Computed tomographic documentation of a comminuted fourth carpal bone fracture associated with carpal instability treated by partial carpal arthrodesis in an Arabian filly.
Authors: Waselau Martin, Bertone Alicia L, Green Eric M
Journal: Veterinary surgery : VS
Summary
# Editorial Summary An 8-month-old Arabian filly presented with a fourth carpal bone fracture that initially appeared as a simple slab on radiographs but was revealed via computed tomography to be significantly comminuted with associated carpal instability and lateral collapse of the middle carpal and carpometacarpal joints. Rather than attempting reconstruction of the fragmented bone, the surgical team elected to perform partial carpal arthrodesis across both the middle carpal and carpometacarpal joints using two narrow dynamic compression plates, prioritising stability over preservation of individual joint motion. By eight months post-operatively, the filly had achieved complete bony fusion with maintained carpal flexion, soundness at walk and light trot, and only moderate osteoarthritic changes confined to the middle carpal joint, permitting return to low-level ridden work. This case demonstrates that CT imaging is substantially superior to standard radiography for characterising complex carpal fractures where comminution cannot be clearly visualised, and that early partial carpal arthrodesis represents a viable alternative to primary bone reconstruction when fracture fragments cannot be reliably reassembled. For practitioners managing comminuted carpal injuries with concurrent instability, this approach offers a pragmatic route to functional recovery despite the trade-off of some carpal motion, particularly in young horses where prolonged healing and rehabilitation may otherwise be prohibitively lengthy.
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Practical Takeaways
- •If standard radiographs don't clearly show carpal fracture configuration, use CT imaging before deciding between reconstruction and arthrodesis
- •Partial carpal arthrodesis can successfully stabilize comminuted fourth carpal bone fractures that cannot be reconstructed, with good functional outcomes
- •Even with moderate carpal osteoarthritis post-fusion, horses may retain adequate carpal flexion for low-level work
Key Findings
- •CT imaging successfully identified fracture comminution that standard radiography failed to detect in an 8-month-old Arabian filly
- •Partial carpal arthrodesis of the middle and carpometacarpal joints provided stable fixation and maintained substantial carpal flexion
- •Complete bony fusion achieved at 8 months post-surgery with no lameness at walk or trot and return to light pleasure riding