Cat metacarpal luxation - please discuss!

Re: Cat metacarpal luxation - please discuss!

John Flynn — Sun, 01 Sep 2013 23:20:09 GMT

[quote user="Hannah Wynne Richards"]I'm not surprised it has an obvious limp (given all the iron-mongery)[/quote]

Quite so

Would it have less of a limp had it been restricted to cage/room? I don't know

The cat in question has apparently not been obeying doctors orders (when do they) and has made it out to the gardn on at least one occasion where it decided to jump hedges pursued by a somewhat less agile owner before finally being returned to room arrest.

With the majority view being evenly split between cage/room rest and pancarpal arthrodesis (also requiring some rest surely?), I guess the only option in the poll that would have allowed fairly immediate short-term return to outside living (and therefore arguably possibly the least short-term welfare impingment) would have been the amputation one that unsurprisingly didn't attract very many votes!

Re: Cat metacarpal luxation - please discuss!

Hannah Wynne Richards — Fri, 30 Aug 2013 15:35:49 GMT

I'm not surprised it has an obvious limp (given all the iron-mongery)

I was 1 of the 25% who voted for rest (at least initially)

Wynne

Re: Cat metacarpal luxation - please discuss!

John Flynn — Fri, 30 Aug 2013 10:11:56 GMT

[quote user="Richard Carter"]so what is the proximal wire through or is it around the joint?[/quote]

Good question!

I think it's probably just about going through the distal aspect of the radial carpal bone lateral to medial, but I don't know for sure. I suspect that was where it was intended to go at any rate, but I'm not totally sure off the xrays that it made it and alternatively it could be lodged in the intercarpal joint or engaging part of another carpal bone?

I assume it felt to have purchase on something or other if able to bend up like that to include in frame.

Re: Cat metacarpal luxation - please discuss!

Richard Carter — Fri, 30 Aug 2013 09:29:38 GMT

so what is the proximal wire through or is it around the joint?

Re: Cat metacarpal luxation - please discuss!

John Flynn — Thu, 29 Aug 2013 21:15:45 GMT

Quite a mixed bag of responses there - I hadn't necessarily expected votes for all the options!

And thanks for all the contributing posts - I don't like the way people add red stars to these - it looks really unfriendly to me as I think everyone has a valid contribution to make to discussions.

I spoke to the vet who had sent the xrays, and the cat had a "SPIDER" type pin placement done without debridement of articular cartilage if anyone is interested.

I'll report back if I hear what the final outcome of this was. Is apparnetly ambulatory with an obvious limp - but given penetration of phalangeal-metacarpal joint on 2 digits I guess that ain't a surprise. Vet plans to leave frame on 6 to 8 weeks then remove and see what stability like and do partial arthrodesis if any further issues.

Re: Cat metacarpal luxation - please discuss!

Richard Carter — Mon, 19 Aug 2013 18:01:54 GMT

it was the tibia-tarsal joint, not metatarsals no perhaps not so good

Re: Cat metacarpal luxation - please discuss!

John Flynn — Mon, 19 Aug 2013 17:01:34 GMT

[quote user="Richard Carter"]can one reduce under ga, then strap - I saw a tarsal dislocation that a colleague repaired very well using vicryl to hold bones and joint in position / support while nature and cat got together to repair whatever had given way. no pins or drills needed - just a straight needle.[/quote]

Good question

I guess a carpo-metacarpal luxation is not that different from a tarso-metatarsal luxation (correct me if I'm wrong...)?

However, if it was a tibio-tarsal luxation that your colleague dealt with then I imagine that has a good deal more inherent stability on reduction than e the equivalent injury to the carpus. The tibia and talus slot together quite neatly, while the carpal joint reminds me of a pile of pebbles stacked upon each other.

Do you remember where in the tarsal joint the dislocation was?

Re: Cat metacarpal luxation - please discuss!

Michael Woodhouse — Mon, 19 Aug 2013 12:08:29 GMT

[quote user="Braden Collins"]

Would Vicryl have dome much good after the first few days? Doesn't is lose almost all its tensile strength within 1-2 weeks?

[/quote]

75% @ 14 days, 50% @ 21 days and 25% @ 28days

How long do we need support for? I suspect if bone plates dissolved at a similar speed most would heel fine..........

Re: Cat metacarpal luxation - please discuss!

Braden Collins — Mon, 19 Aug 2013 11:19:04 GMT

Would Vicryl have dome much good after the first few days? Doesn't is lose almost all its tensile strength within 1-2 weeks?

Re: Cat metacarpal luxation - please discuss!

Richard Carter — Mon, 19 Aug 2013 08:59:58 GMT

can one reduce under ga, then strap - I saw a tarsal dislocation that a colleague repaired very well using vicryl to hold bones and joint in position / support while nature and cat got together to repair whatever had given way. no pins or drills needed - just a straight needle.

Re: Cat metacarpal luxation - please discuss!

John Flynn — Mon, 19 Aug 2013 00:11:22 GMT

[quote user="Joyce Whitehead"]Unfortunately the answer to the poll would have to be partly based on an additional sub question - "how much does the owner want to spend?" And my answer would also be to get an orthopod to have a look![/quote]

Totally agree, Joyce. We would then need the further sub question of "how much will each approach cost?" and risk a downward spiral as those who do 3 pancarpal arthrodeses for a tenner debate with those who wouldn't place a bandage for less than the price of their annual indemnity insurance. And I appreciate that you'd need a pretty throrough physical examination, and quite possible further imaging, in addition to the radiographs posted to make any firm recommendations on an individual case.

But was trying to keep as a generic clinical discussion of the radigoraphically-apparent injury. Think of it as a multiple choice question in an exam if that helps. (Or imagine that the owner is holding a gun to your head asking what you think should be done clinically if you prefer - and the option of "use my ninja skills to disarm the owner and call the police" is not going to be included in the poll before anyone suggests it )

You're free to vote in the poll if you want to with whatever you think would be your preferred approach, or what appraoch you think an expert might take if the cat found its way to one.

I posted because I was surprised how little information was available on the ligaments in the cat's intercarpal and carpo-metacarpal joints there was. I have a suspicion that extrapolation of experience of dogs with similar lesions might not be altogether valid, and may lead to more invasive techniques than are strictly essential, and I wondered what others thought?

Looking at a cat surgery book, the following is suggested:

Carpometacarpal joint instability/luxation

Hyperextension injury

Partial carpal arthrodesis

Dorsal, medial or lateral instability with intact palmar ligaments

Dorsal plate or internal fixator (adaptation function)

Screw and wire technique

Partial carpal arthrodesis

I think it would be difficult to know whether this injury had intact palmar support in advance of any intervention unless it was reducible first. I was interested as to whether the dorsal nature of the luxation inferred a higher likelihood of intact palmar support or not (I thought it probably did)?

Re: Cat metacarpal luxation - please discuss!

Joyce Whitehead — Sun, 18 Aug 2013 21:35:04 GMT

Unfortunately the answer to the poll would have to be partly based on an additional sub question - "how much does the owner want to spend?" And my answer would also be to get an orthopod to have a look!

Re: Cat metacarpal luxation - please discuss!

mariette asselbergs — Sat, 17 Aug 2013 14:12:56 GMT

What do they do nowadays in children with sprained wrist? Just a bandage like in the old days?

Mariette

Re: Cat metacarpal luxation - please discuss!

Miriam Lodewyks — Fri, 16 Aug 2013 22:34:27 GMT

Not an expert - refer to orthopod!