Ch 64 Tarsus and metatarsus Flashcards

1
Q

Anatomy

observed susceptibility to overstress injury

A
  • seven tarsal bones
  • talus is the only bone that forms an articulation with both the tibia and the fibula (body [trochlear], the head, and the neck)
  • calcaneus, the tuber calcanei, provides attachment for the common calcanean tendon.
  • medial side of the bone is a bony process, the sustentaculum tali
  • central tarsal bone = buttress support for the joint
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What breed may have sesamoids at the tarsometatarsal joint?
How frequently are they reported?

A

Greyhounds
- Lateral plantar sesamois in 50%
- Small medial intertarsal tarsometatarsal sesamoid 27%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What percentage of tarsal movement occurs at the tarsocrural joint?

A

90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List the 6 main articulations of the tarsus

ginglymus (hinge joint)

A
  • tarsocrural
  • talocalcaneal
  • talocalcaneocentral
  • calcaneoquartal
  • centrodistal
  • tarsometatarsal
    Proximal intertarsal joint includes talocalcaneocentral and calcaneoquartal joints
    Distal intertarsal joint includes the central tarsal and its articulation with the 1st, 2nd anf 3rd tarsal bones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the tarsal canal?

A

A thickening of the plantar fascia medial to the calcanues and plantar to the talus, containing several important structures (plantar brances of saphenous artery and vein, medial and lateral plantar nerves, tendon sheath of flexor hallucis longus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List the three compontents of the medial collateral ligament and specific whether they are taut in flexion/extension/both

A

Long part
- From medial malleolus to central tarsal bone (and talus and 2nd)
- Taut in extension

Tibiocentral (short)
- Taut in extension

Tibiotalar (short)
- Taut in FLEXION (runs 90 degress to the other two)
- Most substantial component of MCL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List the components of the lateral collateral ligament and specific wheter each component is taut in extension of flexion

A

Long
- Taut in extension

Calcaneofibular short ligament
- Taut in extension
- Most substantial compontent of LCL

Talofibular (short)
- Taut in flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List the three components of the plantar ligaments

A

Middle plantar ligament
- Base of calcaneus to 4th tarsal and to MT IV and V

Medial plantar ligament
- Sustentaculum tali to central tarsal bone and then to MT joint capsule

Lateral plantar ligament
- Leaves caudal surface of calcaneus and unites with long collateral before attaching to base of MT V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

CATS; What are the main differences in ligamentous anatomy of the tarsus?

A

Only have short collateral ligaments

MCL
- oblique tibiotalar
- straight talocentral

LCL
- Calcaneofibular
- talofibular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the main arterial and nervous supply to the tarsus?

A

Dorsal
- Cranial tibial artery (becomes dorsal pedal and dorsal MT arteries)

Plantar
- Plantar branch of saphenous artery (medial and plantar)

Nerves
- Tibial nerve (becomes medial and lateral plantar nerves)
- Common peroneal nerve
- Saphenous nerve (sensation to dorsomedial tarsus and MT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the normal standing angle of the tarsus of the dog and cat?

A

Dog: 135 - 145 deg
Cat: 115 - 125 deg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

assessing stability

A
  • joints stressed in mediolateral, dorsoplantar, and rotatory planes.

tarsocrural joint
- 39 degrees in flexion to 164 degrees in extension in the normal canine joint
- a greater range of 22 degrees (flexion) to 167 degrees (extension) is found in the cat.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

imaging

A
  • Superimposition of the tarsal bones, distal tibia, and fibula on radiographs of the tarsus can cause difficulties interpreting the full extent of tarsal fractures.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Fractures of the Talus

A

body:
- involve the proximal articular surface,The prognosis is generally guarded.
- Fractures of the articular surface: Kirschner wires, small screws that are countersunk, or bioabsorbable rods
- osteotomy of the malleolus may be required to repair fractures

neck and head
- external splint stabilization using transarticular external skeletal fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Fractures of the Calcaneus

what common in racing greyhounds?

A
  • affect the function of the common calcanean tendon apparatus
  • racing Greyhounds, the calcaneus of the right tarsus is more likely (often concurrent with central bone #)
  • Fracture of the base of the bone with avulsion of the plantar ligaments (proximal intertarsal subluxation)

imaging
- Stress views > plantar avulsion fractures.
- CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the four patterns of fracture of the calcaneus?

