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EQUINE VETERINARY EDUCATION / AE / MAY 2018
Case 3 Premedication, sedation, induction and maintenance of general anaesthesia were as described for Case 1. The horse was placed in right lateral recumbency and prepared for partial arthrodesis of MC and CMC joints. Cartilage debridement of MC and CMC joints was achieved as in Case 2. Cancellous bone graft (approximately 4 mL) was collected from the ileal wing and inserted through the arthroscopy portals of the MC joint. Three LCP plates were
applied using the same minimally invasive technique under fluoroscopic and radiographic control. The decision to place
3 plates instead of 2 was made to allow placement of more screws into both rows of the carpal bones in order to add stability to the construct (D. Richardson, personal communication, 2014). The plates were placed in a dorsolateral (6-hole, narrow 4.5 mm), dorsomedial (7-hole narrow 4.5 mm) and axial (6-hole broad 4.5 mm) position and stabilised using a combination of 5.0 LHS and 4.5 mm cortical screws. The proximal holes of all 3 plates were filled with LHS that anchored the proximal row of the carpal bones. The second most proximal holes of the dorsolateral and dorsomedial plate were filled with a 4.5 mm cortical screw that was angled proximally in order to anchor the proximal row of the carpal bones. The third, fourth most proximal and the most distal holes of the axial plate were filled with 4.5 mm cortical screw at slight angles in order to avoid contact with the LHS of the dorsolateral and dorsomedial plates (Fig 5). Skin closure, full limb fibreglass cast application and assisted recovery was as described for Case 1. Total anaesthesia time was 4.5 h and total surgery time 3 h.
Post-surgical management and outcome
Fig 3: Plate fixation using the locking compression plate drill guides through stab incisions.
Case 1 The gelding was fully weightbearing directly after surgery. Treatment with sodium penicillin (Penicilline G, 22,000 iu/kg bwt. i.v.) and gentamicin (Forticine, 6.6 mg/kg bwt. i.v.) was continued for 5 days. Phenylbutazone (Phenylarthrite, 2.2 mg/ kg bwt. i.v.) was given for 5 days and then dose was reduced to 1.1 mg/kg bwt. i.v.) for another 10 days. The cast was removed standing 2 weeks after surgery and the skin sutures were removed at the same time. A sleeve (tube) cast from proximal antebrachium to distal metacarpus was applied for 4.5 weeks to maintain the carpus in an extended position. A Robert Jones bandage was applied for 2 more weeks. The horse was turned out on a large paddock 4 months after surgery. Radiographs taken 8 months after surgery showed thickening of the periarticular tissues
a) b) c)
Fig 4: Case 2: pancarpal arthrodesis with 2 plates (one 12-hole, 5.5 mm broad locking compression plate and one 13-hole, 4.5 mm broad locking compression plate) 36 h post-operative radiographs. (a) Lateromedial projection, (b) dorsopalmar projection, (c) dorsomedial–palmarolateral oblique projection.
© 2016 EVJ Ltd
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