Carpus/metacarpus Flashcards
What is the treatment/management for a simple fracture of the 3rd metacarpal bone?
Zone 2 external coaptation
May be conservative
May be surgical (if condyles or diaphysis involved)
What is the treatment for a displaced, open or comminuted fracture of the 3rd metacarpus?
Euthanasia
What is ‘shore shins’ or ‘bucked shin complex’? What horses are affected?
Dorsal metacarpal disease
Young racehorses
Dorsal metacarpal disease can cause periosteitis as a 2 year old. What can this lead to as they age?
Cortical stress fracture
What is the treatment for dorsal metacarpal disease?
Altered training regime
If refractory: shockwave, osteostixis (bone drilling) or screw placement
Fractures of the splint bones are common due to kicks or trauma, especially the lateral hindlimb bone. How can they treated?
Conservative - remove loose fragments (beware sequestrum!)
Or surgical - partial ostectomy, internal fixation)
What causes exostosis of the splint bones?
Trauma –> periostea bleed –> new bone formation
Exostosis of the splint bones is usually cosmetic, but can cause lameness whilst forming or if it interferes with…
Suspensory ligament
What is the management for splint bone exostosis?
Conservative: rest, cold therapy, NSAIDs
Avoid surgery unless severe
A horse presents with an acute history of lameness, swelling around the cannon and fetlock sinking. What is the most likely diagnosis?
SDFT tendonitis
How is SDFT tendonitis diagnosed?
Ultrasound
How is SDFT tendonitis treated in the acute phase?
Limit inflammation with cold hosing and NSAIDs
Protect limb with dressing/support bandage
Box rest
How can SDFT tendonitis be treated in the reparative/proliferative phase?
Promote angiogenesis - tendon splitting, stem cells, platelet rich plasma (PRP)
A horse presents with a swelling the proximal palmar metacarpus, deeper to the SDFT. What is the likely diagnosis?
ALDDFT desmitis
accessory/check ligament
A horse presents with a DFTS effusion, notching of the limb, mild/moderate lameness and pain on flexion. What is your likely diagnosis?
PAL syndrome
Palmar/plantar annular ligament
How is PAL syndrome diagnosed?
Ultrasound
Assess PAL thickness - should be 1-2mm
What is the conservative treatment for PAL syndrome?
Rest/controlled exercise
Cold hosing
NSAIDs
Steroids/hyaluronate into sheath
What are the surgical treatment options for PAL syndrome?
Tenoscopy - assess tendon tear and remove if damaged PAL desmotomy (relieves compression)
Carpal osteoarthritis is a degenerative disease affecting one or more of the carpal joints. What can it be secondary to?
Trauma
Sepsis
Fracture
Soft tissue injury
What breed of horses are predisposed to carpometacarpal joint osteoarthritis?
Arab
What is the treatment/management of carpometacarpal OA?
Intra-articular medications
Arthrodesis if advanced
What predisposes horses to osteochondral fragmentation (AKA carpal chip fracture)?
Sclerosis of subchondral bone
OA - may be fragmentation of osteophyte
What is the treatment for osteochondral fragmentation (AKA carpal chip fracture)?
Arthroscopic removal of fragment
What is the treatment for accessory carpal bone fractures?
Conservative treatment - most heal by fibrous union
Surgery difficult as curved/shallow bone - used mainly to remove fragments
What is the treatment for carpal subluxation?
Stabilise with zone 3 external coaptation
Radiograph and assess
Many cases require arthrodesis or euthanasia