A

Midbody
Slab
Avulsion
Salter-Harris I

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Tx options for calcaneal #

A

Lag screws
- K-wires
- Pin and tension band (ensure don’t interfere with flexor tendons)
- Lateral bone plate
- Arthrodesis of calceneoquartal joint (avulsion fractures)

Greyhound, prognosis is good for functional return but poor for a return to racing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are they 5 types of central tarsal bone Fx?

A

Type I: Nondisplaced dorsal slab fracture
Type II: Displaced dorsal slab Fx
Type III: Large displaced medial Fx
Type IV: Medial slab fracture with dorsal slab Fx
Type V: Comminuted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Fracture of the Central Tarsal Bone

A
  • almost exclusively racing Greyhound, right tarsus
  • fatigue fractures, a type of stress fracture caused by repetitive loading
  • type V fractures may be the most common
  • type I and type II fractures, collapse does not usually occur, can be dificult to dx

Tx:
- splint before sx
- screws placed in lag fashion is the optimum treatment for types I through IV
- In type IV or V > augmented by bone plate to the medial aspect to prevent collapse

prgnosis: typically good after successful surgical intervention in all types of central tarsal bone fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What breed is predisposed to fracture dislocation of the central tarsal bone?

Tx: stabilization of the central bone to the fourth tarsal bone

A

Border Collies - Associated with a fracture of the plantar process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Luxation or Subluxation of the Tarsocrural Joint

A

usually assioated with:
(1) malleolar fracture,
(2) collateral ligament rupture, or
(3) shearing injury

  • not uncommon to find a combination of fracture and ligament disruption
  • medial ligaments are disrupted most frequently > significant subject to greater stress dt slightly valgus posture of the hock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Fractured Malleolus

A
  • pin and tension band wire repair or a small screw placed in lag fashion.
  • articular fracture
  • Fractures of the malleolus heal more readily and are associated with a better prognosis than collateral ligament ruptures.
  • 3 to 4 weeks after stabilization using a short lateral splint or transarticular external skeletal fixator.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Management of a Ruptured Ligament

A
  • Primary repair of the ligament should be attempted: locking loop pattern + internal splint bone anchors/screws with washers, at the attachment points of the ligament
  • collateral ligaments are complex > long and a short need reconstruction
  • one screw placed at the communal attachment of the collateral ligament on the distal tibia or fibula and the other two at the distal attachment points of the short and long parts
  • transosseous tunnels to allow correct placement of suture material without the use of metal implants
  • malleolar tunnel resulted in a more isometrically placed prosthesis
  • monofilament: high incidence of postoperative infection described with braided

cats
- prognosis for cats with tarsocrural luxation has traditionally been considered guarded
- novel method offer better?

Post-op
- 4 to 6 weeks after surgery is essential
- cast or TA ESF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Nicholson 2012
modified repair method

A

cats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

dog tarsocural repair
Beever 2016

A

repair of tarsocrural instability – various repair/stabilisation methods
- complications: 24/26 limbs (92.3%)
- prosthetic ligaments associated with major complications (5/8 required subsequent removal)
- ESF-associated complications common

Eight joints had internal fracture fixation and transarticular external skeletal fixator, six had external fixator alone, four had prosthetic ligaments with external fixator, and four had prosthetic ligaments with external coaptation. Two joints had pantarsal arthrodesis and two primary ligament repair

Complications are common; however many are external fixator related. Regardless of technique, a degree of ongoing lameness is likely.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Shearing Injuries

A

Injuries to the medial side predominate
- soft tissue damage is complicated by orthopedic injury, and neural and vascular loss may be extensive
- Radiography should be performed to obtain additional information about bone loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the main considerations when considering repair of shearing injuries? (4)

A
  • Contamination and possible infection
  • Loss of vital structures
  • Instability
  • Is the remaining bone sufficient to attain a function outcome?

If more than 50% of the joint is intact, saving the joint is justified

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

shearing Tx

A
  1. open wound mgmt, tarsus splinted bandage + antibiosis
  2. TA-ESF: Large proportion of cases, stability is acceptable when the fixator is removed 4 to 6 weeks later (scar tissue), in small or sedentary dogs
  3. larger or more athletic animals may require artificial ligaments
  4. pantarsal arthrodesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the reported outcome of shearing injuries of the tarsus?

