Presentation
Presented with a 5-6 week history of left thoracic limb lameness that has been non responsive to NSAID therapy. On physical exam there is left carpal effusion.
Patient Data
Radiographs: Multiple craniocaudal and lateral projections of the left carpus are available for review as well as orthogonal projections of the right carpus with comparison. Within the left carpus the radial carpal bone appears sclerotic particularly at the medial distal aspect. There is an irregularly margined poorly defined linear lucency extending from the proximal medial to distal lateral aspect of the radial carpal bone seen on multiple projections. The distal most medial portion of the radial carpal bone adjacent to the first and second carpal bones is irregular with a curvilinear lucent portion. The remainder of the viewable skeletal structures are unremarkable. There is mild soft tissue swelling dorsal and medial to the left carpal joint.
CT:There is a small osseous defect at the palmar aspect of the 4th carpal bone and an osseous fragment is present just palmar to it. The osseous defect is surrounded by mild sclerosis. There is a fracture line extending from the proximal medial aspect of the radial carpal bone to the distal articular surface of the same bone more laterally. The fracture line is irregular and there is mild osseous resorption identified surrounding this fracture in the mid body of the radial carpal bone.
Orthogonal projections of the right carpus for comparison are normal.
Case Discussion
Chronic fracture of the left radial carpal bone with secondary mild osteoarthrosis of the left radiocarpal joint. Chronic fracture of the palmar aspect of the left 4th carpal bone.
Due to the complexity of the carpal joint, fractures are better seen on CT imaging than radiographs, and this may also reveal additional areas of trauma.
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