Biaxial fractures of proximal sesamoid bones were common in cadavers of racing Thoroughbreds. Differences between medial and lateral bones for characteristics associated with fracture may relate to differences in fracture pathogeneses for these bones. Osteophytes and vascular channels were common findings; however, fractures were less likely to occur in bones with these features.

Risk factors for musculoskeletal injuries in 2-year-old Thoroughbred racehorses

Musculoskeletal injuries (MSI) in racehorses have been identified as the most common cause of lost training days and weeks spent resting at pasture. Several training-, track- and horse-related risk factors have been identified. However, there is no clear understanding of the inter-relationship between these factors. The aim of this longitudinal cohort study was to investigate risk factors for MSI in 2-year-old Thoroughbred racehorses. Australian Thoroughbred trainers were convenience sampled and enrolled in a 27-month longitudinal cohort study. The study population consisted of all 2-year-old Thoroughbred racehorses trained by a participating trainer. Horses were followed from the time of enrollment until the completion of the study or until they were lost to follow-up. Trainers were visited at approximately 14-day intervals to collect training and injury data. Training days were categorised as fast days if the maximum speed during training exceeded 800 m/min. For each horse, the first training period that included one or more fast days was analysed. A multiple logistic regression model was used to determine those horse- and training-related variables that were associated with MSI. Data from 274 horses trained by 14 trainers at five racetracks were analysed. Forty percent of the horses sustained a MSI during their first fast preparation. The average distance trained at speeds >or=800 m/min and the percentages of fast days from the first fast day until the end of the preparation were the only variables associated with MSI. After accounting for these variables there were still significant differences between trainers. This suggests that there are other training-related variables such as the rate of increase in distance trained at speeds >or=800 m/min that may be risk factors for MSI. In addition, other factors such as the level of veterinary involvement and the training centre/racetrack may be risk factors for MSI. More analysis using multi-level modelling is required to determine the relationship between trainer- and track-related risk factors.

Analysis of horse race videos to identify intra-race risk factors for fatal distal limb fracture

The objective of this study was to identify risk factors, during racing, associated with imminent fatal distal limb fracture in Thoroughbreds. One hundred and nine cases of fatal distal limb fracture were identified from all 59 UK racecourses over a 2-year period (February 1999-January 2001). Three uninjured control horses were randomly selected from the same race as the case horse. Videos of races in which fractures occurred were viewed using a defined protocol. Fractures in flat races occurred at any time during the race, whereas 74% (45/61) of cases in national hunt type races occurred in the second half of races. More than 75% (79/103) of cases were spontaneous, i.e. there was no obvious external influence such as a fall at a fence or collision with another horse. Sixty-six percent (44/67) of horses, sustaining a forelimb fracture, fractured the forelimb they were using as lead leg at the time of fracture. When case and control horses were compared, horses that were: (a) making good progress through the race, (b) reluctant to start and (c) received encouragement in the final 10s before the time of fracture, were more likely to sustain a fracture.

Risk factors for injury to the superficial digital flexor tendon and suspensory apparatus in Thoroughbred racehorses in New Zealand

AIM

To investigate risk factors for injury to the superficial digital flexor tendon (SDFT) and suspensory apparatus (SA) of the forelimbs in Thoroughbred racehorses in New Zealand.

METHODS

Poisson and negative binomial regression, with exposure time represented by cumulative training days for each horse, were used to relate explanatory variables to the incidence rate (IR) of cases of inflammation of the SDFT (n=51), and injuries involving the SA (n=48) in a population of 1,571 commercially- trained racehorses over 554,745 study days. Only the first occurrence of an injury for any one horse was eligible for inclusion. Separate analyses were run for data from horses in training regardless of whether they had started in a trial or race, and using a subset of these data restricted to those preparations associated with at least one start in a trial or race. Results were reported as incidence rate ratios (IRR) and 95% confidence intervals (CI).