A

91% good to excellent outcome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Luxation or Subluxation of the Proximal Intertarsal Joint Due to Plantar Instability

A
  • allows dorsiflexion of the calcaneoquartal and talocalcaneocentral joints;
  • subluxation develops with weight bearing
  • not trauma, the onset of the condition is often insidious, may not be painful
  • animal is plantigrade
32
Q

What breed are predisposed to nontraumatic plantar instability of the proximal intertarsal joint?

A

Middle-aged, overweight Shelties

often bilateral

33
Q

(Luxation/subluxation of PITJ
What is the recommended Tx?

A

Arthrodesis of calcaneoquartal joint
- Transfixation pin and tension band
- Single compression screw through cancaneus and into 4th tarsal bone
- Lateral plate

poor healing capacity of the plantar ligaments.

34
Q

Subluxation of the Proximal Intertarsal Joint Due to Dorsal Instability

A
  • Injury is due to damage to the short dorsal ligaments spanning the joint.
  • dorsal aspect is not the tension side of the joint, instability may be difficult to appreciate (plantar flexion)
  • external coaptation, screws and orthopedic wires, external skeletal fixation, and plate fixation with or without arthrodesis.
  • Good results are anticipated
35
Q

Tarsometatarsal Subluxation and Luxation

A
  • associated pain and discomfort
  • Fractures of the fourth tarsal bone and of metatarsal bones II and V common
  • plantar luxation
  • Dorsiflexion occurs as a result of disruption of the plantar tarsal fibrocartilage
36
Q

What are the options for arthrodesis of the T-MT joints?

A
  • IM pin and tension band
  • Cross pins +/- IM pin
  • Multiple pins from MTs into distal tarsal bones
  • Lateral plate
  • ESF (functional ankylosis)

most reliable arthrodesis = laterally applied bone plate

37
Q

What breed is overrepresented for external MT rotation?
How is it treated?

A

Bernese Mt Dog
Tx: correct rotational deformity and arthrodesis of proximal intertartsal joint

38
Q

What are the main parts of the common calcaneal tendon?

A
  • Paired tendons of the gastrocnemius
  • Common tendon of gracilis, semitendinosus and biceps femoris
  • Superficial digital flexor tendon
39
Q

Complete Disruption of the Common Calcanean Tendon

Tx considerations (3)

A
  • traumatic incident
  • ususally complete mid tear
  • hyperextension of the stifle joint and a plantigrade stance
  • Ultrasonography can be useful in identifying the site and nature of the tear.

considerations:
- Poor healing of tendon leading to lengthy convalescence
- Distraction of severed tendon ends
- Size and comparative fragility of the tendons after trauma

40
Q

Tx- complete

A
  • remove the gap by approximating the tendon ends. A locking-loop or three-loop pulley (0, 1, or 2 polydioxanone)
  • appose tendon ends 3-0 PDS
  • immobilization of the tarsus: screw, ESF, cast
  • No single method has proved superior
  • immobilization of the tarsus does not completely eliminate strain within the common calcanean tendon during ambulation > contraction of the gastrocnemius muscle continues
  • calcaneotibial screw is an easy and effective (3.2 drill, 4.5mm), removed 6-8 weeks
  • protect with cast

halstead principles for tendon

41
Q

Partial Disruption of the Common Calcanean Tendon (Avulsion of the Tendon of Insertion of the Gastrocnemius Muscle)

A
  • separation of the tendon of the gastrocnemius muscle from the calcaneus, leaving the superficial flexor tendon intact
  • lameness, and swelling may be palpable at the insertion of the tendon on the calcaneus
  • Knuckling of the digits may accompany this moderate plantigrade stance > tight pull caused by stretching of the superficial digital flexor tendon
  • cause of this condition is obscure, but it is likely a result of repetitive trauma
42
Q

What breeds are predisposed to partial rupture of the common calcaneal tendon?

A

Labradors
Doberman Pinschers
Old, female cats

43
Q

Tx - partial

A
  • surgical reattachment of the tendon to the calcaneus > using bone tunnels for suture placement
  • calcaneotibial screw fpr immobilation

chronic disruptions
- tendon must be resected and reattachment to the calcaneus is not feasible
- polyethylene terephthalate prosthesis (Sutured at myotendinous junction of gastroc and attached to calcaneus with interference screw)
- cast for 6 weeks
- 2/10 cases developed a postoperative infection
- 6/10 cases excellent

pantarsal arthrodesis

44
Q

cats

A
  • (67%) had tendino-osseous avulsions at the calcaneus
  • Complications were generally associated with the method used to maintain tarsocrural extension
  • consdier 2mm calcaneotibial screw (fracture risk)
45
Q

What is the reported outcomes of surgical repair of common calcaneal tendon repair in dogs and cats?

