Standing lag screw fixation of a palmar intermediate carpal bone slab fracture in a pony

Summary

A 21‐year‐old New Forest pony was referred with acute onset right forelimb lameness. Radiography and low‐field standing magnetic resonance imaging (MRI) identified a complete, nondisplaced frontal plane slab fracture involving the palmar aspect of the intermediate carpal bone. Bone‐oedema surrounding the fracture margins supported a recent onset. Given the large fragment size, it was elected to attempt internal fixation over conservative management or fragment removal. Under standing sedation and local anaesthesia, two 3.5 mm cortical screws were placed in lag fashion from dorsal to palmar under radiographic guidance. Preoperative MRI aided in screw length selection. Surgery proceeded uneventfully and post‐operative radiographs confirmed accurate implant placement. The pony was comfortable post‐operatively and discharged 24 h following surgery with a recommendation for 6 weeks box rest prior to reassessment. At the 6‐ and 12‐week follow‐ups, the pony was sound at walk and started on ridden walking exercise at the 4‐month reassessment. In summary, this case illustrates that standing internal fixation of suitably configured palmar slab fractures of the intermediate carpal bone is feasible and may provide a favourable prognosis for return to ridden exercise.