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[[Image:Equine Orthopaedics and Rheumatology Q&A 09.jpg|centre|500px]]<br>
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'''A 10-year old Quarterhorse roping gelding presented for sudden onset lameness of the left forelimb. An arthroscopic view of the left midcarpal joint is illustrated.'''
    
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<FlashCard questions="4">
 
<FlashCard questions="4">
|q1=What is your diagnosis?
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|q1=What lesion is present?
|a1=A fracture of the distal part of one of the splint bones.
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|a1=Cartilage loss/erosion on the medial palmar aspect of the distal articular surface of the radial carpal bone.
 
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|l1=
|q2=Assuming that the injury is not associated with external trauma, how is it likely to have occurred?
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|q2=What is the likely diagnosis?
 
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|a2=
These fractures are thought to occur as a result of stresses placed on the splint bone by the adjacent suspensory ligament. <br><br>
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Osteoarthritis of the left mid-carpal joint.
It has been suggested that, during hard exercise, the suspensory ligament snaps back against the relatively fixed small metacarpal or metatarsal bones, causing the distal part of the bone to fracture.
   
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|l2=
|q3=What associated structure may have been injured?
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|q3=What would be the best approach to treating this horse?
|a3= The adjacent suspensory ligament branch may have been sprained or even ruptured.
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|a3=The defect, which was confined to the medial aspect of the radial carpal bone, could be debrided. <br><br>
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In addition, the joint could be treated intra-articularly with hyaluronan or poly-sulphated glycosaminoglycan, supplemented with systemic therapy with these drugs and possibly non-steroidal anti-inflammatory agents.
 
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|q4= If the horse has both problems, which is most likely to cause persistent lameness?
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|q4= What is your prognosis?
|a4= The splint bone fracture is unlikely to heal by bony union, but the fibrous union formed does not usually cause any problems. <br><br>
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|a4= When osteoarthritis is present and appears to have occurred insidiously, the prognosis is guarded. <br>Even if the problem is resolved in the short term, the owner needs to be warned that the lameness could recur at any time, and on subsequent occasions it may be refractory to further treatment.
However an associated sprain of a branch of the suspensory ligament may well continue to cause lameness.
   
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[[Category:Equine Orthopaedics and Rheumatology Q&A]]
 
[[Category:Equine Orthopaedics and Rheumatology Q&A]]