RESULTS

Male horses had a higher risk of injury to the SA (IRR 2.57; p=0.005) and tended to have a higher risk of injury to the SDFT (IRR 1.74; p=0.09) than female horses. Increasing age was associated with increased risk of injury. Horses aged 4 and > or =5 years were 6.76 (p<0.001) and 15.26 (p<0.001) times more likely to incur injury to the SDFT, and 2.91 (p=0.02) and 3.54 (p=0.005) times more likely to incur injury to the SA, respectively, than 2-year-olds. Horses were more likely to suffer an injury to the SDFT or SA in a training preparation that was not associated with any starts in official trials or races compared with those preparations that were associated with more than one start (p<0.001), and more likely to injure the SA compared with preparations containing one start (p=0.03). The IR of injury to the SDFT tended to be lower between November-January (IRR 0.78; p=0.08) and February-April (IRR 0.75; p=0.08) compared with August-October. Incidence of injury to the SDFT or SA was not associated with the cumulative distance raced in the last 30 days of a training preparation.

CONCLUSION

This study identified risk factors for injury to the SDFT and SA in Thoroughbred racehorses in New Zealand. Injuries were more likely in males, older horses and in horses in training preparations without any starts. There was no evidence of association between injury and cumulative high-speed exercise.

Evaluation of horseshoe characteristics and high-speed exercise history as possible risk factors for catastrophic musculoskeletal injury in Thoroughbred racehorses

OBJECTIVE

To evaluate horseshoe characteristics and high-speed exercise history as risk factors for catastrophic musculoskeletal injury in Thoroughbred racehorses.

ANIMALS

377 horses (37,529 race starts).

PROCEDURES

Shoe characteristics included material, toe grab height, heel traction device, pads, and rim shoes. Racing variables were obtained from a computerized database. Forty-three horses that had a musculoskeletal injury and then failed to race or train for 6 months (cases) and 334 noninjured horses from the same race in which a horse was injured (controls) were compared regarding risk factors.

RESULTS

Overall, 98% of race starts were associated with aluminum shoes, 85% with toe grabs, 32% with pads, and 12% with rims on forelimb horseshoes. Among 43 horses with musculoskeletal injury, sex (geldings), an extended interval since last race, and reduced exercise during the 30 or 60 days preceding injury were risk factors for catastrophic injury. Odds of injury in racehorses with toe grabs on front shoes were 1.5 times the odds of injury in horses without toe grabs, but this association was not significant (95% confidence interval, 0.5 to 4.1).

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that horses that return to racing after an extended period of reduced exercise are at high risk of catastrophic musculoskeletal injury. Results regarding the use of toe grabs as a possible risk factor for catastrophic injury were inconclusive because the probability of declaring (in error) that use of toe grabs was associated with an increased risk of musculoskeletal injury (eg, odds ratio > 1.0) was 38%.

Effect of training location and time period on racehorse performance in New Zealand. 1. Descriptive analysis

AIM

To describe characteristics of Thoroughbred training stables in Matamata and in all other locations in New Zealand combined, over two 19-month time periods in 1996-1997 and 1998-1999, representing equal length periods immediately prior to and after the construction of a new training surface at the Matamata Racing Club.

METHODS

Retrospective records covering all horses training and racing in New Zealand during two 19-month time periods (1996-1997 and 1998-1999), covering 161 locations, were obtained from New Zealand Thoroughbred Racing (NZTR). Outcome variables included whether a horse was raced again in the 6 months following any start in the first 13 months of either time period, number of race starts for every horse, and finishing position. Summary measures with confidence intervals (CI) and unadjusted odds ratios (OR), measuring strength of associations for various factors, were computed.

RESULTS

The datasets contained information on 45,446 horses, 11,336 races, 5,110 trials and a total of 110,643 race starts. Horses trained at Matamata represented 8% (3,715) of the total horse datasets, and accounted for 11,977 race starts (10.8%). They were more likely to start in a race or trial in either time period and were 1.4 and 1.3 times as likely to finish first, second or third compared with horses trained at other locations in 1996-1997 and 1998-1999, respectively. A 6-month no-race period occurred for 9,306/12,584 (74%) horses that started at least once in the first 13 months of either time period. Horses trained at Matamata were less likely to have a 6-month no-race period than horses trained at other locations in both time periods. There was no effect of time period within each location on the probability of either a horse having a 6-month no-race period or of a race start being followed by a 6-month no-race period, but there was an overall effect of time and more 6-month no-race periods were observed in 1998-1999 relative to 1996-1997.

