Page 178 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Musculoskeletal system: 1.4 The forelimb 153

VetBooks.ir 1.281 1.282 1.283 1.284

Figs. 1.281, 1.282 Dorsolateral/plantaromedial Figs. 1.283, 1.284 A distal-third fourth metatarsal
oblique radiographic view (1.281) of a comminuted bone fracture before (1.283) and after (1.284) surgical
fourth metatarsal bone, with a decreased exposure removal.
to highlight the smaller less radiodense bone. The
dorsoplantar view (1.282) reveals multiple fracture
lines along the length of the fourth metatarsal.

overlying the margins of the bone and the associ- Partial ostectomy of the distal portion to remove the
ated third metacarpal/metatarsal bone may mean affected piece of bone and associated infected soft
that repeat radiography is required for an accurate tissues should be considered in refractory open cases
assessment. In chronic open fractures, sequestration or in chronic, non-healing closed fractures of the
formation may be evident. Fractures involving the distal portion of bone (Figs. 1.283, 1.284). Removal
distal aspect of the splint bone may show evidence of the entire fourth metatarsal bone is possible due
of chronicity and callus formation and diagnostic to its shared articulation with the fourth tarsal
analgesia may be required to determine the clinical bone, but luxation of the tarsometatarsal bone dur-
significance. Ultrasonographic assessment of associ- ing recovery from general anaesthesia has occurred
ated soft tissues is advised. in some cases. Internal fixation of the splint bone is
indicated where there is a risk of instability at the
Management articulation proximally.
The initial assessment of open fractures may involve
lavage and local debridement. Removal of debris and Prognosis
small loose fragments may be performed at the time Conservative management of splint bone fractures
and the limb supported appropriately. Sequestrum results in good outcome in many cases. Cases man-
formation leading to a chronic draining tract can be aged by partial ostectomy (or complete with the
managed through local debridement in many cases. fourth metatarsal bone) also have a good outcome.