Waselau Martin, Bertone Alicia L, Green Eric M
Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.
Vet Surg. 2006 Oct;35(7):618-25. doi: 10.1111/j.1532-950X.2006.00199.x.
To report treatment of a unilateral comminuted fourth carpal bone (C4) fracture associated with carpal instability by partial carpal arthrodesis (PCA) of the middle carpal joint (MCJ) and carpometacarpal joint (CMCJ).
Case Report.
An 8-month-old Arabian filly.
A C4 slab fracture was diagnosed radiographically; however, fracture comminution was conclusively diagnosed after computed tomographic (CT) imaging. PCA of the MCJ and CMCJ was performed with 2 narrow dynamic compression plates.
PCA provided appropriate carpal stability and correct limb alignment immediately after surgery. Complete bony fusion with substantial carpal flexion and no lameness at walk or light trot was observed 8 months after surgery.
Carpal CT was successfully used to define fracture configuration after standard radiographic examination failed to delineate comminution. PCA was selected because of joint instability and lateral carpal collapse of MCJ and CMCJ and can be successfully used to treat comminuted C4 slab fractures associated with carpal instability. Moderate MCJ osteoarthritis without radiocarpal joint involvement allows pain-free, substantial carpal flexion and thus, return to low-level pleasure riding may be possible.
CT imaging may more adequately characterize traumatic carpal bone injury, particularly, when carpal bone fracture configuration cannot be determined on standard radiographs. Early PCA of the MCJ and CMCJ is an useful alternative to treat comminuted C4 slab fractures that cannot be reconstructed.
报告通过腕中关节（MCJ）和腕掌关节（CMCJ）的部分腕关节融合术（PCA）治疗与腕关节不稳定相关的单侧粉碎性第四腕骨（C4）骨折。
病例报告。
一匹8个月大的阿拉伯雌马。
通过X线摄影诊断为C4板状骨折；然而，在计算机断层扫描（CT）成像后最终确诊为骨折粉碎。使用2块窄动力加压钢板对MCJ和CMCJ进行PCA。
PCA在术后立即提供了适当的腕关节稳定性和正确的肢体对线。术后8个月观察到完全骨融合，腕关节有明显屈曲，行走或轻快小跑时无跛行。
在标准X线检查未能显示粉碎情况后，腕关节CT成功用于确定骨折形态。由于MCJ和CMCJ的关节不稳定和腕关节外侧塌陷而选择PCA，其可成功用于治疗与腕关节不稳定相关的粉碎性C4板状骨折。无桡腕关节受累的中度MCJ骨关节炎可实现无痛、明显的腕关节屈曲，因此，有可能恢复低水平的休闲骑行。
CT成像可能更充分地描述创伤性腕骨损伤特征，特别是在标准X线片无法确定腕骨骨折形态时。早期对MCJ和CMCJ进行PCA是治疗无法重建的粉碎性C4板状骨折的一种有效替代方法。