CONCLUSION

Summary statistics are presented for Thoroughbred racing in New Zealand over two 19-month time periods. Differences between the populations of horses trained in Matamata compared with those trained at other locations were attributed, in part, to the fact that many of the more successful racehorse trainers in the country have stables at Matamata. As a result, the population of horses in Matamata may not be representative of the racehorse population in New Zealand. Although more likely to win or place in both time periods, the magnitude of the advantage to horses in Matamata was reduced in 1998-1999 relative to 1996-1997, and this could be due, in part, to effects of the new track surface at Matamata. There was no evidence of a rise in risk of a 6-month no-race period following any race start in those horses trained in Matamata in 1998-1999 relative to either horses trained at other locations or to horses trained in Matamata during the earlier time period.

Effects of injury to the suspensory apparatus, exercise, and horseshoe characteristics on the risk of lateral condylar fracture and suspensory apparatus failure in forelimbs of thoroughbred racehorses

OBJECTIVE

To assess concurrently the effects of moderate ligamentous suspensory apparatus injury (MLSAI), racing-speed exercise, and horseshoe characteristics on risk of catastrophic suspensory apparatus failure (SAF) or metacarpal condylar fracture (CDY) in forelimbs of racehorses.

SAMPLE POPULATION

Cadavers of 301 Thoroughbred racehorses (108 with SAF, 33 with CDY and 160 control horses).

PROCEDURE

A cross-sectional epidemiologic study was used to describe distributions and relationships between MLSAI, exercise, and horseshoe variables. Logistic regression was used to assess potential risk factors for developing SAF and CDY.

RESULTS

Exercise variables were more highly associated with age than height of a steel bar affixed to the ground surface of the front of a horseshoe (ie, toe grab) or sex. Marginal associations were detected between MLSAI and age and height of toe grab. Higher risk for developing SAF was associated with MLSAI, use of a pad on a horseshoe, longer interval since last period of > or = 60 days without a race or timed workout (ie, layup), 2 to 5 career races, and higher intensity of recent exercise. Higher risk for developing CDY was associated with MLSAI, male horses, age between 2 and 5 years, higher intensity of recent exercise, and longer interval since layup.

CONCLUSIONS AND CLINICAL RELEVANCE

Recognition of MLSAI and rehabilitation of affected horses should reduce incidence of SAF and CDY. Horses in longterm continuous training with recent high-intensity exercise are at greater risk for injury. Use of pads in horseshoes was associated with SAF, although the relationship may not be causal.

Observer variation in visual assessment of forelimb horseshoe characteristics on Thoroughbred racehorses

OBJECTIVE

To assess the accuracy and reliability of a visual method of evaluating horseshoe characteristics.

ANIMALS

1,199 Thoroughbred racehorses.

PROCEDURE

Characteristics of 1 forelimb horseshoe were visually assessed on horses immediately prior to racing by 5 field observers at 5 major racetracks in California. Characteristics evaluated included horseshoe type; toe grab height; and the presence of a rim, pad, and heel traction devices. Sensitivity and specificity for observer assessment of horseshoe characteristics were calculated by comparing observer assessments to a postmortem laboratory standard for horses that died within 48 hours of a race. Intraobserver agreement was assessed in a subset of horses by comparing horseshoe observations made before and after the horse's race. Interobserver agreement was evaluated by comparing horseshoe assessment among observers who examined the same subset of horses prior to racing on select days.

RESULTS

The sensitivity and specificity of this visual method of evaluating horseshoe characteristics were good and ranged from 0.75 to 1 and 0.67 to 1, respectively. Agreement beyond chance (weighted kappa values) between observers and the laboratory standard for toe grab height was fair (0.60 to 0.62). Intraobserver and interobserver agreements (kappa values) were high (0.86 to 0.99 and 0.71 to 1, respectively).

CONCLUSIONS AND CLINICAL RELEVANCE

Visual observation of horseshoes can be a feasible and reproducible method for assessing horseshoe characteristics prospectively in a large cohort of horses under racing conditions.

Race- and course-level risk factors for fatal distal limb fracture in racing Thoroughbreds

REASONS FOR PERFORMING STUDY

Considerable variation in the rates of equine fatality at different racecourses draws attention to probable risk factors at the level of course or race that might be partly responsible. Distal limb fractures are the most common cause of equine fatality on UK racecourses and identification of risk factors for such injuries and subsequent implementation of intervention strategies could significantly reduce the total number of racecourse fatalities.

