1. Veterinary Specialists of South Florida Presents

2. Metacarpal and Metatarsal Fractures Dr. Hugh McClelland Veterinary Specialists of South Florida

3. “Thor”  Signalment  10yo MC Miniature Pinscher  Presenting Complaint  Acute non-weight bearing lameness of the right pelvic limb  History  Owner came home and found him at the top of the stairs carrying the right pelvic limb. The paw was grossly deformed.  Physical Examination  Palpation of the right paw revealed soft tissue swelling, pain, crepitus and instability consistent with multiple metatarsal fractures. No other remarkable findings on physical exam.

4. “Thor”  Problems  Acute onset of crepitus, instability, pain and swelling of the right hind paw  Differential Diagnosis  Joint luxation  Multiple fractures  Initial Tx and Diagnostics  CBC/Chemistry/UA for classification of anesthetic risk  Hydromorphone 0.6mg (0.1mg/kg) IV  Manual reduction  Lateral and dorsoplantar radiographs

6. Diagnosis: Metatarsal Fracture Closed complete non-displaced transverse proximal diaphyseal fractures of metatarsals II through V

7. Metacarpal and Metatarsal Fractures

8. Metacarpal and metartarsal fractures: Epidemiology

9. Epidemiology  8.1% of all fractures in dogs  3.3% of all fractures in cats  Metacarpal fractures more common than metatarsal fractures

10. Epidemiology  Young racing greyhounds (fatigue fractures)  Left fifth metacarpal most common  Usually “rail side,” i.e. right medial and left lateral metacarpals and metatarsals  Small dogs and cats (traumatic fractures)  Hit by car  Fall from height (high-rise syndrome)  Stepped upon  Gunshot  Bite  Lawnmower  Trap

11. Clinical presentation Chief complaint Acute lameness Poor racing performance PE findings Soft tissue swelling Pain Crepitus Valgus or varus deformity if insertion of the collateral ligaments on MC/MT II or V is affected Joint effusion if intrarticular fracture

12. Pathophysiology  Fractures usually involve the weight bearing bones (MC/MT III and IV)  All four bones fractured 41% of the time in one study  Often open (poor soft tissue coverage)  Slow healing time (poor soft tissue coverage)

13. Therapeutic Goals  Fracture stabilization for bone healing and early return to function  Minimize degenerative joint disease

14. Acute Treatment Options  Conservative management  Closed reduction + cast or splint  Simple, closed, nondisplaced fractures  Fractures involving only one or possibly two bones, providing that one of the central weight bearing bones is intact  Can lead to healing in more serious cases, but good alignment unlikely to result

15. Acute Treatment Options  Surgical fixation  bone plate, lag screw, IM pin, or external fixator  Fracture of the main weight bearing bones (MC/MT 3 and 4)  >2 MC or MT fractures in the same limb  Displaced or comminuted fractures  Open fractures  Joint involvement  Large breed or working dogs

16. Before proceeding, assess systemic health and rule out concurrent injuries

17. Chronic Treatment  Surgical: Support with a splint or cast for 4 weeks, then exercise restriction for another four weeks  Conservative: remove bandage after clinical signs of union (6 weeks in young animals, longer in older patients) followed by 3-4 weeks of exercise restriction

18. Complications  Non union is possible no matter what treatment is chosen  Malunion or delayed union  Bandage complications  Infection  Vascular or nervous damage

19. Monitoring  For surgical cases, periodic physical examination and radiographic rechecks until healing achieved  For non-surgical cases, periodically remove the cast or splint and assess pain, stability, and function until healing achieved

20. Prognosis  Good for simple fractures with adequate reduction and fixation/stabilization  Guarded for articular, highly displaced, or comminuted fractures

21. “Thor”  Surgical stabilization was elected. elected.  Open reduction and internal fixation with bone plates A 1-5,7 plate was applied to the dorsal surface of MT III and a 1-5,6 plate was applied to the dorsal surface of MT II. The distal row of metatarsal bones was incorporated to allow the placement of three screws proximally. A 1-5,7 plate was applied to the dorsal surface of MT III and a 1-5,6 plate was applied to the dorsal surface of MT II. The distal row of metatarsal bones was incorporated to allow the placement of three screws proximally.

23. “Thor”  At 6 weeks post-op Thor was weight bearing on all four limbs. The bandage was removed. weight bearing on all four limbs. The bandage was removed.  Currently 10 weeks post-op with good clinical function.

24. “Emma”  Signalment  4mo FI Boxer  Presenting Complaint  Acute non-weight bearing lameness of the right thoracic limb  History  Jumped up and landed awkwardly on the limb, otherwise healthy  Physical Examination  Palpation of the paw revealed soft tissue swelling, pain, crepitus and instability consistent with multiple metacarpal fractures. No other remarkable findings on physical exam.  Initial Database  Lateral and dorsopalmar radiographs

26. “Emma”  Diagnosis  Closed, complete, transverse, minimally displaced mid- diaphyseal fractures of metacarpals II through V  Plan  Surgery was recommended but declined.  A spoon splint and padded bandage was applied.  Emma was discharged with instructions for strict cage rest, bandage care, and follow up with the referring veterinarian.  Outcome  Currently two weeks post injury  Time will tell

27. References  Muir P, Norris J. Metacarpal and metatarsal fractures in dogs. Journal of Small Animal Practice 1997; 38: 344-348.  De La Puerta B, Emmerson T, Moores A, Pead M. Epoxy putty external skeletal fixation for fractures of the four main maetacarpal and metatarsal bones in cats and dogs. Vet Comp Orthop Traumatol 2008; 21: 451-458.  Degasperi B, Gradner G, Dupre G. Intramedullary pinning of metacarpal and metatarsal fractures in cats using a simple distraction technique. Vet Surg 2007; 36:382-388.  Risselada M, Verleyen P, Van Bree H, Verhoeven G. The use of an external skeletal traction device for distal fractures in the dog. Vet Comp Orthop Traumatol 2007; 20:131-135.  Fossum G: Metacarpal, metatarsal, phalangeal, and sesamoid bone fractures and luxations. In Fossum G (ed): Small Animal Surgery, ed 3 pp. 829-834.

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