9 day old male foal, Italian Saddlebred
History
The foal was referred for mid diaphyseal fracture of the right third metacarpal bone caused by a kick of the mare a few hours before referral.
Clinical examination
At admission the foal was bright, bearing weight on three limbs and regularly nursing. A Robert-Jones bandage was applied by the referring veterinarian. The bandage was removed and a Vetcast® cast was applied. The fracture was not exposed.
Radiographic examination: The radiographic examination showed a multiple displaced diaphyseal fracture of the right third metacarpal bone.
Treatment
Tetanus toxoid and antibiotic prophylaxis (Procain Penicillin G 22.000 UI/kg IM and Amikacin 20 mg/kg IV SID) were started. The foal underwent internal fixation of the fracture using a ten-hole broad DCP applied dorsally. A further screw in lag fashion was used to fix a large “butterfly” fragment on the lateral aspect of the bone. To compensate bone loss in the fracture area, a bone graft was applied on the lateral aspect of the bone using ipsilateral ileal tuberosity as a donor site. A moderate degree of valgus deformity was still evident, centered at the fracture site. At the end of the surgery, a new cast was applied with Vetcast® extended proximally to the elbow joint. Recovery from anaesthesia was uneventful and fast.
Post operative course: Antibiotic prophylaxis was maintained for ten days. Skin sutures were removed 14 days post operatively concurrently with cast renewal. At 4-days intervals for the first 14 days post op at and 10-days intervals thereafter the area was submitted to radiographic control. At discharge 2 months after surgery, the cast was removed and the limb protected with a splint cast. The owner was warned to keep the foal at stall rest for 4 weeks and then at pasture turn out in a small paddock for 8 weeks.
Follow up:
Eight months after discharge the foal was re-admitted for implant removal. A radiographic control confirmed good healing of the fracture and a lesser degree of valgus deformity. The plate was removed and the foal was discharged after 3 days. Four weeks of box rest were recommended.