Surgical Treatment and Imaging of Metacarpal Exostosis-Suspensory Adhesions in Three Horses

Introduction: Metacarpal exostosis-suspensory adhesions and impingement are commonly implicated in lameness. Visualization and surgical management has been described in textbooks but there is little reporting of clinical cases. This study aims to highlight agreement between surgical and ultrasonographic findings.

Case Descriptions and Results: A 14-year-old mare with a right MCIV exostosis. There was a mild-to-moderate right forelimb lameness. Radiographs demonstrated an active exostosis in the middle third of MCIV. Ultrasonography highlighted suspensory impingement. Surgery was performed. Impingement and adhesions were identified. MCIV was amputated proximally, and the suspensory freed. The horse received standardized postoperative care and made excellent postoperative progress.

An 8-year-old gelding with a left MCII exostosis associated with the midportion of the suspensory ligament. There was a mild-to-moderate forelimb lameness, localized to the feet and partially the exostosis. Ultrasonography demonstrated an exostosis-suspensory adhesion, with a focal tear of the ligament. At surgery, there were adhesions between the suspensory midbody and the exostosis. The adhesions were transected and MCII amputated proximally. Postoperative management was as above. The horse returned to work, but lameness recurred 14 months postoperatively.

An 11-year-old gelding with a left MCIV exostosis. There was no significant lameness. Radiographs demonstrated proliferative exostosis at the proximal-mid MCIV. Ultrasonography demonstrated suspensory impingement. Surgery demonstrated exostosis-suspensory and lateral palmar metacarpal nerve adhesions. These were transected and MCIV amputated. Rehabilitation postoperatively was as above. The horse made a full return to work.

Discussion/Conclusion: These cases demonstrate a strong correlation between ultrasonographic and the surgical findings. The follow-up is encouraging, with a relatively fast return to work.

No conflict of interest has been declared by the author(s).