Arthroscopic removal of palmar intermediate carpal bone fracture fragments in four horses using a transthecal approach through the carpal flexor tendon sheath

Charlotte Hewitt-Dedman, Henry D. O'Neill , Bruce M. Bladon

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Objective
To describe the removal of palmar intermediate carpal bone (ICB) fracture fragments using a transthecal approach through the carpal flexor tendon sheath.

Study design
Case series.

Animals
Four horses with fractures of the palmar aspect of the ICB.

Methods
Two horses were injured when falling and two during recovery from general anesthesia. Three horses underwent MRI to supplement conventional imaging. Three horses had concurrent fractures of the radial and/or accessory carpal bones. Conventional proximolateral carpal sheath arthroscope and instrument portals were used, supplemented with a medial instrument portal through the carpal flexor retinaculum to access the palmar carpal ligament. Optimized dissection through the latter was facilitated by needle guidance and radiography. The fragment was dissected from the soft tissue attachments and the palmar ICB fragments retrieved through the carpal sheath in all horses. Surgery time was 85 to 142 min.

Results
Limitations of this technique include a long surgery time and the potential for hemorrhage to impair visibility during surgery. All four horses were discharged 3 to 8 days postoperatively. Three horses returned to full athletic work within 9 months postoperatively and one horse was euthanized due to persistent lameness.

Conclusion
A tenoscopic transthecal carpal flexor tendon sheath approach provides access for removal of palmar ICB fracture fragments but should be viewed as an advanced arthroscopic procedure.

Clinical significance
A transthecal approach through the carpal flexor tendon sheath offers an alternative technique for removal of palmar ICB fracture fragments.
Original languageEnglish
Pages (from-to)929-939
JournalVeterinary Surgery
Volume51
Issue number6
Early online date11 Apr 2022
DOIs
Publication statusPublished - Aug 2022

Fingerprint

Dive into the research topics of 'Arthroscopic removal of palmar intermediate carpal bone fracture fragments in four horses using a transthecal approach through the carpal flexor tendon sheath'. Together they form a unique fingerprint.

Cite this