Multimodal imaging and surgical repair of a dorsal-oblique plane, proximal third metacarpal fracture and the diagnostic challenge of radiographic visualisation

A 10-year-old Connemara mare presented with persistent 3/5 (AAEP) right forelimb lameness following a traumatic incident whilst hunting, which was localised to the proximal metacarpal and distal carpal regions with diagnostic anaesthesia. Radiography revealed non-specific moderately increased mineral opacity at the proximomedial margin of the third metacarpus, dorsal to the enthesis of the proximal suspensory ligament. However, subsequent computed tomography (CT) performed under general anaesthesia, identified an incomplete, dorsal - obliquely orientated third metacarpal fracture arising from the interosseous space between the third and second metacarpi, also involving the carpometacarpal joint. Using CT guidance, internal surgical fixation was performed under the same anaesthetic episode and resulted in a shortened post-operative recovery period with a successful return to previous athletic function. Surgical fixation can be performed using cross-sectional imaging guidance to optimise recovery and facilitate a positive outcome.