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958 Tarsal Trauma

TREATMENT • Consider corticosteroids if tail paralysis is • Guarded to poor if feline thromboembolic
secondary to spinal cord/nerve compression disease (recurrence risk, heart failure)
Treatment Overview
VetBooks.ir Musculoskeletal or neurologic: • After patient is stable, treatment depends PEARLS & CONSIDERATIONS
(controversial [p. 555]).
• Treatment to address underlying cause
on underlying cause.
• Medical management of fractures, using pain
management, bandages for immobilization Chronic Treatment Comments
• The most common causes of tail paralysis
• For limber tail syndrome, the use of antiin- • Hygiene are trauma and degenerative lumbosacral
flammatories might improve the symptoms. • Bladder catheterization if necessary stenosis; prognosis depends on deep pain
• Amputate tail if vascular compromise • Physical therapy for paraparetic patients perception and vascular supply.
○ Leave 3-4 coccygeal vertebrae if well • In dogs and cats, the tail is not essential to
vascularized Possible Complications life; tail amputation in patients with normal
○ Amputate to the level of healthy skin • Depends on therapeutic options limb function and bladder control provides
margins if tail is devascularized • Beware of corticosteroid administration: excellent quality of life.
Cardiovascular/thromboembolic disease: associated with gastrointestinal ulceration, • Beware: pain originating from the pelvic
• Tail amputation if tail is soiled by urine and/ colonic perforation canal (e.g., prostatic abscess, degenerative
or feces or if tail has not revascularized well lumbosacral stenosis) can mimic tail paralysis.
• Address underlying cardiac disease. Recommended Monitoring
Neoplasia: Depends on primary cause and therapeutic Technician Tip
• Wide surgical excision if possible options Hygiene and topical care to prevent urine/fecal
• Radiation therapy or chemotherapy if contact dermatitis is a key to chronic care:
indicated and if possible PROGNOSIS & OUTCOME bathing, keeping area dry and clean, clipping
Skin wound of the tail (p. 909): perianal/perineal region, and protective oint-
• With vascular compromise, amputate tail at • Trauma ment if necessary.
appropriate level. ○ Intact deep pain perception and normal
• Without vascular compromise, treat by vascularization: guarded. Generally, these SUGGESTED READING
local debridement (wet-to-dry bandaging patients regain enough motor activity to de Lahunta A, et al: Veterinary neuroanatomy and
or surgical debridement). maintain hygiene. clinical neurology, ed 3, St. Louis, 2009, Saunders.
• Use second-intention healing (bandages with ○ Absence of deep pain for more than 48
hydrogel). hours: poor prognosis for return of motor AUTHOR: Bertrand Lussier, DMV, MSc, DACVS
• If wound closure impossible by second- activity but good if tail amputated and EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
intention healing, use secondary closure normal voluntary hindlimb activity and
(local skin flaps, free skin grafts). bladder control
• Limber tail syndrome: condition is self-
Acute General Treatment limited and resolves in 7-21 days (anecdotal).
• If identified, treat shock, concurrent trauma, Recurrence is possible.
or cardiac disease

Tarsal Trauma Bonus Material Client Education
Sheet
Online

BASIC INFORMATION RISK FACTORS Etiology and Pathophysiology
Racing/agility activities; hindlimb trauma • Racing on counterclockwise tracks predis-
Definition poses to right-sided injuries.
Tarsal trauma includes ligament damage, Clinical Presentation • In racing greyhounds, there is a classic triad
luxation/subluxation of individual tarsal bones, DISEASE FORMS/SUBTYPES of fractures involving the central tarsal bone,
fractures, shearing injuries Sprains, fractures, shearing/degloving wounds, calcaneus, and the fifth proximal metatarsal
coaptation-related injuries bone.
Synonym • In border collies, cause of central tarsal bone
Tarsal breakdown HISTORY, CHIEF COMPLAINT subluxation/fracture is unknown.
Hindlimb trauma; lameness after competition/
Epidemiology exercise
GENETICS, BREED PREDISPOSITION DIAGNOSIS
• Racing greyhounds: central tarsal bone PHYSICAL EXAM FINDINGS Diagnostic Overview
fractures • Lameness Most injuries are diagnosed by physical/
• Border collies: central tarsal bone fracture/ • Swelling radiographic examinations.
luxation • Open wounds
• Shelties and collies: superficial digital flexor • Pain/crepitation Differential Diagnosis
tendon luxation • Instability with plantigrade stance • Autoimmune polyarthropathy (systemic
• Cats: tibiotarsal luxation with lateral mal- • Mediolateral/rotational instability lupus erythematosus, rheumatoid arthritis)
leolar fracture • Tarsal deformity

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