C. M. Riggs

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.

Risk of fatal distal limb fractures among Thoroughbreds involved in the five types of racing in the United Kingdom.

The risk of fatal distal limb fractures in thoroughbreds racing in the UK was calculated and shown to vary considerably between the different types of race. Flat turf racing was associated with the lowest risk (0-4 per 1000 starts) and national hunt flat racing was associated with the highest risk (2.2 per 1000 starts). The types of fracture were classified by detailed radiographic and postmortem examinations of all the cases recorded over two years, and the distribution of the different types of fracture in the five main types of racing was examined. Overall, lateral condylar fractures of the third metacarpus were the most common, and they were also the most common in national hunt-type races (hurdle, steeplechase and national hunt flat races). In all-weather flat racing biaxial proximal sesamoid fractures were most common, and in turf flat racing fractures of the first phalanx were most common. The risk of fractures of more than one bone was greater in national hunt-type races.

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.

Descriptive analysis of retirement of Thoroughbred racehorses due to tendon injuries at the Hong Kong Jockey Club (1992-2004)

REASONS FOR PERFORMING STUDY This study was part of a programme to optimise the longevity and maximise the health and welfare of the Thoroughbred racehorses in Hong Kong. Injuries to the superficial digital flexor (SDF) tendon are the most common veterinary reason for premature retirement in this population. OBJECTIVE To describe the frequency and pattern of retirements associated with SDF tendon injuries in Thoroughbred racehorses and to compare the characteristics of these horses with those that retired for other reasons. METHODS A retrospective analysis of retirement records documented in the Hong Kong Jockey Club clinical database between 1992 and 2004 was conducted. As this is complete census data, no statistical inference to the population is necessary. RESULTS The mean annual cumulative incidence of retirements due to tendon injury was 3.2% accounting for 14% of all retirements. The risk of tendon injury increased over the 12 year period from 23-4.2%. The racing career, number of starts and earnings of horses retired with tendon injuries were reduced by 25.6, 41.2 and 53.3%, respectively. Thirteen percent of these horses never raced in Hong Kong. A greater proportion of 3- and 4-year-olds and entire males were retired because of tendon injuries. Ninety-seven percent of injuries affected the forelimb, the right more frequently than the left. Only 19.7% of retired horses that had received ultrasound examination for SDF tendon injury retired for this reason. CONCLUSIONS This study provides population based data on the frequency, career and economic losses associated with tendon injury induced retirement. POTENTIAL RELEVANCE This descriptive study has provided a useful resource for further case-control studies to investigate risk factors for retirement from racing due to tendon injury. This is the first step toward the development of management tools to reduce the incidence of tendon injury related retirement in Hong Kong.

Post mortem evaluation of palmar osteochondral disease (traumatic osteochondrosis) of the metacarpo/metatarsophalangeal joint in Thoroughbred racehorses.

REASONS FOR PERFORMING STUDY Thoroughbred racehorses are commonly affected by subchondral bone injury, but the exact prevalence and the distribution of palmar/plantar osteochondral disease (POD) lesions are unknown. The relationship between pathologies has not been elucidated, although it is widely accepted that POD is a manifestation of traumatic overload arthrosis. HYPOTHESIS There is an association between grade of POD and other pathologies affecting the third metacarpal and metatarsal (MC/MTIII) condyles (wear lines, cartilage loss, marginal remodelling, dorsal impact injuries and linear fissures). OBJECTIVES To evaluate the pathology found affecting the distal MC/MTIII condyles of Thoroughbred racehorses at post mortem examination, to describe the prevalence and distribution of POD lesions within a population of racing Thoroughbreds and to determine relationships between pathologies of the distal condyles of the third metacarpal and metatarsal bones. METHODS The metacarpo/metatarsophalangeal joints of 64 Thoroughbred racehorses were examined at routine post mortem examination and graded for third metacarpal and metatarsal condylar pathology. Associations between pathologies were determined. RESULTS POD had a within horse prevalence of 67%. There was a significant linear relationship between grade of POD and grades of wear lines, cartilage ulceration and dorsal impact injuries. There was a significant relationship, but this was not linear, between grade of POD and grade of linear fissures. Using ordinal logistic regression, compared to condyles with grade 0 or grade 2 linear fissures, condyles with grade 1 linear fissures were found to be more likely to have a lower POD grade. POTENTIAL RELEVANCE POD can be considered to be a manifestation of traumatic overload arthrosis, but the role of subchondral bone adaptation is complex and warrants further investigation.

Use of free text clinical records in identifying syndromes and analysing health data

The analysis of data in clinical records could be useful to epidemiologists in planning analytical studies and identifying new research initiatives. This paper describes the method used to develop a systematic, replicable technique for compressing many words of text into fewer content categories on the basis of explicit rules of user-defined coding, and systematically sorting a large volume of records accurately and reliably. The method was used to categorise the reasons for retirement from racing in Hong Kong of 3727 thoroughbred racehorses between the 1992/93 and 2003/04 racing seasons into a user-defined dictionary. An automated process successfully categorised 95 per cent of the records. The other 5 per cent were assigned manually to one of the dictionary categories. The whole process from initial screening to the categorisation of all the records took approximately 100 man-hours to complete.