A

Dogs:
- Good to excellent in 72-94%
- Return to work 71%

Cats:
- 84% good outcome

46
Q

What breeds are overrepresented for luxation of the SDFT?
What dirction does it usually luxate?
how to test for it?

A

Shelties
Collies
Greyhounds
- Usually occurs in a lateral direction (disruption of the medial retaining structures)
- may luxate intermitently or be fixed laterally
- Can test by rotating metatarsus medially while flexing the tarsus

variable presentation, ranging from very mild to severe lameness.

47
Q

Tx luxation superficial digital flexor muscle

A
  • SDFT broadens to form a fibrocartilaginous cap as it passes over the tuber calcanei
  • endon relocated in a central position of the groove > surgical release (i.e., desmotomy on the side toward which the tendon luxates)
  • medial retaining tissue is repaired
  • immobilized for a minimum of 4 weeks
48
Q

Basic Principles of Surgical Arthrodesis (6)

49
Q

Arthrodesis of the Tarsocrural Joint/Pantarsal Arthrodesis

A

indications:

  • Shearing injuries with critical loss of bone
  • Instability of the joint
  • Painful osteoarthritis that cannot be managed medically, usually following osteochondritis dissecans lesions
  • Comminuted fractures of the tarsus
  • Failure of the common calcanean tendon
  • success with various tehcniques, though plate best
  • plantar placement is the most biomechanically > medial and dorsal most common
  • High levels of complications when only the tarsocrural joint is fused
  • customized plates placed medially or laterally > have biomechanical advantages over dorsal
50
Q

Describe the basic steps for a pantarsal arthrodesis

A
  • Medial malleolar osteotomy
  • Glide hole from medial tibia to medial side of tibial cochlea
  • Cartilage on tibial removed at 90 degree to long axis
  • Cartilage on talus removed at 45 degree
  • Reduced (forms 135 degree angle)
  • Holed drilled through glide hole into talus and lag screw placed
  • Plate contoured for at least 4 screws in tibia and 2-3 in MT
  • Calcaneotibial screw placed through the plate or seperately
  • Cartilage removed from remaining joints and bone graft placed
  • Dorsal or medial 3.5/2.7mm hybrid plate
51
Q

What augmentation can be adding to a pantarsal arthrodesis? (4)

A

IM pins
transarticular lag screw
calcaneotibial screw
external coaptation/ESF

  • plate dorsal aspect of the tarsus requires supplementary support during 4 to 8 weeks
  • plates are mechanically compromised, inability of the plate to resist the bending forces
52
Q

What complication can be seen with medial plating for pantarsal arthrodesis

A

Plantar necrosis with loss of soft tissue including MT pad

53
Q

What is the reported complication rate after pantarsal arthrodesis?

A

30 - 70%
High complication rate mostly from attempts to arthrodese only the tarsocrural joint

Good outcome expected in more than 50 - 70%

complcations
- failure ot fuse
- failure of implant
- infection
- Achilles tendon pain
- necrosis

54
Q

Arthrodesis of the Calcaneoquartal Joint

A
  • when the plantar ligaments are damaged, producing dorsiflexion at the level of the proximal intertarsal joints
    • lagged screw placed through the calcaneus and into the fourth tarsal bone (2/35 failures)
  • laterally placed hybrid bone plate
  • plate requires contouring vs portion of the fourth tarsal bone or head of metatarsal V or both may be removed

Outcome is expected to be good.
complications
- result of implant failure, which may be caused by technical errors, failure of arthrodesis, or inadequate protection immediately following surgery

55
Q

approach for partial arthrodesis

56
Q

Arthrodesis of the Tarsometatarsal Joints

A

cross-pins, cross-pins plus an intramedullary pin,62 external skeletal fixation,33,72 and the application of a laterally positioned plate

57
Q

The Function of the Short Medial Collateral
Ligaments of the Canine Tarsus:
A Cadaveric Study
Sandra Bogisch,

A
  • cases with an instability of
    the tarsocrural joint in flexion only
  • The two short medial collateral ligaments
    (SMCLs) run deep to the long ligament, the tibiocentral ligament,
    and the tibiotalar ligament.

