Surgical Treatments of Carpus Problems

At the AAEP Focus meeting in Ft. Collins, Colo., Wayne McIlwraith, BVSc, PhD, FRCVS, DSc, DrMedVet (hc), Dipl. ACVS, Barbara Cox Anthony Chair and Director of Orthopaedic Research at Colorado State University, presented surgical options to manage problems of the carpus (knee).

McIlwraith discussed chip fractures and fragmentation in the carpal joint, which are the end result of a chronic process with associated difficulty in returning a horse to normal athletics. This is a common condition of racehorses. Usually, this is a result of repetitive damage and microtrauma to the bone. Severe lameness is evidence of major damage, although there is a poor correlation between clinical and radiographic signs.

As soon as a chip fragment occurs, surgery should be done to ward off progressive damage that would occur if the horse continues to perform and race. Although this is a chronic process, it can be helped with surgery to normalize the inside of the joint and to minimize osteoarthritis. McIlwraith stated that arthroscopy is a gold-standard tool for both diagnosis and surgical treatment of the carpal joints.

McIlwraith described OCD lesions of the carpus and mentioned that the prognosis is not very good, particularly in a racehorse when OCD is likely of traumatic etiology; usually the horse experiences ongoing osteoarthritis despite treatment. The affected carpus is distended from synovitis and the horse is lame; flexion of the carpus exacerbates the lameness. Subchondral bone cysts also occur in the carpus in the distal radius (the end of the forearm bone closest to the ground), and have a more favorable prognosis with treatment depending on location and duration. Both OCD and cystic lesions can be approached with arthroscopic surgery.

McIlwraith stressed that post-operative management strategies, such as bandaging, anti-inflammatory medications, and physical therapy (walking, swimming, or underwater treadmill use) are critical to surgical success of carpal injuries.

About the Author

Nancy S. Loving, DVM

Nancy S. Loving, DVM, owns Loving Equine Clinic in Boulder, Colorado, and has a special interest in managing the care of sport horses. Her book, All Horse Systems Go, is a comprehensive veterinary care and conditioning resource in full color that covers all facets of horse care. She has also authored the books Go the Distance as a resource for endurance horse owners, Conformation and Performance, and First Aid for Horse and Rider in addition to many veterinary articles for both horse owner and professional audiences.

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