Pathological and clinical features associated with palmar/plantar osteochondral disease of the metacarpo/metatarsophalangeal joint in Thoroughbred racehorses.

REASONS FOR PERFORMING STUDY Palmar/plantar osteochondral disease (POD) of the metacarpo/metatarsophalangeal (Mc/MtPh) joints is common in Thoroughbred racehorses, but there is little information on predilection sites, associated pathologies and clinical signs. OBJECTIVES To describe the distribution of POD at post mortem examination and to examine the association of POD with other pathologies and clinical histories. METHODS The Mc/MtPh joints of 102 Thoroughbred racehorses were examined post mortem. Gross pathology of associated osteochondral elements, suspensory ligament and flexor tendons was recorded. Clinical data were extracted from computerised records. Relationships between all Mc/MtPh joint pathologies, clinical data and grade of POD in each condyle were determined using multilevel, ordinal logistic regression models. RESULTS Palmar/plantar osteochondral disease was recorded (grade 1-3 in at least one condyle) in 80.4% (95% confidence interval 71-88) of horses. The grade of POD was significantly higher in the forelimb, where the medial condyle had higher grades, than in the hindlimb, where the POD grade was higher in the lateral condyle. There was a significant positive relationship between POD grade and multiple other joint pathologies, whereas grades of linear fissures had a negative relationship with grade of POD. There was no relationship between grade of POD and tendon and suspensory ligament gross pathology, although horses with a history of tendon injury had significantly lower POD grades. Horses that had a clinical history of a Mc/MtPh joint problem had higher POD grades. In addition, horses that had been retired from racing for more than 2 months at the date of death had significantly lower POD grades. CONCLUSIONS AND POTENTIAL RELEVANCE Palmar/plantar osteochondral disease has specific predilection sites. Horses with a clinical history of Mc/MtPh-associated lameness had higher POD grades, whereas those with a history of superficial digital flexor tendon injury and retired horses had lower grades. The progression of POD and its ability to heal requires further evaluation.

Comprehensive protein profiling of synovial fluid in osteoarthritis following protein equalization

Summary Objective The aim of the study was to characterise the protein complement of synovial fluid (SF) in health and osteoarthritis (OA) using liquid chromatography mass spectrometry (LC-MS/MS) following peptide-based depletion of high abundance proteins. Design SF was used from nine normal and nine OA Thoroughbred horses. Samples were analysed with LC-MS/MS using a NanoAcquity™ LC coupled to an LTQ Orbitrap Velos. In order to enrich the lower-abundance protein fractions protein equalisation was first undertaken using ProteoMiner™. Progenesis-QI™ LC-MS software was used for label-free quantification. In addition immunohistochemistry, western blotting and mRNA expression analysis was undertaken on selected joint tissues. Results The number of protein identifications was increased by 33% in the ProteoMiner™ treated SF compared to undepleted SF. A total of 764 proteins (462 with≥2 significant peptides) were identified in SF. A subset of 10 proteins were identified which were differentially expressed in OA SF. S100-A10, a calcium binding protein was upregulated in OA and validated with western blotting and immunohistochemistry. Several new OA specific peptide fragments (neopeptides) were identified. Conclusion The protein equalisation method compressed the dynamic range of the synovial proteins identifying the most comprehensive SF proteome to date. A number of proteins were identified for the first time in SF which may be involved in the pathogenesis of OA. We identified a distinct set of proteins and neopeptides that may act as potential biomarkers to distinguish between normal and OA joints.

Horse-, training- and race-level risk factors for palmar/plantar osteochondral disease in the racing Thoroughbred

Reasons for performing study Palmar/plantar osteochondral disease (POD) is a common, debilitating condition in Thoroughbred racehorses; however, training- and racing-related factors associated with this disease are unknown. Objectives To determine horse-, racing- and training-related risk factors for POD. The general hypotheses were that early training and racing, and increased intensity of racing and training, lead to increased severity of POD. Methods The metacarpo/metatarsophalangeal joints of 164 Thoroughbred racehorses were examined at post mortem and graded for third metacarpal and metatarsal POD. The relationships between training- and racing-related factors and grade of POD in each condyle were determined using multilevel, multivariable, ordinal logistic regression models. Results A total of 1288 condyles were graded. Factors associated with higher grades of POD were the total lifetime number of races, an increase in gallop sessions in the previous season, racing before import to Hong Kong and an increase in the number of short (8–16 weeks) between-race intervals per season. Horses in their first racing season were more likely to have lower POD grades, while horses that had a long between-race interval (greater than 16 weeks) in the season prior to euthanasia were also more likely to have lower POD grades. Lower POD grades were significantly more likely as days since last race increased up to 400 days. Age at first race was not significantly associated with grade of POD. Conclusions and potential relevance Cumulative racing exposure and training intensity in the previous season were associated with higher grades of POD, supporting the hypothesis that the disease is due to repetitive loading. Longer between-race intervals and increased time since racing were associated with lower POD grades, which may indicate that lesions heal. Further work is required to enable optimisation of racing and training programmes to reduce the frequency and severity of this disease.