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Summary The main aspect of this work was a comprehensive retrospective analysis of findings published since 1913 in German and English veterinary medical publications regarding equine middle (second) phalangeal fractures. The clinically relevant anatomy of the middle phalangeal region is delved into, and statistical investigations on the occurrence and frequency of fractures are summarized. A review of professional opinions and case descriptions regarding their causes and origin, diagnostics, pathomorphological appearance and secondary diseases is provided. The development of conservative and surgical therapeutic approaches and techniques is described, whereby progress made by the AO/ASIF was focused on in particular. Archived data evaluated in this study as well as radiograms obtained over the last 30 years from the equine clinics of the Free Berlin University and Cantonal Veterinary Hospital of the University of Zurich were available for comparison. Twenty-four detailed case descriptions and radiograms were assessed regarding their agreement or disparity with the literature. Supplementary diagnostic and therapeutic recommendations are provided. The typical appearance of the middle phalangeal fracture from the majority of cases examined in this study was as a multiple fragment fracture which was almost always of a similar configuration. We can not confirm here the positive prognosis sometimes given in the literature regarding functional recovery. Osteosynthesis (fixation) and phalangeal joint arthrodesis with lag screws and dorsal plates as is recommended in current publications can be confirmed as the therapeutic measure of choice. The technique of operating under radioscopic control ( "CADS" - Computer-Assisted-Orthopedic-Surgery ) optimally takes into account the specific problems listed here and the limited possibilities in the surgical therapy of middle phalangeal fractures; it also provides diagnostic information important for determining a prognosis regarding the degree of joint damage by the fracture which conventional X-ray diagnostics does not offer. The most severe complications in the healing process with comminuted middle phalangeal fractures treated with lag screw fixation alone are implant failure and pathological fracture following osteoporosis related to physical inactivity. Regularly appearing secondary diseases of healed middle phalangeal fractures include progressive ossifying periostitis of the middle phalangeal region, degenerative hoof joint disease and hyperextension of the hoof-pastern axis. Orthopaedic measures on the hoof, which have largely been neglected until now in the literature, are described as supplementary therapeutic measures during and after healing of the middle phalangeal fractures. Middle phalangeal fracture is a still very seldom occurring injury that is very difficult to treat. It is therefore exemplary for equine diseases where prophylactic measures for the horses are of greater importance than the efficacy of the repair measures. Changes in the keeping and usage of horses from primarily work to leisure in modern years is reflected in the causes underlying the fractures docu- mented here: in more than 60 % of the cases in this study the case history re- vealed that the horses were subjected to severe strain of their locomotory appara- tus without having undergone any controlled preparatory warming-up phase. Whereas in earlier years middle phalangeal fractures were caused by accidents while the horses were under heavy strain, today in most cases easily avoidable management errors are the cause for the life-threatening injury.