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  3. Diagnosis
  4. Indications
  5. Treatment

Authors of section


Jörg Auer, Larry Bramlage, Patricia Hogan, Alan Ruggles, Jeffrey Watkins

Executive Editor

Jörg Auer

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Nonsurgical management

1. Nonsurgical treatment

Cast application

The foot is elevated and cleaned.

The sole is filled with plaster of Paris to develop an even footing surface followed by applying one role of fiber glass cast material around the hoof capsule.
Once the cast has set the horse can place weight on it again. The sole of the cast is protected by hoof acrylic to prevent rapid wear.

Fracture of the distal sesamoid bone

Bar shoes

Another alternative is to apply a bar shoe with side clips. Ideally, the sole is filled as described above.

Fracture of the distal sesamoid bone

2. Aftertreatment

The cast is changed at 2 weeks and left in place for another 4 weeks. At that time the hoof is wrapped only with non-elastic tape for 2 weeks.
Follow-up radiographs are taken at 2 months after initiation of the treatment. Dependent on the result and the findings of a brief lameness exam treatment is either continued or stopped.

Bar shoes with side clips are changed at 4-6 weeks intervals. At the third application the side clips can usually be removed. It is advisable to take radiographs at the 2nd changing of the shoes to assess healing.

Above: Good healing of the fracture could be appreciated on the 12 months follow up radiographs. Only at the distal aspect of the proximal sesamoid bone could a small semicircular defect at the former fracture site be detected. The horse was at that time sound.

nonsurgical management


Both techniques effectively prevent hoof expansion during weight-bearing, which leads to a contracted foot. The same problem occurs with the bar shoe and side clips.

screw fixation and resection

Once the cast is removed a special shoe whose heels are tapered to the outside is applied to facilitate expansion of the heels. This procedure takes some time.

screw fixation and resection


A reasonable prognosis can be given for future use of the horse. It usually takes 4-6 months for the fracture to heal at which time the horse can be ridden again. However, radiographically, the fracture line is visible much longer. Initially a fibrous union develops, which ossifies within 6-12 months.
In some cases a nonunion develops. Subsequent treatment with internal fixation by means of screw fixation in lag technique may lead to fracture healing. However, the prognosis for a sound horse is guarded.

Above: a two-year follow up radiograph of the parasagittal body fracture shown above revealed a nonunion of the fracture. However the bone surrounding the fracture increased in density.

nonsurgical management