OBJECTIVES

To identify race- and course-level risk factors for fatal distal limb fracture in Thoroughbreds on UK racecourses.

METHODS

A case-control study design was used. Case races were defined as those in which one or more horses sustained fatal fracture of the distal limb. Controls were selected in 2 different ways. Firstly, 3 races in which no fracture occurred were selected from all races of the same type held within 5 days of the case race (Analysis 1). Secondly, 3 control races were selected for each case race from all races of the same type held in the same year (Analysis 2). One hundred and nine cases were included in the study. Information about the race and the racecourses was collected from Computer Raceform. Conditional logistic regression was used to identify the relationship between a number of independent variables and the likelihood of fracture in a race.

RESULTS

Longer races with a larger number of runners were more likely to contain a fracture. Firmer going and fewer days since the last race on the same course were associated with an increased risk of fracture. The going at the course at the previous race meeting was also associated with the likelihood of fracture.

CONCLUSIONS

Modifications to the going on the day of a race and greater emphasis on ground maintenance between race meetings may have an impact on the risk of fatal distal limb fracture during racing.

POTENTIAL RELEVANCE

Modification of risk factors such as the going and number of days since the last race meeting could reduce the number of equine fatalities on UK racecourses. The condition of the racecourse may be an important risk factor and future research should focus on the identification of course maintenance techniques that produce the safest possible racing surfaces.

Prevalence of superficial digital flexor tendonitis and suspensory desmitis in Japanese Thoroughbred flat racehorses in 1999

REASONS FOR PERFORMING STUDY

Overstrain injuries to the superficial digital flexor tendon (SDFT) and suspensory ligament (SI) are among the most common musculoskeletal injuries which contribute to the considerable wastage of racing Thoroughbreds. Many epidemiological studies have demonstrated the prevalence of and risk factors for tendon injury when racing but have not included those injuries sustained during training. However, since tendon injury during training is seen commonly in clinical practice, it is appropriate to determine the overall prevalence of tendon injury sustained during both training and racing.

OBJECTIVE

To determine the prevalence of overstrain injury to the SDFT and SL during training and racing among Thoroughbred flat racehorses in Japan in 1999.

METHODS

A retrospective study was performed using a sample population of 10,262 Thoroughbred racehorses. The medical information database of Thoroughbred racehorses registered by the Japan Racing Association (JRA) in 1999 was analysed for SDFT and SL overstrain injury diagnosed by a veterinarian employed by JRA during training and racing. Jump racehorses were excluded from this study.

RESULTS

The prevalence of forelimb SDFT tendonitis and SL desmitis was 11.1% (1130 cases) and 3.61% (370 cases) of the population, respectively. In the hindlimb, there were 0.06% (6 cases) and 0.14% (14 cases), respectively. Risks of SDF tendonitis in the forelimb in 3-year-olds or older horses were significantly higher than in 2-year-olds. In contrast, the risk of SL desmitis in the forelimb at age 3 and 4 years was 2.23 and 2.11 times higher, respectively, than in 2-year-olds, but this increased to 5.07 times in those age > or = 5 years. Entire males were at greater risk in comparison to females and geldings.

CONCLUSIONS

The results suggest that the prevalence of SDF tendonitis and SL desmitis in the forelimb was associated with the horse's age and sex. The prevalence of SL desmitis increased further with age compared with SDF tendonitis, possibly reflecting a more rapid accumulation of degeneration in this structure.

POTENTIAL RELEVANCE

The age-related risk demonstrated in this study provides further support that overstrain injuries are associated with accumulated degeneration. These data provide a valuable resource for further research into the aetiology of tendon injury in the racehorse.

Use of computed tomography angiography to evaluate the vascular anatomy of the distal portion of the forelimb of horses

OBJECTIVE

To provide a detailed description of the vascular anatomy of the distal portion of the forelimbs of horses by use of computed tomography angiography (CTA).

SAMPLE POPULATION

6 forelimbs of 5 horses and 1 forelimb from an equine cadaver; none of the horses had orthopedic or vascular disease.

