As horse enthusiasts and caretakers, we know that our equine companions can occasionally face injuries that require careful attention and treatment. One such injury that can be particularly challenging is a 4th Metatarsal Fracture. In this blog, we’ll delve into this injury, exploring its different types, treatment options, and long-term prognosis.

Understanding the 4th Metatarsal Fracture

A 4th Metatarsal Fracture, also known as a lateral splint bone fracture, is a bone injury that horses can sustain. This type of fracture is categorized into two main types: proximal fractures, which occur higher up the leg, and distal or mid-body fractures, which are closer to the hoof.

Treatment Options

Proximal Fractures

1. Conservative Management

For proximal fractures, the initial approach is often conservative management. This includes:
Stall Rest: The horse, in this case, is usually confined to stall rest for a period of 6-8 weeks, followed by two months of hand-walking or limited turnout in a small paddock.
Medications: Anti-inflammatory medications are prescribed to manage pain and inflammation. Monitoring the horse’s pain level is crucial, as additional pain medications may be needed.
Wound Debridement: If there are open wounds, wound debridement is performed to clean and promote healing.
Monitoring: Regular monitoring of lameness, pain level, and any discharge from wounds is essential. Additional debridements may be required during the recovery process.
X-ray Evaluation: X-rays should be repeated at around 4-6 weeks to assess healing progress before considering increased exercise or turnout. Further recommendations for surgical intervention or continued recovery are made based on these X-ray findings.

2. Surgical Fixation

In some cases, surgical fixation may be necessary to minimize complications and residual lameness. However, implants are not recommended in cases with open fractures due to infection risks. Delayed surgical correction can be considered once infections have cleared.

3. Bone Removal

In rare instances, complete removal of the 4th metatarsal (lateral splint bone) may be necessary. This typically occurs when conservative therapy fails to resolve lameness, or in cases of extensive comminuted fractures or bone infection. However, it’s important to note that this procedure carries some risk of destabilizing the hock joint.

Distal & Mid-body Fractures

For distal and mid-body fractures, the approach is somewhat similar:

Stall Rest: The horse is usually kept on stall rest for 4-6 weeks, followed by a controlled exercise program for 4-6 weeks.
Medications: Anti-inflammatory medications are administered, and pain levels are closely monitored, with additional pain medications available if needed.
Monitoring: Regular monitoring of lameness and wound healing is crucial. X-rays are repeated at 4-6 weeks to assess healing progress and guide further treatment.
Fragment Removal: Surgical management is often recommended for these fractures to promote faster recovery and reduce callus formation that may affect the suspensory ligament.


The long-term prognosis for horses with 4th Metatarsal Fractures is generally good. Most horses recover well and can return to their intended use with time. Complications, such as involvement of the hind suspensory ligament, are rare but can occur.

In conclusion, a 4th Metatarsal Fracture is a challenging injury that requires careful management and a customized treatment plan. The dedication of horse owners and the expertise of veterinarians play a vital role in ensuring a successful recovery for our equine companions, allowing them to return to their active and vibrant lives.