Extremely Blessed (aka Bunny), presented to the CUHA Large Animal Emergency Service on May 20, 2006, for evaluation of acute, traumatic, non-weight bearing lameness of the left forelimb following a training accident. The referring DVM evaluated her at the farm and referred her to the CUHA following splinting of the limb. Upon presentation, radiographs were taken of the affected limb. These revealed a severely comminuted fracture of the left front proximal phalanx, lacking an intact strut of bone. There was also marked bruising on the lateral aspect of the pastern; however, the skin was intact. No other problems were identified on the physical exam. The fracture was managed with external skeletal fixation techniques, specifically a transfixation pin cast. This report will focus on the use of tranfixation casts as therapy for severely comminuted phalanx fractures in equines, including cast and pin options, expected complications, and long-term prognosis.