Comparison of three drilling techniques for carpometacarpal joint arthrodesis in horses.
Authors: Lang Hayley M, Panizzi Luca, Allen Andrew L, Woodbury Murray R, Barber Spencer M
Journal: Veterinary surgery : VS
Summary
# Carpometacarpal Joint Arthrodesis: Drilling Technique Comparison Carpometacarpal (CMC) joint arthrodesis is a surgical salvage procedure for horses with severe joint disease, yet optimal drilling methodology remains poorly defined. Using 15 cadaveric equine forelimbs, Lang and colleagues compared three distinct approaches: a four-entry fanning technique with a 4.5 mm drill bit, a three-tract technique using a 5.5 mm bit, and a three-tract technique with a 4.5 mm bit, with damage quantified through visual inspection, gross examination, and microradiographic planimetry of both articular cartilage and subchondral bone. The fanning technique (technique 1) produced significantly greater total damage to the CMC joint than the 4.5 mm three-tract approach, whilst the 5.5 mm three-tract method (technique 2) created more evenly distributed damage across joint surfaces compared with the proximal-surface–dominant damage seen with fanning. Paradoxically, the fanning and 5.5 mm three-tract techniques may prove most effective clinically because they generate the substantial articular disruption necessary to promote fusion, whereas the 4.5 mm three-tract approach created insufficient trauma for reliable arthrodesis despite minimising tissue damage. These findings warrant clinical validation to establish whether the initial iatrogenic damage that optimises fusion rates translates to acceptable long-term functional outcomes in lame horses.
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Practical Takeaways
- •When performing CMC joint arthrodesis, the fanning technique (Technique 1) or 5.5 mm 3-drill approach (Technique 2) appear most effective for achieving fusion, though they create more initial joint damage than smaller drill alternatives
- •The smaller 4.5 mm 3-drill technique produces the least tissue damage but may be less effective for arthrodesis — balancing tissue trauma against fusion success requires clinical follow-up data
- •This is cadaveric data only; clinical outcomes and healing rates in living horses need to be assessed before definitive surgical recommendations can be made
Key Findings
- •Technique 1 (fanning with 4.5 mm drill) produced the most total cartilage and subchondral bone damage across the CMC joint
- •Technique 3 (4.5 mm non-fanned 3 drill tracts) produced significantly less damage than techniques 1 and 2
- •Technique 2 (5.5 mm non-fanned 3 drill tracts) distributed damage more evenly between proximal and distal surfaces compared to technique 1
- •Techniques 1 and 2 are recommended as most likely to achieve arthrodesis despite producing more initial damage than technique 3