to provide objective guidance. Suggestions that with the right insight nearly every catastrophic fracture in flat racehorses could be foretold [93] are not justifiable. However, the prevention of some work/stress‐related fractures through conditioning and training methods, surface design and maintenance [94] and potentially from genetic studies [95] appears feasible goals. Robust epidemiological studies should identify risk factors, enable change to be rational and, if both are correct, reduction in work‐related (stress) fractures is a reasonable expectation. Unfortunately, epidemiologic evidence thus far is inconsistent [96]. Previously heralded mineral‐based dietary influences appear unlikely to contribute [97]. Screening of horses in training or monitoring at‐risk individuals by biomarkers as yet appears to lack sensitivity and specificity [98]. Assessment by diagnostic imaging is an attractive concept but remains unproven [95,99–104]. Longitudinal studies, of which there are few in man [105], are a laudable goal [95] but unlikely to be practical in equine athletes.
Notwithstanding the above, monotonic fractures that result from trauma will continue to present and challenge veterinarians. The potential for survival, humane preservation of life and return to useful function continues to progress proximally in the horse's limb. Development of CT equipment that will allow three‐dimensional evaluation of the proximal appendicular and axial skeleton appears close to the horizon. Variable angle LCPs (VA‐LCP) are now in production for man and should soon join the veterinary surgeons’ armamentarium [42]. Refinements such as the addition of hard carbon film to improve drill efficiency and reduce bone temperature may become the norm [106]. Further development of biodegradable plates and screws is anticipated together with drug, osteoconductive and osteoinductive coatings to implants [42, 107, 108]. Customized implants made using 3D printing technology are also an enticing prospect but access to adequate technological knowledge and appropriate materials is unlikely to be widespread in equine surgery. Computer‐assisted surgery in horses is in its infancy [109, 110] but will not be a substitute for anatomic knowledge or surgical skill. There is little current evidence to support clinical application of cellular, growth factor or cell signalling molecules in improving the rate or quality of fracture healing [42]. However, in common with other regenerative disciplines, targeted nuclear manipulation appears rational and holds promise.
It has been stated that orthopaedic surgery may be reduced to three key factors: knowledge, understanding and accuracy [111]. Publications (hopefully this included) add to the body of corporate knowledge. Competent equine fracture repair requires a trained and experienced team including imagers, surgeons, anaesthetists, theatre technicians and nurses. Accuracy is aided by technology but requires discipline, training and experience. Understanding is a never‐ending personal challenge. Technical errors are inevitable when even ‘simple’ fractures are repaired by inexperienced personnel. Technology aside, size, behaviour and temperament will always be challenges to equine fracture management. However, if the rate of progress seen in the last 50 years continues, then many of these will be met and current limitations will be confined to historical perspective.
References
1 1 Hill, C.L. (2013). A Plaine and Easie Waie to Remedie a Horse. Equine Medicine in Early Modern England. Leidon‐Boston: Brill.
2 2 Clutton‐Brock, J.U. (1987). A Natural History of Domesticated Animals. Cambridge: Cambridge University Press.
3 3 Bartosiewicz, L. and Gaˆl, E. (2013). Shuffling Nags, Lame Ducks: The Archaeology of Animal Disease. Oxford: Oxbow Books.
4 4 Antikas, T.G. (2008). They didn't shoot horses: fracture management in a horse of the 5th century BCE from Sindos, Central Macedonia, Greece. Veterinarija Ir Zootechnika 42: 24–27.
5 5 Boessneck, J. and Meyer‐Lemppenau, U. (1966). Shuffling Nags, Lame Ducks: The Archeology of Animal Disease. Oxford: Oxbow Books.
6 6 Boessneck, J., von den Driesch‐Karpf, A., Gejval, N.G. et al. (1968). Die Knochenfunde von Säugetiere und von Menschen. In: The Archaeology of Skedemosse III (The Royal Swedish Academy of Letters, History and Antiquity). Stockholm: Almqvist & Wiksell.
7 7 Undrescu, M., Neer, W.R.. (2005). Looking for Human Therapeutic Intervention in the Healing of Fractures of Domestic Animals: Diet and Health in Past animal Populations: Current Research and Future Directions: Proceedings of the 9th ICAZ Conference. Durham. Davies, J., Fabis, M., Mainland, I., Richards, M.P., Thomas, R. Oxford: Oxbow Books.
