Successful Management of Severe Open Metacarpophalangeal Joint Dorsal Luxation in a Horse

A 3-year-old Darreh-Shuri stallion was presented with left forelimb open dorsal fetlock luxation immediately after being hit by a motorized vehicle. The horse was in a non-weight-bearing position on the affected limb. General physical examination revealed normal vital parameters and no special concurrent abnormality. Radiographic examination in lateromedial and dorsopalmar views of the affected limb showed complete luxation of the metacarpophalangeal joint with no fractures. Ultrasonographic evaluation revealed intact collateral ligaments. Under general anesthesia and following routine preparations, forceful manual pressure was exerted on the distal part of the metacarpus and proximal part of the first phalanx to reduce the luxation. Joint capsule and skin laceration were sutured. Intraarticular amikacin (500 mg) was administered and repeated on the third and fifth days postoperatively. A palmar polyvinyl chloride, synthetic plastic polymer (PVC) splint was placed following adequate padding from the carpus to the toe. The higher and lower third of the splint was casted and the middle part left open to manage the joint and skin lesion. Intraarticular sodium hyaluronate (20 mg) was administered 10 days later. After cast removal following 5 weeks, the stallion revealed no sign of lameness. The owner was instructed to keep the stallion confined to a stall for at least 2 more months with a restricted daily short hand walk. Special casting methods for immobilization of a limb with an open joint luxation can tremendously improve the healing process.