Long-term prognosis of metacarpal and metatarsal fractures in dogs

Summary

Objectives: Lameness after metacarpal and metatarsal fractures in dogs is reported to occur with an incidence of 18% to 70%. On the basis of long-term results, the prognosis of these injuries was re-evaluated retrospectively.

Methods: Medical records of 100 dogs with complete clinical and radiographic follow-up examinations after an average of four years (4 months – 14 years) were evaluated. According to their treatment, patients were allocated to three groups (Group 1 = conservative, Group 2 = surgical, Group 3 = combined). Assessment included complications during the healing period and the final radiographic and functional outcome, which was statistically compared for differences between groups (Fisher exact test, exact Wilcoxon-Mann-Whitney test). Further, risk factors for each bone were analyzed (stepwise, multiple logistic regression model). In 15 dogs, kinetic data (relative stance phase, peak vertical force and impulse) were investigated by computed gait analysis.

Results: Complications were observed in 11 of 67 (16%) conservatively, in three of 25 (12%) surgically, and in three of eight (37%) conservatively and surgically treated dogs. Overall frequency of lameness evaluated by visual clinical assessment was three percent. Frequency of osteoarthritis and nonunion was also low, accounting for three percent and one percent respectively, although healing of mainly single-bone fractures resulted in malunions in 14% radiographically. Synostoses were found in 19% of patients, and significantly more frequent in surgically treated dogs. A higher risk of complications was identified for metatarsal compared to metacarpal fractures. Further, an increased risk for complications was detected for a higher degree of displacement and instability.

Clinical significance: According to the longterm results found in this study, the prognosis for metacarpal and metatarsal fractures is better than reported in the literature to date. With the reservation that more severe injuries are generally treated surgically, and these fractures more frequently developed synostosis, no significant difference could be detected between conservative and surgical treatment.

Keywords

Dog - fracture - metacarpus - metatarsus - conservative treatment - surgical treatment - prognosis

