Fracture of the Distal Phalanx Average Cost

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What is Fracture of the Distal Phalanx?

The distal phalanx is a delicate part of your horse and needs the hoof wall and cushioning to protect it from injury. In almost all fractures that do not affect the joint, rest for six to nine months may be all that is needed to return your horse to soundness. However, when the joint is included, it can take over a year of rest and surgery. If your horse is under three years old, healing can be complete and your horse can return to regular work. Older horses may not be able to heal no matter what treatment you provide. Some of the complications are infection, permanent lameness, and severe arthritis to name a few.

Fracture of the distal phalanx (coffin bone) in horses most often happens after an injury such as being kicked or racing on a hard surface. The distal phalanx is the bottom bone of the foot and is attached to the inner wall of the horse’s hoof. Even though the distal phalanx is protected by the hoof, it can be fractured and injured. Any kind of fracture in the distal phalanx can cause your horse to become lame because of the severe pain. This is a common injury that is seen more in the forelegs than the hind legs. If the fracture does not include a joint, treating with a compression bandage, nerve anesthesia, and 48 hours of stall rest can be a huge improvement. However, the majority of distal phalanx fractures are more extensive and need immediate and thorough treatment. The distal phalanx is the most important part of your horse’s survival because without a functional distal phalanx the horse is unable to stand at all.

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Symptoms of Fracture of the Distal Phalanx in Horses

The symptoms of a fracture of the distal phalanx can vary depending on the type of fracture. However, the general symptoms are all similar, which are:

  • Severe lameness worse on soft ground
  • Cannot support weight on limb
  • Sudden onset limping
  • Heat in the walls of the hoof
  • Able to feel pulse in foot
  • Inflammation or bump around the pastern or coronet
  • Holding foot abnormally when resting
  • Wound or missing part of hoof walls
  • Trouble walking on gravel or hard ground like concrete
  • Standing with one leg placed out front


  • Wing fracture without joint involvement is usually mild and may only need rest for one to three months
  • Fracture with joint involvement is much more serious and can result in permanent lameness if surgical repair is not done right away; arthritis is common in this condition even after surgery
  • Sagittal, parasagittal and axial fracture goes up the middle of the bone and into the joint. Less than half of these horses are able to be sound after treatment
  • Extensor process fracture is a fracture of the top of the bone and is an important part of movement in the foot. Arthritis is common in this condition as well
  • Multi fragmented fracture consists of several fractures which may or may not involve the joint. The prognosis for a full recovery in this condition is guarded
  • Solar margin fracture is similar to the wing fracture with just a small chip or crack that does not involve the joint. Prognosis is good in this case
  • Foal fracture is a different type of solar margin fracture. Chances of full recovery are good because of the horse’s age

Causes of Fracture of the Distal Phalanx in Horses

Risk is highest in:  

  • Foals
  • Quarter Horses
  • Standardbred racehorses
  • Thoroughbred racehorses

Diagnosis of Fracture of the Distal Phalanx in Horses

The veterinarian will need to know your horse’s medical history and workload. Be sure to mention the symptoms you have noticed and if you know the cause of the fracture, tell the veterinarian. A physical examination will be done, including height, weight, body condition score, conformation, body temperature, blood pressure, heart rate, and breath sounds. The lameness check is essential to diagnosing a fracture of the distal phalanx. This procedure is done by the veterinarian watching your horse’s movement at a trot, canter, and walk in a circle as well as a straight line. Hoof tester and flexion examination are completed and then the veterinarian will use a nerve block (anesthesia) to numb the area before sending you off to trot your horse again. A hoof tester and hoof examination is also an important diagnostic tool.

An ultrasound and radiographs (x-rays) will be done to find the fracture and determine how bad it is. Sometimes an arthroscopic exploration is necessary as well. Finally, the veterinarian will take a urine and blood sample for diagnostic analysis.

Treatment of Fracture of the Distal Phalanx in Horses

Treating your horse depends completely on the type of fracture.

Full Bar Shoe

A full bar shoe (with clips) is a common treatment for three to six months. This keeps the foot immobilized for the time needed to heal.

Stall Rest

The length of stall rest is dependent upon which type of fracture your horse has. This can be done alone or with other treatments like surgery.


There are several medications such as sodium hyaluronate that can be injected for pain and inflammation. NSAIDs for pain and swelling. Phenylbutazone Bute is sometimes used as an aid in reducing inflammation and pain.


Surgical implants can be used in some cases.

Recovery of Fracture of the Distal Phalanx in Horses

Your horse’s prognosis is guarded to good, but it depends on the type of fracture. Types 1, 2, 4, and 5 are all guarded to fair. Types 6 and 7 both have good prognoses. Type 3 is guarded even if it is treated with surgery because there are high complication rates. As long as you follow the veterinarian’s instructions and follow up with questions or concerns, your horse has a chance at recovering from a fracture of the distal phalanx.