Equis ISSN 2398-2977

MC / MT 4: removal

Synonym(s): Splint bone amputation, Complete splint bone removal

Contributor(s): Graham Munroe, Vetstream Ltd, Chris Whitton, David G Wilson

Introduction

  • Fractures of the splint bones are common. Fractures of the MT 4 are usually due to kicks from other horses/ponies. The proximal to middle thirds are often involved with open wounds, increased contamination and comminution. Bone infection and sequestration can ensue.
  • Many treatments are available for treating fractured splint bones, including box rest, compression and support bandaging, standing local debridement and lavage if there are open wounds, systemic NSAIDs and antibiotics, segmental ostectomy, plate and/or screw fixation, and complete removal of the splint bone.
  • The fourth metatarsal bone has a minor articulation with the tarsus unlike MT/MC 2 and MC 4.
  • Complete removal has therefore little impact on the biomechanics of the hindlimb.

Uses

  • Open and/or comminuted fractures of the proximal third of the fourth metatarsal bone   MC / MT 2 and 4: fracture      MC / MT 4: removal 01    MC / MT 4: removal 13    MC / MT 4: removal 14  .

Advantages

  • Complete removal of infected bone and soft tissue decreasing contamination by bacteria and foreign material, and improving response to systemic antibiotics.
  • No internal fixation implants are used, decreasing costs, infection risks and complications post-operatively.
  • Minimal periosteal reaction post-operatively with better cosmetic results than with fixation or conservative treatments.
  • Quicker return to soundness and exercise than with fixation or conservative treatments.

Disadvantages

  • Removes small amount of biomechanical support for hock, although this does not appear to be clinically significant.
  • Invasive surgery with GA risks and initially higher costs than conservative treatments.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Good.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Jenson P W et al (2004) Segmental ostectomy of the second and fourth metacarpal and metatarsal bones in horses: 17 cases (1993-2002). J Am Vet Med Assoc 224 (2), 271-274 PubMed.
  • Baxter G M, Doran R E & Allen D (1992) Complete excision of a fractured fourth metatarsal bone in eight horses. Vet Surg 21, 273-278 PubMed.
  • Allen D & White N A (1987) Management of fractures and exostosis of the metacarpals and metatarsals II and IV in 25 horses. Equine Vet J 19 (4), 326-330 PubMed.

Other sources of information

  • Doran R (1996)Fractures of the small metacarpal and metatarsal (splint) bones.In:Equine Fracture Repair.Ed: A J Nixon. W B Saunders, Philadelphia.


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