EQUINE VETERINARY EDUCATION / AE / MAY 2018


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Fig 5: Case 3: partial carpal arthrodesis of the middle carpal and carpometacarpal joints with 3 plates (lateral 6-hole narrow locking compression plate [LCP], medial 7-hole narrow LCP and sagittal 6-hole broad LCP), 24 h post-operative radiographs. (a) dorsolateral-palmaromedial oblique projection, (b) dorsopalmar projection.


(swelling), more pronounced dorsally. The LM projection showed bony fusion of the MC joint and new periosteal bone formation around the proximal part of the plates. Recurrent inflammation of the soft tissues on the dorsal aspect of the carpus resulted in episodes of lameness and a subclinical infection without drainage was suspected. It was decided to remove the plates under general anaesthesia. No signs of pus or liquid around the plates were found intraoperatively and the bacterial swab cultures of the plates were negative. Control radiographs immediately after plate removal showed ankylosis of the MC joint with periarticular bone (osteophytes) dorsally and medially and marked narrowing of the CMC joint space with periarticular bone formation (Fig 6). A full limb cast was applied for recovery and then replaced with a Robert Jones bandage that was left in place for 15 days until removal of the sutures. The horse was kept in the box for another 15 days and was then hand walked for one month. Then the horse had hydrotherapic rehabilitation with an oval water horse walker (System Voncini)3 during a period of 2.5 months. The first week, the horse was trained for 5 min/ day, then the time of training was progressively increased to 20 min/day during the next 3 weeks. Twelve months after the initial surgical operation, examination by the authors revealed that the horse was not lame at the walk and showed a 2/5 AAEP lameness at the trot on a straight line. The owner was advised to use the horse as a leisure horse (ridden trot and light gallop). Today, 3 years after surgery, the owner reported that the horse is used as a leisure riding horse and a video of the horse showed that it was lame free at the walk and at the trot on a straight line. Carpal flexion is pain free and the maximal angle between the radius and the MCIII was calculated from a picture at 42.6° (Tulloch et al. 2015).


Fig 6: Case 1: Partial arthrodesis of the middle carpal and carpometacarpal joints with 2 plates, 8 months post-operative radiographs immediately after removal of the plates. (a) Lateromedial projection, (b) dorsopalmar projection. Bony ankylosis of the MC, with severe periarticular bone osteophytes, more pronounced dorsally and medially. Severe thinning of the carpometacarpal joint space, with marked periarticular bone osteophytes.


Case 2 The mare was fully weightbearing immediately after surgery. Antimicrobial treatment was continued for 10 days. Phenylbutazone (Phenylarthrite, 2.2 mg/kg bwt. i.v.) was given for 8 days. As for Case 1, the cast was removed 2 weeks after surgery and, at the same time, the skin sutures and staples were removed and a sleeve cast was applied. The sleeve cast was replaced by a modified Robert Jones full limb bandage 1.5 months after surgery (4 weeks after its application) and the mare was discharged from the clinic 9 weeks after surgery. The bandage was kept for another month and was changed once a week. A clinical examination 3 months after surgery revealed


grade 2/5 AAEP lameness (Swanson 1984) at the walk and 3/ 5 at the trot with an abnormal gait due to the mechanical stiffness of the carpus. The radiographic evaluation at 5 months revealed ankylosis of the MC and ABC joints and thinning of the CMC joint, periarticular bone formation (osteophytes) of all 3 joints (more pronounced laterally) with mild thickening of the periarticular tissues (Fig 7). Nine months after surgery, the referring veterinarian reported, that the painful part of the lameness had disappeared and a 2/5 AAEP lameness at the trot remained due to the mechanical stiffness; the mare still showed an altered gait but was able to lie down and get up and could gallop in the paddock.


Case 3 As in Cases 1 and 2, the colt was comfortable in the cast after surgery and the antimicrobial treatment was continued for 5 days and anti-inflammatory medication were continued as in Case 2. Two weeks after surgery, the cast and sutures were removed standing and a sleeve cast was applied. The colt was discharged 15 days after surgery, the owner being


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