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Tarsal Trauma 959

• Shearing injuries: wound management, Recommended Monitoring
surgical stabilization if needed • Lameness evaluation 1-3 months after injury/
VetBooks.ir Acute General Treatment • Serial radiographs to evaluate fracture Diseases and Disorders
treatment
• Minimally displaced, nonarticular fractures
healing/arthrodesis progression
and ligament sprains with no or minimal
instability can be stabilized for 4-8 weeks PROGNOSIS & OUTCOME
with an external splint.
• Luxated joints, intraarticular fractures, and • Good to excellent for noncompeting dogs;
high-grade sprains are supported in a modi- variable for return to preinjury status for
fied Robert Jones bandage or splint until competing dogs
surgery (p. 1161). • Residual/recurrent instability at some point
○ Short/long collateral ligament disruption throughout range of motion is not uncom-
requires stabilization with tension band mon in collateral ligament reconstruction;
principle (malleolar fractures) or replace- synthetic ligaments are anchored from point
ment with prosthetic suture. A to point B, which differs from the multiple
○ Individual tarsal bone fractures require attachment sites of a normal ligament.
lag screw fixation, except for lesions of • In noncompeting animals, solitary intertarsal
the calcaneus, which require bone plate joint fusion/ankylosis (i.e., calcaneotarsal,
or tension band repair. calcaneoquartal, quartalmetatarsal) can lead
○ Plantar and mediolateral intertarsal and to near-normal function.
tarsometatarsal subluxations are unstable • Despite extensive damage in shearing injuries,
and require partial tarsal arthrodesis. acceptable function is possible with various
○ Dorsal intertarsal and tarsometatarsal reconstructive efforts. Cases with neurovascu-
subluxations are stable (compressed) when lar compromise may necessitate amputation.
TARSAL TRAUMA A hinged orthosis is used by
this 6-year-old Labrador retriever only when running/ bearing weight. Surgical repair is needed
playing with other dogs because of mild persistent only if lameness persists. PEARLS & CONSIDERATIONS
instability after short and long collateral ligaments • Superficial digital flexor tendon luxation is
prosthetic reconstruction. treated by suturing torn retinacular tissues. Comments
• Shearing injuries require wound management. • When conservatively managed, intraarticular
○ Lavage open wounds using warm saline, fractures rarely heal with osseous bridging,
• Infectious (e.g., Lyme borreliosis, rickettsial lactated Ringer’s, or dilute chlorhexidine leading to degenerative joint disease. Surgical
disease) polyarthropathy solutions. treatment is recommended to reduce the risk
• Achilles mechanism disruption ○ Tissue coverage with moistened gauze of such adverse consequences.
sponges is useful in debridement (wet- • Patients with mild, persistent instability
Initial Database to-dry bandages); change daily. after collateral ligament reconstruction can
• Careful palpation/evaluation of mediolateral ○ Alternatively, direct application of sugar or be normal while walking but lame during
instability with tarsus in extension (long honey has been used for reducing infection more intense activities; a custom-made,
collaterals) and tarsocrural internal/external and promoting healing, although the role hinged thermoplastic orthosis can be very
rotation instability with tarsus in flexion of such treatment in the joint is unclear. useful to stabilize the tarsus when needed.
(short collaterals) (p. 1143) ○ Final surgical debridement/lavage can be
• Orthogonal radiographs performed during orthopedic stabilization Technician Tips
• CBC, serum biochemistry panel, and uri- surgery. • When tarsal trauma confirmed, prepare for
nalysis to assess anesthetic risk; the American ○ Wounds with healthy granulation tissue modified Robert-Jones bandaging with or
Society of Anesthesiologists Classification is and early epithelialization can be sutured without splinting.
provided on p. 1196. or covered with nonadherent dressings and • Prepare for wound irrigation and manage-
allowed to heal by second intention. ment, if applicable.
Advanced or Confirmatory Testing • Pantarsal arthrodesis should be considered
• Oblique radiography and/or CT (nondis- for shearing injuries with severe/critical loss SUGGESTED READING
placed fractures) of bone/cartilage and for some comminuted DeCamp CE, et al: Fractures and other orthopedic
• Stress radiography (mediolateral radiograph fractures. injuries of the tarsus, metatarsus, and phalanges.
with tarsus manually forced into dorsal and In Permattei DL, et al, editors: Brinker, Piermattei,
plantar extension and a dorsoplantar radio- Chronic Treatment and Flo’s Handbook of small animal orthopedics
graph with mediolateral stress) to identify Surgical repairs require 4-12 weeks of external and fracture repair, ed 5, St. Louis, 2016, Elsevier,
location of instability coaptation and exercise restriction. pp 707-752.
AUTHOR: Louis Huneault, DMV, MSc, DACVS
TREATMENT Possible Complications EDITOR: Kathleen Linn, DVM, MS, DACVS
• Reduction/implant failure
Treatment Overview • Delayed/failed arthrodesis
The goal of therapy is anatomic/functional • Vascular injury
restoration of tarsal functions: • Wound infection
• Fractures: anatomic reduction/stabilization • Coaptation-related morbidity
• Ligamentous injuries: reestablishment of joint • Degenerative joint disease
support by repairing collateral ligaments or
arthrodesis/ankylosis

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