Arthroscopic removal of palmar intermediate carpal bone fracture fragments in four horses using a transthecal approach through the carpal flexor tendon sheath.
Authors: Hewitt-Dedman Charlotte L, O'Neill Henry D, Bladon Bruce M
Journal: Veterinary surgery : VS
Summary
# Arthroscopic Management of Palmar Intermediate Carpal Bone Fractures: A Novel Transthecal Approach Fractures of the palmar intermediate carpal bone (ICB) present a surgical challenge because their location makes conventional carpal arthroscopy difficult; Hewitt-Dedman and colleagues describe an innovative solution using a transthecal approach through the carpal flexor tendon sheath in four clinical cases. The procedure utilised standard proximolateral carpal sheath portals supplemented by a medial instrument portal through the carpal flexor retinaculum, with needle guidance and radiographic assistance to navigate the palmar carpal ligament and isolate fracture fragments for removal. All four horses were successfully discharged within 3–8 days, with three returning to full athletic work by nine months; one was euthanized due to persistent lameness, representing a 75% return-to-work rate. Whilst surgery time of 85–142 minutes and intraoperative bleeding that can compromise visibility present notable limitations, this technique expands the surgical toolkit for a previously difficult-to-access carpal pathology, particularly relevant given that three of the four cases involved concurrent radial or accessory carpal bone fractures. For practitioners managing horses with palmar ICB fractures, this approach warrants consideration as an advanced option, though it demands meticulous surgical technique and appropriate training before implementation in clinical practice.
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Practical Takeaways
- •This advanced arthroscopic technique provides an alternative approach for accessing and removing palmar carpal fracture fragments that may not be accessible via conventional portals
- •Plan for extended surgery time (85-142 minutes) and be prepared to manage hemorrhage to maintain adequate visualization during the procedure
- •While 75% of horses returned to full work, outcomes are variable—set realistic expectations with owners that persistent lameness may occur despite successful fragment removal
Key Findings
- •Transthecal approach through carpal flexor tendon sheath successfully retrieved palmar ICB fracture fragments in all 4 horses
- •Three of four horses (75%) returned to full athletic work within 9 months postoperatively
- •Surgery time ranged from 85-142 minutes, with hemorrhage potentially impairing visibility as a limiting factor
- •One horse was euthanized due to persistent lameness despite successful fragment removal