8 8 Powell, L., Southwell‐Wright, W., and Gowland, R. (2016). Care in the Past: Archaeological and Interdisciplinary Perspectives. Oxbow Books.
9 9 Groot, M.. (2008). Understanding past human‐animal relationships through the analysis of fractures: a case study from a Roman site in the Netherlands: Current Research in Animal Palaeopathology: Proceedings of the Second ICAZ Animal Palaeopathology Working Group Conference: Miklίková, R.T. Archaeopress: Oxford.
10 10 den Driesch, V. and La, A. (1989). Paléopathologie animale: analyse d'ossements animaux pathologiques pré‐ et protohistoriques. Revenue de Médecine Vétérinaire 40: 645–652.
11 11 Smith, F. and Bullock, F. (1919). The Early History of Veterinary Literature and its British Development. London: Bailliaere, Tindall and Cox.
12 12 Shehada, H.A. (2013). Orthopaedic Bandages (for Setting Broken Bones): Mamluks and animals: Non‐invasive practices in veterinary medicine in medieval Islam. Boston: Brill.
13 13 Bartosiewicz, L., Demeure, R., Mottet, I., and Van Neer, W. (1997). Magnetic resonance imaging in the study of spavin in recent and subfossil cattle. Arthropozoologica 25/26: 57–60.
14 14 Blundeville, T. The Foure Chiefest Offices Belonging to Horsmanshippe: That Is to Say, the Office of the Breeder, of the Rider, or the Keeper, and of the Ferrer, 1565. Henry Denham.
15 15 Hope, W. (1702). The Compleat Horseman. London: Banwicks.
16 16 Youatt, W. (1843). The Horse, 2e. London: Chapman and Hall.
17 17 Clayton Jones, D.G. (1975). The repair of equine fractures 1843‐1975. Vet. Rec. 97: 193–197.
18 18 Williams, W. (1893). Fractures and Diseases of Bones: The principles and practice of veterinary surgery, 8e. Edinburgh/Glasgow: John Menzies & Co.
19 19 Clater, F. (1853). Every Man and his Own Farrier: Containing the Causes, Symptoms and Most Approved Methods of Cure of the Diseases in Horses and Dogs. London: Baldwin & Cradock: Simpkin and Marshall: Houston and Son.
20 20 Fitzwygram, F. (1869). Horses and Stables. London: Longmans Green: Reader and Dyer.
21 21 Smith, F. (1884). Fracture within the stifle joint. Q. J. Vet. Sci. India. 2: 236.
22 22 Auer, J.A., Pohler, O., Schlűnder, M. et al. (2013). History of AOVET: The First 40 Years. Davos Platz: AO Publishing.
23 23 Eton, W. (1809). A Survey of the Turkish Empire: Turkish Arts and Sciences. London: Codell T, Davies W.
24 24 Williams, W. (1872). The Principles and Practice of Veterinary Surgery. Edinburgh/Glasgow: John Menzies & Co.
25 25 Williams, A.C. and Williams, H.P. (1883). The Journal of Comparative Medicine and Veterinary Archives (eds. A.C. Williams, H.P. Williams and W.R. Jenkins). New York: Philadelphia.
26 26 Wotley Axe, J. (1905). The Horse: Its Treatment in Health and Disease, vol. 5. London: The Gresham Publishing Co.
27 27 Gunn, R. (1927). Radiology as an aid to diagnosis in veterinary practice. Aust. Vet. J. 3: 129–136.
28 28 Kendrick, J.W. (1950). Two cases of fracture in the horse. Cornell Vet. 40: 273–274.
29 29 Adams, O.R. (1962). Lameness in Horses. London: Ballieue: Tindall and Cox.
30 30 Salter, R.B. and Harris, W.R. (1963). Injuries involving the epiphyseal plate. J. Bone Joint Surg. 45: 587–622.
31 31 Auer, J.A. (2012). Principals of fracture treatment. In: Equine Surgery, 4e (eds. J.A. Auer and J.A. Stick), 1047–1081. St Louis: Missouri: Elsevier.
32 32 Műller, M.E., Bandi, W., Allgower, M. et al. (1965). Technique of Internal Fixation of Fractures. Berlin/Heidelberg/New York: