cat with fractured metacarpals

RE: cat with fractured metacarpals

Martin Atkinson — Wed, 28 Sep 2016 09:30:32 GMT

Well I chickened out of surgery and referred the cat to our local orthopod, Alex Li at Chiltern Referrals. He decided on a review radiograph that the fragments were well aligned in our dressing and were so small that it would not be practical to improve on this with surgery so we are going to continue to manage this with external support.

RE: cat with fractured metacarpals

David Mills — Wed, 21 Sep 2016 09:31:44 GMT

I'd just pin the two middle ones. They've got rough edges so should give additional stability and once aligned the callus formation should be rapid (depending on age). It'll be fiddly. I'd probably push the pin out of the distal fragment, reduce and then drive into the main fragment.

I don't use external support bar a dressing for a day or so post-op. If you curl the ends of the pins flush with the bone, I've not had to remove any yet (n=13).

RE: cat with fractured metacarpals

Kara Gibson — Wed, 21 Sep 2016 09:19:06 GMT

Those fragments are quite displaced so i suspect will really struggle to heal conservatively. I would be pinning these and using a dressing for 4-6 wks. Likely will need the pins removing once healed also.

RE: cat with fractured metacarpals

Beats — Tue, 20 Sep 2016 19:15:32 GMT

Those are quite small distal fragments on the main 2 metacarpals - probably could dowel pin OK still (defnitely with few weeks external coaptation afterwards though for me), but I'd personally try a "SPIDER"-type ipn frame on this. A bit like the last picture in http://www.veterinaryirelandjournal.com/files/sa_feb_2014.pdf but with less epoxy putty and I'd probably do an open approach on your case. Cost still minimal (5 k-wires and a bit of epoxy putty), but a little more technically-demanding, time-consuming and you'll need a drill...

I have only treated a handful of these, so hopefully others will have more experience to share on your case.

RE: cat with fractured metacarpals

Martin Atkinson — Tue, 20 Sep 2016 17:17:00 GMT

[quote user="Beats"]If you have xrays others might have more experience to share.[/quote]Here it is. Sorry about the quality the developer needed changing and I haven't been dragged screaming and shouting into the 21st century with digital yet so there are some interference lines on the photograph but the fractures are clear.

RE: cat with fractured metacarpals

David Mills — Tue, 20 Sep 2016 17:10:23 GMT

We see these quite commonly and normally pin the two central metatarsals/carpals. Usually takes 45m-1h and strangely satisfying. General advice is if both central ones have gone, then fixation is indicated.

The last one we didn't (n=1) took 4 months to heal, with intermittent lameness, which is rather a long time really to be resting a young (or even old) cat.

RE: cat with fractured metacarpals

Beats — Tue, 20 Sep 2016 16:00:46 GMT

i like toggle-pinning cat metacarpals as cheap and cheerful (cost of a K-wire and 2 x pairs of mosquito forceps), and, xray dependent, might do that. Provides alignment (and stability against bending forces) and any intact metacarpals probably provide sufficent additional stability, but does involve additional soft tissue damage to achieve this. If minimally displaced may be no advantage to this over bandaging alone. More rigid forms of fixation may lead to cat out and jumping through windows again earlier than these options.

If you have xrays others might have more experience to share.