Summary A 3‐year‐old Warmblood filly that presented for lameness was diagnosed with an open, comminuted fracture of proximal metacarpal IV (MCIV). Initial treatment with local debridement and systemic antimicrobial administration was unsuccessful, with the development of osteomyelitis. A segmental ostectomy resulted in avulsion of the proximal MCIV from the third metacarpal bone post‐operatively. Reduction and internal fixation of the displaced MCIV with cortical lag screws resulted in immediate bone failure upon recovery. The proximal MCIV was then removed standing under sedation and local anaesthesia. Subsequent joint instability led to the development of osteoarthritis in the carpometacarpal and middle carpal joints, but the horse showed no obvious lameness 12‐month post‐operatively. Despite the surgical complications being previously described, there are limited case reports on the removal of MCIV in the horse and the associated outcomes. Although this surgical procedure is historically not recommended and the long‐term soundness of this horse is yet to be determined, this case report may support MCIV removal when other treatment options have failed.
Lloyd et al. (2025) studied this question.