Unlike the long medial collateral ligament, which stabilizes against deviation toward lateral, the SMCL stabilizes against subluxation
toward medial, with the tibiotalar ligament being the major stabilizer in flexion.

58
Q

Clinical experience and outcomes using a commercially available micro-plating system for metabone fractures in dogs and cats: 10 cases (2019-2023)
Marturello 2024

A

1.9 to 6.6 kg
locking
External coaptation was not used in any case. Radiographic follow-up documented clinical or bony union in all cases
One major complication (screw removal) and two minor complications (partial construct failure) were observed

59
Q

Outcomes of 15 dogs and two cats with metabone fractures
treated with fluoroscopically guided normograde
metabone pinning
von Pfeil

A

Retrospective case series
No major
complications occurred
requiring only short-term external coaptation in
most patients. Time to bone union and return to normal function compared
favorably to previously reported techniques

Closed reduction and stabilization were achieved in
48/57 (84%)
Median time to radiographic bone union in all FGNMP-treated metabones was 6 weeks

60
Q

Biomechanical
comparison of four prosthetic ligament repair techniques for tarsal medial collateral ligament injury in dogs
Martin

A

AN construct consisted of 3 bone anchors connected with monofilament nylon suture. The AU construct consisted of low-profile suture anchors connected with multifilament ultrahigh-molecular-weight polyethylene (UHMWPE) suture. The TN and TU constructs involved the creation of 3 bone tunnels and use of nylon or UHMWPE suture,

Relative to intact tarsal joints, joint laxity was significantly increased following completion of all 4 constructs.

Ultimate strength was greatest for the UHMWPE-suture constructs

61
Q

Risk Factors Associated with Plantar Necrosis
following Tarsal Arthrodesis in Dogs
Holroyd 2023

A
  • assess whether damage to the dorsal pedal artery during metatarsal screw placement
  • ex-vivo anatomical study: 19
    canine cadavers, (2) retrospective clinical study: 39 dogs

The intermetatarsal channel lies within the most proximal 25% of MTIII in 95% of cases.

92%of cases that had a screw placed at the level of the intermetatarsal
channel did not develop plantar necrosis

8% of these dogs went on to develop plantar necrosis.

vascular compromise
of the dorsal pedal artery/perforating metatarsal artery, and
occlusion of the collateral blood supply

  • preoperative or postoperative swelling, external coaptation or tight closure) and/or via direct interruption to the principal arterial blood supply

low incidence of plantar
necrosis is due to sustained collateral blood supply in the
majority of cases

in our study, plantar necrosis
occurred only in lateral ParTA cases, with 13% of laterally
plated cases developing plantar necrosis

all three cases
that developed plantar necrosis in this study had tensionrelieving
incisions and traumatic tarsometatarsal joint injuries.

tarsometatarsal joint region is often the tightest region to
close; therefore, swelling in this region may increase skin
tension and the risk of a

authors propose that disruption
of both the principal and collateral blood supply is required for plantar necrosis to occur.

Two cases of plantar necrosis had a modified Robert-Jones
dressing applied for 7 days, and the third case had a modified
Robert-Jones dressing applied for 6 weeks

62
Q

Pantarsal
arthrodesis stabilized with circular external skeletal fixators in 8 dogs (2010–2022)
Seger 2024

A
  • Fixator removal was performed at a mean time of 11.3 weeks
  • Complications developed in 4 dogs (50%) - 2 delayed arthodesis, 2 infection, 1 fracture
  • Six dogs had excellent outcomes.
  • requires rigorous postoperative care but obviates the need for supplemental postoperative coaptation

applied following surgical debridement and grafting of the involved articulations through limited approaches, mitigating soft tissue and vascular disruption that is described secondary to plating techniques

63
Q

Pantarsal arthrodesis in cats using orthogonal plating
Salvatierra 2018

A

seven tarsi of six cats
veterinary cuttable plates (VCPs) without postoperative external coaptation
Intraoperative complications in 2
Postoperative complications in the bilateral single-session PTA. gastrocnemius myotendinopathy (firm linear mass was palpable in the region of myotendinous region, resolved with achilles cut) protrusion of a screw head
very good outcomes in all cats (FMPI score)

64
Q

Surgical management of superficial digital flexor tendon luxation in dogs: 48 cases (2005-2020)
Goh 2022

