Management of Small Metacarpal / Metatarsal Bone Fractures: Conservative Approach

At this meeting in 2012 Tessier presented a case of a horse which underwent surgery to amputate the distal aspect of the fourth metatarsal bone. The horse sustained a fatal fracture of the third metatarsal bone during recovery from anaesthesia. This complication has also been reported previously, so I asked the audience, who had seen a fracture of the cannon bone following surgery to remove a splint bone? A clear majority raised their hand, including myself. The unanswered question appeared to be, if a fatal cannon bone fracture is a possible complication, is surgery necessary?

The second and fourth metacarpal or metatarsal bones, the “splint” bones, are an integral part of the carpometacarpal and tarsometatarsal articulation. The bones have a radiographically visible medulla in the proximal third only. There are extensive soft tissue attachments to the proximal part of the bone, including the palmar metacarpal and plantar metatarsal fascia.

There are many case series reporting surgery for treatment of fractures of the splint bones, many dating back to the 80’s and 90’s. There is general agreement in the literature that fractures of the distal portion of the bone may be associated with concurrent soft tissue injuries, notable desmitis of the branches of the suspensory ligament. Surgery may be performed but is seldom necessary.  [...]