PROCEDURE

Horses were anesthetized and CTA was conducted on the dependent forelimb. A catheter was inserted in the median artery, and contrast medium was infused at a rate of 3 mL/s. A computed tomography (CT) scanner was used to obtain contiguous slices from the region of the proximal sesamoid bones to the toe. All horses were allowed to recover from anesthesia. To help identify vessel patterns in the distal portion of the forelimb, the median artery and lateral palmar digital vein of a heparinized forelimb obtained from an equine cadaver were infused with red and blue polymethylmethacrylate and the distal portion of that forelimb was then sectioned to correspond to CTA images.

RESULTS

Vessel patterns in CTA images matched vascular anatomic structures of the cadaver forelimb and were consistent with published anatomic structures. Major and minor vessels were consistently visible in CTA images of all horses. There were no complications reported in any horses.

CONCLUSIONS AND CLINICAL RELEVANCE

Use of CTA provided a highly detailed depiction of the vasculature of the distal portion of the equine forelimb. This was a safe technique and should be useful in the evaluation of the blood supply to the distal portion of the forelimb.

Evaluation of forelimb horseshoe characteristics of thoroughbreds racing on dirt surfaces

OBJECTIVE

To describe forelimb horseshoe characteristics of horses racing on dirt surfaces and determine whether these characteristics vary with region of California, season, horse characteristics, and race-related factors.

ANIMALS

5,730 Thoroughbred racehorses.

PROCEDURE

From June 17, 2000, to June 16, 2001, the characteristics of 1 forelimb horseshoe of horses that raced on dirt surfaces at 5 major racetracks in California were recorded. These characteristics included shoe type; toe grab height; and presence of a rim, pad, and heel traction devices (jar caulks, heel stickers, heel blocks, and special nails). Horse and race information was obtained from commercial records. One race/horse was randomly selected.

RESULTS

99% of forelimb horseshoes were aluminum racing plates, 35% had a pad, 23% had a rim, and 8% had a heel traction device. A toe grab was observed on 75% of forelimb horseshoes (14% very low [< or = 2 mm], 30% low [> 2 and < or = 4 mm], 30% regular [> 4 and < or = 6 mm], and 1% high [> 6 and < or = 8 mm]). Forelimb horseshoe characteristics varied with region of California, season, age and sex of the horse, race purse and distance, and track surface condition. Log-linear modeling revealed that all of these factors were significantly interrelated.

CONCLUSIONS AND CLINICAL RELEVANCE

Complex interrelationships among forelimb horseshoe characteristics and region, season, age and sex of the horse, and race-related factors need to be considered when evaluating the relationships between injury and horseshoe characteristics in Thoroughbred racehorses.

A Biomechanical Comparison of Headless Tapered Variable Pitch Compression and AO Cortical Bone Screws for Fixation of a Simulated Midbody Transverse Fracture of the Proximal Sesamoid Bone in Horses

OBJECTIVE

To compare mechanical properties and failure characteristics of 2 methods of fixation for repair of a transverse, midbody fracture of the proximal sesamoid bone (PSB): 4.5-mm AO cortical bone screw (AO) placed in lag fashion and 4/5-mm Acutrak (AT) self-compressing screw.

STUDY DESIGN

An in vitro biomechanical evaluation of intact forelimb preparations and forelimb preparations with a simulated midbody PSB fracture stabilized by a bone screw.

SAMPLE POPULATION

Sixteen paired and 8 unilateral cadaveric equine forelimbs.

METHODS

A midbody transverse osteotomy was created in the medial PSB of bilateral forelimbs of 8 equine cadavers. The osteotomized PSB in 1 forelimb from each cadaver was repaired with an AO screw. The osteotomized PSB in each contralateral limb was repaired with an AT screw. Eight unilateral intact control limbs were also studied. Mechanical properties were determined from axial compression, single cycle to failure, load-deformation curves. Failure characteristics were determined by evaluation of video images and radiographs.

RESULTS

No statistically significant differences were found between repair groups. Both AO and AT groups had significantly lower mechanical properties than intact limbs except for stiffness.

