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The carpus

image of The carpus
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Abstract

Conditions affecting the structure and function of the carpus are common in small animal practice and can have debilitating consequences for thoracic limb function. This chapter covers the key aspects of anatomy, investigations, congenital abnormalities, developmental abnormalities, traumatic carpal injuries and arthrodesis. Includes . : Pancarpal arthrodesis; Partial carpal arthrodesis.

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Figures

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20.1 Radiograph of the canine carpus showing the position of the radial (RC), ulnar (UC) and small numbered carpal bones (1–5). There is a sesamoid bone (*) medial to the middle carpal joint within the tendon of insertion of the abductor pollicis longus muscle.
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20.2 (a) Ligaments of the palmar aspect of the carpus. The palmar fibrocartilage is not shown. (b) Lateral aspect of the carpus showing the main soft tissue attachments of the accessory carpal bone. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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20.3 (a) A 12-week-old Labrador Retriever with carpal flexural deformity. Note the altered digit posture. (b) Carpal flexural deformity in a 17-week-old Boxer.
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20.4 Traumatic luxation of the antebrachiocarpal joint in a 2-year-old working Labrador Retriever. A fracture of the distal ulna is also present.
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20.5 Antebrachiocarpal joint subluxation associated with a traumatic grade III sprain of the radial collateral ligaments in a 4-year-old German Shepherd Dog, sustained in a road traffic accident.
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20.6 Luxation of the radial carpal bone in a 3-year-old Border Collie.
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20.7 (a) Shearing injury affecting the medial aspect of the distal antebrachium, carpus and metacarpus. (b) The carpus has been stabilized using a transarticular external skeletal fixator. (Courtesy of Simon Gilbert)
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20.9 (a) Dorsopalmar radiograph of the carpus in a 4-year-old Boxer. A parasagittal radial carpal bone fracture (arrowed) is present. (b) Transverse CT image of a Y-shaped fracture in the radial carpal bone of a 6-year-old Brittany Spaniel, subsequently managed by pancarpal arthrodesis. (c) The Boxer in (a) was also managed with pancarpal arthrodesis using a CastLess pancarpal arthrodesis plate. (b, Courtesy of Gordon Brown)
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20.10 (a) Computed tomographic cross-sectional image of the distal antebrachium of a 6-year-old Irish Setter with stenosing tenosynovitis of the abductor pollicis longus tendon. There is bony remodelling (arrowed) of the margins of the medial sulcus of the radius through which the tendon passes. (b) CT 3D volume rendered reconstruction showing the remodelled and protruding groove (arrowed) on the craniomedial aspect of the same radius. The bone remodelling is much easier to appreciate on the CT images. (c–d) Dorsopalmar and mediolateral radiographs of the carpus of a dog with the same condition showing bone remodelling of the cranial and medial aspects of the distal radius (arrowed). (c, d, Courtesy of Gareth Arthurs)
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20.11 Stressed mediolateral radiograph of the carpus of a 3-year-old Dalmatian showing carpal hyperextension as a result of carpometacarpal instability, in this case resulting from a fall from a cliff.
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20.12 (a) Stressed mediolateral and (b) dorsopalmar radiographs of the carpus of a 2-year-old Border Collie. The hyperextension in this case is associated with a fracture of the base of the fifth metacarpal (arrowed).
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20.13 Dorsal placement of a hybrid dynamic compression (3.5/2.7 mm) plate for pancarpal arthrodesis.
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20.14 A 6-year-old Greyhound with a distal radial articular fracture has been managed with pancarpal arthrodesis; orthogonally placed 2.7 mm locking compression plates have been used.
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20.15 The CastLess partial carpal arthrodesis plate. (Courtesy of Neil Burton)
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20.16 Patient positioning for a mediolateral view of the carpus. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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20.17 Patient positioning for a dorsopalmar view of the carpus. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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20.18 Patient positioning for a stressed extended mediolateral view of the carpus. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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20.19 Patient positioning for a flexed mediolateral view of the carpus. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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20.20 Patient positioning for stressed dorsopalmar views of the carpus; placing the ties as shown will stress the lateral aspect of the joint. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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20.21 (a) Mid-dorsal skin incision over the carpus parallel to the cephalic vein. (b) The extensor carpi radialis tendons are sectioned and the common digital extensor tendon is retracted. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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20.22 Removal of the articular cartilage from the radial carpal bone using a high-speed bone burr.
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20.23 Placement of a 3.5/2.7 mm hybrid dynamic compression plate.
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20.24 Positioning and screw hole numbering for CastLess pancarpal arthrodesis (PCA) plate application. MC = metacarpal. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 20.25
20.25 A T-plate has been placed on the dorsal aspect of the carpus, centred on metacarpal 3. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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