Targeted fetlock views match full series in many horse PPE cases
Bottom line
Lateromedial and oblique radiographs may be enough for many equine fetlock PPEs
A new retrospective study in Equine Veterinary Journal suggests that a lateromedial view plus oblique projections can detect most fetlock pathologies during equine pre-purchase examinations as effectively as a full radiographic series. The study, by A. Northwood and D. Berner, compared four projection sets, including lateromedial alone, lateromedial plus dorsopalmar/plantar, lateromedial plus obliques, and a full series. The authors found that the lateromedial-plus-oblique combination performed similarly to the full series for most pathology detection, while lateromedial alone was less comprehensive. The paper addresses a long-running question in equine PPE practice, where radiographic protocols vary by region and by clinician preference. (beva.onlinelibrary.wiley.com)
Why it matters: For equine veterinarians, the findings could support a more efficient fetlock imaging protocol in selected PPE settings, especially when time, cost, and field logistics matter. That said, the broader PPE context still matters: fetlocks are a common focus in prepurchase imaging, full sport-horse radiographic sets can run to 40 to 42 views overall, and image quality remains critical to interpretation. Existing guidance and educational materials also show that standard fetlock workups often include four views, and some lesions may still require additional or nonstandard projections depending on the clinical question. In other words, this study may inform streamlining, but it doesn't eliminate the need for case-by-case judgment. (vet.cornell.edu)
What to watch: Whether PPE protocols, especially in practices balancing cost and resale expectations, start shifting toward targeted fetlock series rather than routine full-view sets. (beva.onlinelibrary.wiley.com)
Key facts
- Study type
- Retrospective observational study
- Journal
- Equine Veterinary Journal
- Authors
- A. Northwood and D. Berner
- Setting
- Equine pre-purchase examinations
- Comparison
- Lateromedial alone, lateromedial plus dorsopalmar/plantar, lateromedial plus obliques, and a full series
- Main finding
- Lateromedial plus oblique projections performed similarly to the full series for most pathology detection
- Secondary finding
- Lateromedial alone was less comprehensive
- Practice context
- Radiographic protocols vary by region and clinician preference
A new study in Equine Veterinary Journal is likely to add fuel to an old debate in equine prepurchase imaging: how many fetlock radiographs are really necessary. In a retrospective observational analysis, researchers A. Northwood and D. Berner found that lateromedial and oblique projections detected most fetlock pathologies as effectively as a full radiographic series in horses undergoing pre-purchase evaluation. (beva.onlinelibrary.wiley.com)
That question matters because fetlock imaging sits at the intersection of medicine, economics, and risk tolerance. Pre-purchase examinations are designed to assess risk at a single point in time, not guarantee future soundness, and radiographs often carry outsized weight in purchase decisions. Cornell’s equine team notes that a full radiographic set for many sport horses can include 40 to 42 views, with four views of all four fetlocks commonly included. At the same time, protocols vary internationally, and the study notes that the German Equine Veterinary Association recommends a lateromedial projection with additional views only if indicated. (vet.cornell.edu)
In the new paper, two observers reviewed fetlock radiographic series using four combinations: lateromedial alone, lateromedial plus dorsopalmar/plantar, lateromedial plus oblique projections, and the full series. The topline finding was that lateromedial plus obliques matched the full series for detecting most pathologies, suggesting that adding oblique views may preserve much of the diagnostic value while reducing the number of images taken. By contrast, earlier background literature and educational references have generally described the standard fetlock series as four projections, and note that additional views are sometimes needed for complete assessment. (beva.onlinelibrary.wiley.com)
The study lands in a field where interpretation is already variable. Separate published research has found substantial variability among equine veterinarians in how survey radiographs from prepurchase exams are interpreted, underscoring that projection choice is only one part of the decision chain. AAEP guidance likewise emphasizes documentation, image quality, and the buyer-focused nature of the purchase exam, rather than a one-size-fits-all imaging formula. (pmc.ncbi.nlm.nih.gov)
Direct outside reaction to this specific paper appears limited so far, but the surrounding industry conversation points in two directions. On one hand, practices and pet parents seeking PPEs often want efficient, cost-conscious imaging strategies. On the other, clinicians involved in high-value sport-horse or sales settings may still favor broader baseline studies, both for risk assessment and for future comparison if lameness develops. Cornell’s overview captures that tension well: radiographs can help identify red flags, but they also feed a "crystal ball" exercise in predicting future significance from present findings. (vet.cornell.edu)
Why it matters: For veterinary professionals, this study could help refine how fetlock imaging is tailored during PPEs. If lateromedial plus oblique views reliably capture most meaningful pathology, some clinicians may be able to shorten imaging protocols without sacrificing much diagnostic performance. That could reduce time in the field, improve workflow, and lower costs for pet parents. But the findings shouldn't be overextended. Fetlock lesions are diverse, some pathologies still benefit from dorsopalmar/plantar or additional specialty views, and poor positioning can undermine any protocol. The practical takeaway is not that full series are obsolete, but that a targeted series may be defensible in selected horses and contexts. (beva.onlinelibrary.wiley.com)
What to watch: The next question is whether this evidence changes real-world PPE protocols, teaching, or insurer and sales expectations, or whether full fetlock series remain the default in higher-stakes transactions despite the efficiency argument. (beva.onlinelibrary.wiley.com)