Metatarsal avulsions - options?

RE: Metatarsal avulsions - options?

Gerry Henry — Wed, 13 Jul 2016 18:39:43 GMT

Nice

RE: Metatarsal avulsions - options?

David Mills — Tue, 12 Jul 2016 17:13:11 GMT

Op done today, rad below for those interested. Ventral and lateral ligamentous support intact. Pins are bent more than rad shows (angulation), tension band is figure of eighted and whilst proximal looks a little proximal during placement seemed OK intra-op and joint stable. Thanks for all advice.

RE: Metatarsal avulsions - options?

David Mills — Mon, 11 Jul 2016 18:49:03 GMT

Thanks Malcolm, detailed reply as always.

Was hoping to use K-wires and avoid a full tarsal arthrodesis given the distal site of the injury. Plates are a bit of a stretch here and we don't normally offer arthrodesis except in select cases. Dog is booked in tomorrow so will see how things go. Strangely, looking forward to it.

RE: Metatarsal avulsions - options?

Malcolm Ness — Mon, 11 Jul 2016 16:00:30 GMT

This looks like a traumatic fracture-luxation of the tarso-metatarsal joints. These are surgical cases. Careful evaluation of the anaesthetised dog should reveal which of the major ligamentous stabilisers of this part of the limb remain intact. Looking at this rad I would be hoping that the ventral fibro-cartilage and the lateral collateral ligaments are functionally intact. The medial collaterals insert on/near the fractured medial metatarsal and will be therefore, ineffective.

Treatment is by arthrodesis. If ventral and lateral stability remains, then that fixation can be achieved by arthrodesis of the two most medial taros-metatarsal joints. Debride the joint surfaces of cartilage and re-align the paw before fixing. Consider placing a cancellous bone autograft. I would use crossed pins, approx 1.5-1.8mm diameter, starting couple of cm distal to the joint and anchored proximally into the 4th and central tarsals respectively. A stout tension wire should then be placed medially (around the slightly protruding pin ends) and tensioned firmly to stabilise the medial collateral deficit.

The repair should be protected in a weight-bearing cast for 4 weeks then a RJ for a further fortnight or so. A plate and screws applied to the medial aspect of the tarsus can be used in place of the pins and wire.

Prognosis for a full functional outcome is excellent though it is often necessary to remove some of the implants as things heal and the dog becomes more active.

RE: Metatarsal avulsions - options?

Hannah Wynne Richards — Sun, 10 Jul 2016 14:12:37 GMT

I'm glad that with 80% of my clients I'd be able to refer this.

Wynne

RE: Metatarsal avulsions - options?

cathal rafferty — Sun, 10 Jul 2016 11:50:40 GMT

We've done a few of these with crossed k wires placed medial and lateral to arthrodese the MT-Tarsal joint. They've all been small dogs though. Of course they need splinting too for 10 weeks or so, with all the complications that can lead to. The other option would be pan tarsal arthrodesis. That might be a better option in a staffie

RE: Metatarsal avulsions - options?

David Mills — Sat, 09 Jul 2016 16:58:10 GMT

Thanks.

What do you think about k wires to stabilise the other metatarsals as well? .

RE: Metatarsal avulsions - options?

stuart mcmorrow — Wed, 06 Jul 2016 17:35:19 GMT

Medial or lateral plate depending on other injuries.

k wires probably not strong enough.