Catastrophic scapular fractures in Californian racehorses: pathology, morphometry and bone density

Reasons for performing study: To enhance understanding of the nature and pathogenesis of scapular fractures in racehorses. Hypothesis: Scapular fractures in racehorses have a consistent configuration related to sites of pre‐existing stress modelling and remodelling. Methods: Fractured and intact scapulae collected post mortem were examined visually and with computed tomography (CT). Scapular fracture configuration, bone modelling changes and standardised CT morphometry and density measurements were recorded. Statistical comparisons were made between fractured, nonfractured contralateral and control scapulae. Results: Thirty‐nine scapulae from 10 Thoroughbred (TB) and 10 Quarter Horse (QH) racehorses were obtained. All 14 fractured scapulae (from 12 horses) had a consistent comminuted fracture configuration. A complete fracture coursed transversely through the neck of the scapula at the level of the distal aspect of the spine (8.9 ± 0.9 cm proximal to the lateral articular margin of the glenoid cavity). The distal fragment of 13 fractured scapulae was split into 2 major fragments by a fracture in the frontal plane that entered the glenoid cavity (2.8 ± 0.4 cm caudal to the cranial articular margin). Focal areas of periosteal proliferation and/or radiolucency were present in the distal aspect of the scapular spine of all fractured and intact contralateral scapulae, but less commonly (P<0.01) in intact scapula from horses without a scapular fracture. Fractured scapulae had 7–10% lower mean density and 46–104% greater density heterogeneity in the spine adjacent to the transverse fracture compared to control scapulae (P<0.03). Conclusions and clinical relevance: Thoroughbred and QH racehorses have a characteristic scapular fracture configuration that is associated with pre‐existing pathology of the distal aspect of the spine. This location is consistent with scapular stress fractures diagnosed in lame TB racehorses. Catastrophic fracture is the acute manifestation of a more chronic process. Consequently, there are opportunities for early detection and prevention of fatalities.