• References

• 1 Ness MG, Abercromby RH, May C. et al. A survey of orthopaedic conditions in small animal veterinary practice in Britain. Vet Comp Orthop Traumatol 1996; 9: 43-52.
• 2 Phillips IR. A survey of bone fractures in the dog and cat. J Small Anim Pract 1979; 20: 661-674.
• 3 Lösslein LK. Metakarpalund Metatarsalfrakturen bei Hund und Katze. Behandlung und Ergebnisse in den Jahren 1975-1981 [Metacarpal and metatarsal fractures in dogs and cats. Treatment and outcomes during the years of 1975-1981]. [Dissertation thesis]. LMU Munich: 1982
• 4 Muir P, Norris JL. Metacarpal and metatarsal fractures in dogs. J Small Anim Pract 1997; 38: 344-348.
• 5 Hickman J. Greyhound injuries. J Small Anim Pract 1975; 16: 455-460.
• 6 Bellenger CR, Johnson KA, Davis PE. et al. Fixation of metacarpal and metatarsal fractures in greyhounds. Austr Vet J 1981; 57: 205-211.
• 7 Ness MG. Metatarsal III fractures in the racing greyhound. J Small Anim Pract 1993; 34: 85-89.
• 8 Manley PA. Distal extremity fractures in small animals. J Vet Orthop 1981; 2: 38-48.
• 9 Kapatkin A, Howe-Smith R, Shofer F. Conservative versus surgical treatment of metacarpal and metatarsal fractures in dogs. Vet Comp Orthop Traumatol 2000; 13: 123-127.
• 10 Wind A. Fractures of the metacarpal (metatarsal) bones. Proc Am Anim Hosp Assoc. 1976 43. 346.
• 11 Anderson MA, Payne JT, Constantinescu GM. Managing fractures and related injuries of the distal extremities in dogs and cats. Vet Med 1993; 88: 957-968.
• 12 Degasperi B, Gradner G, Dupré G. Intramedullary pinning of metacarpal and metatarsal fractures in cats using a simple distraction technique. Vet Surg 2007; 36: 382-388.
• 13 Benedetti LT, Berry K, Bloomberg M. A technique for intramedullary pinning of metatarsals and metacarpals in cats and dogs. J Am Anim Hosp Assoc 1986; 22: 149-152.
• 14 Prabhugoankar NV, Jayaprakash R, Ayyappan S. et al. Surgical management of metacarpal fractures in a dog. Indian J Anim Hlth 2006; 45: 87-90.
• 15 Zahn K, Kornmayer M, Matis U. ‘Dowel’ pinning for feline metacarpal and metatarsal fractures. Vet Comp Orthop Traumatol 2007; 20: 256-263.
• 16 Fitzpatrick N, Riordan JO, Smith TJ. et al. Combined intramedullary and external skeletal fixation of metatarsal and metacarpal fractures in 12 dogs and 19 cats. Vet Surg 2011; 40: 1015-1022.
• 17 Okumura M, Watanabe K, Kadosawa T. et al. Surgical salvage from comminuted metatarsal fracture using a weight-bearing pin-putty apparatus in a dog. Aus Vet J 2000; 78: 95-98.
• 18 Early TD, Dee JF. Trauma to the carpus, tarsus, and phalanges of dogs and cats. Vet Clin North Am Small Anim Pract 1980; 10: 717-747.
• 19 Gentry SJ, Taylor RA, Dee JF. The use of veterinary cuttable plates: 21 cases. J Am Anim Hosp Assoc 1993; 29: 455-459.
• 20 Von Werthern CJ, Bernasconi CE. Application of the maxillofacial mini-plate compact 1.0 in the fracture repair of 12 cats / 2 dogs. Vet Comp Orthop Traumatol 2000; 13: 92-96.
• 21 De La Puerta B, Emmerson T, Moores AP. et al. Epoxy putty external skeletal fixation for fractures of the four main metacarpal and metatarsal bones in cats and dogs. Vet Comp Orthop Traumatol 2008; 21: 451-458.
• 22 Risselada M, Verleyen P, van Bree H. et al. The use of an external skeletal traction device for distal fractures in the dog. Vet Comp Orthop Traumatol 2007; 20: 131-135.
• 23 Seibert RL, Lewis DD, Coomer AR. et al. Stabilisation of metacarpal or metatarsal fractures in three dogs, using circular external fixation. New Zealand Vet J 2011; 59: 96-103.
• 24 Wernham BGJ, Roush JK. Metacarpal and metatarsal fractures in dogs. Compend Contin Educ Vet 2010; 29: E1-7.
• 25 Off W, Matis U. Ganganalyse beim Hund. Teil 1 und 2 [Gait analysis in dogs. Part 1 and 2]. Tierärztl Prax 1997; 25: 8-14 303-311.
• 26 Herzog W, Nigg BM, Read LJ. et al. Asymmetries in ground reaction force patterns in normal human gait. Med Sci Sports Exerc 1989; 21: 110-114.
• 27 Dixon WJ, chief editor. BMDP Statistical Software Manual, Volume 1 and 2. Berkeley: University of California Press; 1993
• 28 Quinn MM, Keuler NS, Lu Y. et al. Evaluation of agreement between numerical rating scales, visual analogue scoring scales,and force plate gait analysis in dogs. Vet Surg 2007; 36: 360-367.
• 29 Evans R, Horstman C, Conzemius M. Accuracy and optimization of force platform gait analysis in Labradors with cranial cruciate disease evaluated at a walking gait. Vet Surg 2005; 34: 445-449.
• 30 De Camp CE. Kinetic and kinematic gait analysis and the assessment of lameness in the dog. Vet Clin North Am Small Anim Pract 1997; 27: 825-840.
• 31 Jevens DJ, Hauptman JG, DeCamp CE. et al. Contributions to variance in force-plate analysis of gait in dogs. Am J Vet Res 1993; 54: 612-615.