Is removal of proximo-plantar osteochondral fragments necessary in young Thoroughbreds?

PICO question In young Thoroughbreds with osteochondral fragments of the proximo-plantar aspect of the proximal phalanx, does pre-emptive surgical removal of the fragments compared to conservative (non-surgical) management reduce the incidence of subsequent lameness? Clinical bottom line There is currently insufficient data to determine the impact, on subsequent lameness, of conservative versus surgical management of proximo-plantar osteochondral fragments in young Thoroughbreds. Indeed, only three relevant studies were found, which include one retrospective study and two smaller case series. Since there are no substantive studies that have specifically focused on the treatment of plantar osteochondral fragmentation in Thoroughbred racehorses, the strength of evidence currently available is low.