Transcript Fractures of the Metacarpus and Metatarsus

Veterinary Specialists of South Florida
Presents
Metacarpal and
Metatarsal Fractures
Dr. Hugh McClelland
Veterinary Specialists of
South Florida
“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.
“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
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CBC/Chemistry/UA for classification of anesthetic risk
Hydromorphone 0.6mg (0.1mg/kg) IV
Manual reduction
Lateral and dorsoplantar radiographs
Diagnosis: Metatarsal
Fracture
Closed complete non-displaced transverse
proximal diaphyseal fractures of metatarsals II
through V
Metacarpal
and
Metatarsal
Fractures
Metacarpal and metartarsal
fractures: Epidemiology
Epidemiology
 8.1% of all fractures in dogs
 3.3% of all fractures in cats
 Metacarpal fractures more common than
metatarsal fractures
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)
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Hit by car
Fall from height (high-rise syndrome)
Stepped upon
Gunshot
Bite
Lawnmower
Trap
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
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)
Therapeutic Goals
 Fracture stabilization for bone healing
and early return to function
 Minimize degenerative joint disease
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
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
Before proceeding, assess
systemic health and rule out
concurrent injuries
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
Complications
 Non union is possible no matter what
treatment is chosen
 Malunion or delayed union
 Bandage complications
 Infection
 Vascular or nervous damage
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
Prognosis
 Good for simple fractures with adequate
reduction and fixation/stabilization
 Guarded for articular, highly displaced, or
comminuted fractures
“Thor”
 Surgical stabilization was
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.
“Thor”
 At 6 weeks post-op Thor was
weight bearing on all four limbs. The bandage
was removed.
 Currently 10 weeks post-op with good clinical
function.
“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
“Emma”
 Diagnosis
 Closed, complete, transverse, minimally displaced middiaphyseal 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
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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