Carpus/metacarpus

Question 1

What is the treatment/management for a simple fracture of the 3rd metacarpal bone?

Answer 1

Zone 2 external coaptation
May be conservative
May be surgical (if condyles or diaphysis involved)

Question 2

What is the treatment for a displaced, open or comminuted fracture of the 3rd metacarpus?

Answer 2

Euthanasia

Question 3

What is ‘shore shins’ or ‘bucked shin complex’? What horses are affected?

Answer 3

Dorsal metacarpal disease

Young racehorses

Question 4

Dorsal metacarpal disease can cause periosteitis as a 2 year old. What can this lead to as they age?

Answer 4

Cortical stress fracture

Question 5

What is the treatment for dorsal metacarpal disease?

Answer 5

Altered training regime

If refractory: shockwave, osteostixis (bone drilling) or screw placement

Question 6

Fractures of the splint bones are common due to kicks or trauma, especially the lateral hindlimb bone. How can they treated?

Answer 6

Conservative - remove loose fragments (beware sequestrum!)

Or surgical - partial ostectomy, internal fixation)

Question 7

What causes exostosis of the splint bones?

Answer 7

Trauma –> periostea bleed –> new bone formation

Question 8

Exostosis of the splint bones is usually cosmetic, but can cause lameness whilst forming or if it interferes with…

Answer 8

Suspensory ligament

Question 9

What is the management for splint bone exostosis?

Answer 9

Conservative: rest, cold therapy, NSAIDs

Avoid surgery unless severe

Question 10

A horse presents with an acute history of lameness, swelling around the cannon and fetlock sinking. What is the most likely diagnosis?

Answer 10

SDFT tendonitis

Question 11

How is SDFT tendonitis diagnosed?

Answer 11

Ultrasound

Question 12

How is SDFT tendonitis treated in the acute phase?

Answer 12

Limit inflammation with cold hosing and NSAIDs
Protect limb with dressing/support bandage
Box rest

Question 13

How can SDFT tendonitis be treated in the reparative/proliferative phase?

Answer 13

Promote angiogenesis - tendon splitting, stem cells, platelet rich plasma (PRP)

Question 14

A horse presents with a swelling the proximal palmar metacarpus, deeper to the SDFT. What is the likely diagnosis?

Answer 14

ALDDFT desmitis

accessory/check ligament

Question 15

A horse presents with a DFTS effusion, notching of the limb, mild/moderate lameness and pain on flexion. What is your likely diagnosis?

Answer 15

PAL syndrome

Palmar/plantar annular ligament

Question 16

How is PAL syndrome diagnosed?

Answer 16

Ultrasound

Assess PAL thickness - should be 1-2mm

Question 17

What is the conservative treatment for PAL syndrome?

Answer 17

Rest/controlled exercise
Cold hosing
NSAIDs
Steroids/hyaluronate into sheath

Question 18

What are the surgical treatment options for PAL syndrome?

Answer 18

Tenoscopy - assess tendon tear and remove if damaged
PAL desmotomy (relieves compression)

Question 19

Carpal osteoarthritis is a degenerative disease affecting one or more of the carpal joints. What can it be secondary to?

Answer 19

Trauma
Sepsis
Fracture
Soft tissue injury

Question 20

What breed of horses are predisposed to carpometacarpal joint osteoarthritis?

Answer 20

Arab

Question 21

What is the treatment/management of carpometacarpal OA?

Answer 21

Intra-articular medications

Arthrodesis if advanced

Question 22

What predisposes horses to osteochondral fragmentation (AKA carpal chip fracture)?

Answer 22

Sclerosis of subchondral bone

OA - may be fragmentation of osteophyte

Question 23

What is the treatment for osteochondral fragmentation (AKA carpal chip fracture)?

Answer 23

Arthroscopic removal of fragment

Question 24

What is the treatment for accessory carpal bone fractures?

Answer 24

Conservative treatment - most heal by fibrous union

Surgery difficult as curved/shallow bone - used mainly to remove fragments

Question 25

What is the treatment for carpal subluxation?

Answer 25

Stabilise with zone 3 external coaptation
Radiograph and assess
Many cases require arthrodesis or euthanasia