33rd Annual Scientific Meeting proceedings

Introduction
Fractures of the accessory carpal bone in the horse often result in a fracture configuration described as dorsal, longitudinal, complete fracture with dorsoproximal fragmentation. Conservative management of accessory carpal bone fracture type has been associated with good outcomes, however, non-union or malunion and delayed fracture healing are often encountered. The removal of these fragments, in an attempt to ameliorate osteoarthritis, is reported in the literature.

Case Description
Five horses with comminuted accessory carpal bone fractures underwent standing arthroscopic removal of dorsoproximal osteochondral fragments within the palmar antebrachiocarpal joint. The antebrachiocarpal joint was anaesthetised and the subcutaneous tissue infiltrated using mepivacaine hydrochloride. A suction punch and a soft tissue motorised ablator were used to dissect the soft tissue attachments. A motorised bone burr was used to debulk the fragments’ size before removal in a piecemeal manner.

Results
All horses recovered well from surgery and were stabled for 3 months. In all five cases, the fracture healed by fibrous union.

Discussion
This is a novel technique that may be suitable in selected cases of accessory carpal bone fracture to ameliorate antebrachiocarpal joint osteoarthritis. Performing the surgery standing negated the need for general anaesthesia.  This description of the technique may encourage surgeons to more widely adopt removal of these fragments as a standing procedure, which may improve horse’s outcome with this fracture configuration.