CONCLUSION

AO and AT constructs were mechanically comparable when used to stabilize a simulated midbody fracture of the medial PSB. Both constructs were mechanically inferior to intact limbs. Clinical Relevance- The AT screw should be considered for clinical use because of the potential for less soft tissue impingement and superior biocompatibility compared with the stainless-steel AO screw. However, postoperative external coaptation is necessary to augment initial fracture stability for either fixation method, and to maintain a standing metacarpophalangeal joint dorsiflexion angle between 150 degrees and 155 degrees.

Descriptive epidemiology of fractures occurring in British Thoroughbred racehorses in training

REASONS FOR PERFORMING STUDY

Musculoskeletal injury is the major cause of days lost from training and wastage in Thoroughbred racehorses. Little scientific information is available on the majority of injuries occurring in training.

OBJECTIVES

To estimate the incidence of fractures in British racehorses in training and describe the occurrence of different fracture types and bones involved.

METHODS

Thirteen UK racehorse trainers participated in a prospective study, providing data on horses in their care for 2 years. Details on horses, their daily exercise and fracture occurrence were recorded.

RESULTS

A total of 1178 horses provided 12,893 months at risk. Nontraumatic fracture incidence was 1.15/100 horse months (95% CI = 0.98, 1.35) and 78% of fractures occurred during training. A wide variety of fracture types and bones were involved, although at least 57% were stress fractures. Pelvic and tibial stress injuries accounted for 28% of fractures diagnosed.

CONCLUSIONS

It is important to study injuries in training as well as in racing. The number of stress fractures suggests that training regimes for young Thoroughbreds could often be improved to create a more robust skeleton, able to withstand injury.

POTENTIAL RELEVANCE

Studying injuries in racehorses in training can provide a scientific basis for the design of safer training regimes.

Risk factors and prevalence of injuries in horses during various types of steeplechase races

OBJECTIVE

To identify the types of injuries sustained by horses that competed in steeplechase races and determine the prevalence of and risk factors for those injuries.

DESIGN

Prospective study.

ANIMALS

2,680 horses that competed in various types of steeplechase races from 1996 through 2000.

PROCEDURE

Data regarding races; environment; equipment problems; the number of horses that entered, started, and finished races; the number of riders that fell; and the number of horses that were slowed or stopped by the rider, ran off the course, fell, and sustained injuries or physical abnormalities during races were collected on a standard form by the official veterinarian who attended each meet. Data from all meets were not recorded; however, in recorded meets, data from every race were reported.

RESULTS

Data for 197 hurdle, 65 timber, 76 flat, and 8 mixed races were recorded. Nine (3.4/1,000 horses that started in races) horses died or were euthanatized, and 7 of those were associated with catastrophic musculoskeletal injury. Seven fractures were recorded. Four fractures involved forelimbs, 1 involved a hind limb, and 2 involved the cervical portion of the vertebral column. All horses with fractures were euthanatized. Deep or hard course conditions were associated with an increased risk of breakdown injuries.

CONCLUSIONS AND CLINICAL RELEVANCE

Successful development and implementation of strategies to prevent injuries and death in horses in steeplechase races depend on a clear understanding of the types and prevalence of injuries involved and risk factors associated with those injuries.

Case-control studies: research in reverse

Epidemiologists benefit greatly from having case-control study designs in their research armamentarium. Case-control studies can yield important scientific findings with relatively little time, money, and effort compared with other study designs. This seemingly quick road to research results entices many newly trained epidemiologists. Indeed, investigators implement case-control studies more frequently than any other analytical epidemiological study. Unfortunately, case-control designs also tend to be more susceptible to biases than other comparative studies. Although easier to do, they are also easier to do wrong. Five main notions guide investigators who do, or readers who assess, case-control studies. First, investigators must explicitly define the criteria for diagnosis of a case and any eligibility criteria used for selection. Second, controls should come from the same population as the cases, and their selection should be independent of the exposures of interest. Third, investigators should blind the data gatherers to the case or control status of participants or, if impossible, at least blind them to the main hypothesis of the study. Fourth, data gatherers need to be thoroughly trained to elicit exposure in a similar manner from cases and controls; they should use memory aids to facilitate and balance recall between cases and controls. Finally, investigators should address confounding in case-control studies, either in the design stage or with analytical techniques. Devotion of meticulous attention to these points enhances the validity of the results and bolsters the reader's confidence in the findings.