A

retrospective
successful surgical outcome (73%) cases. Re-luxation in (15%).
(13%) had a persistent lameness
post-operative complications (71%), with the majority resolved medically.
The risk of surgical failure higher where absorbable suture material was used compared to non-absorbable suture material.
Surgical failure was more common in cases managed with non-rigid immobilisation post-operatively, howver no benefot if left on for >6wks

20/34 complications were directly related to the external coaptation

Previous studies have reported success rates of 83% and 100% following surgery

65
Q

Surgical repair for luxation of the
superficial digital flexor tendon using a
temporary restraining pin
Jury 2021

A

Twenty-three procedures were performed in 19 dogs
Minor complications (35%).
Major complications requiring unplanned surgery (13%). reluxation (9%)
All cases ultimately returned to their pre-injury level of activity
treated without using post-operative immobilisation of the tarsal joint.

The pins were well tolerated but in
many cases the pin could be felt to scrape under the skin and
caused a variable degree of soft tissue reaction which resolved
on removal

66
Q

Medial Bone Plating for Management of Type V
Central Tarsal Bone Fractures in Six Dogs
Easter 2021

A

retrospective review. 6 dogs
all had no or mild lameness and evidence of fracture healing on
radiography. A suspected surgical site infection occurred in one dog
All dogs had concurrent fractures to the
fourth tarsal bone, meatatrasal
A locking compression plate > medial application without arthrodesis (neck of talus to metatarsal II

Despite the bone plate bridging the talocentral, centrodistal
and tarsometatarsal joints, the articular cartilage was
not debrided, and a bone graft was not used.

Ankylosis is expected following immobilization of the low motion joints and is associated with good function

67
Q

Armstrong 2019 – non-racing dogs
- mostly type V with concurrent fracture
- complications 18/32 (62.1%) - 4/32 (12.5%) major – not related to method of fixation

68
Q

Isolated Articular Fractures of the Canine Talus:
Diagnosis and Signalment in Fourteen Dogs
Buj 2021

A

retrospective multicentre case series
most common fracture configuration involved the lateral trochlear ridge only
(n= 9)
orthogonal views, fracture was only visible in five cases

69
Q

Long-term outcomes after pantarsal arthrodesis with
medial plate fixation without external coaptation in 30 dogs
Simone Anes

no plantar necrosis

A

Retrospective case series
Complications occurred in 21 of 36 (58.3%)
22.2%) minor complications,
23.11 (30.6%) major II complications
and 11 (30.6%) major I complications
One (2.8%) dog required amputation
because of catastrophic complication
full function in 12 dogs and acceptable function in 14 dogs

major: SSI, metat fracture, broken screw/implant needing revision, achilles pain, 1 x fail to fuse

additional internal fixation was adopted in
most procedures reported in this case series (33/36), i.e tibiocalcaneal screw

medial plating allows “edge”
loading of the implant, and, compared to dorsal plating,
increases the dorsoplantar bending stiffness of the construct

14 procedures, the gastrocnemius and common tendons were transected according to surgeon preference

bony prominences were meticulously debrided ensure no tension
not to extend debridement and dissection dorsally
None of the dogs described in our study developed plantar necrosis.
None of our dogs had a rigid cast applied, while most of those described in the study of Roch et al had a rigid
splinted dressing or bivalve cast applied.

70
Q

Description and outcome of prosthetic ligament placement
for stabilization of medial or dorsomedial tarsometatarsal
joint luxation in dogs and cats: 16 cases (2004–2017)
Gunstra 2019

A

successfully stabilized the luxated tarsometatarsal
joint in all 16 patients. Six patients developed minor postoperative
complications, which included bandage-associated dermatitis or ulceration
(n = 5) and orthopedic wire failure (1). No major

Prosthetic ligament placement may be an alternative to
arthrodesis for tarsometatarsal joint stabilization in small patients

71
Q

Retrospective evaluation of postoperative joint immobilization using a temporary calcaneotibial screw for medial or lateral tarsocrural joint instability in dogs
Saitoh 2024

A

temporary calcaneotibial screw (CTS) to immobilize medial or lateral tarsocrural joint instability (TCI) in dogs.
CTS + external coaptation → good-excellent outcome in 12/12 dogs
- complications: 1/12 CTS breakage, 3/12 bandage-related

Retrospective study.

Animals: Twelve dogs (including five active working farm dogs)

Surgical techniques to address TCI included primary ligamentous repair, synthetic ligament reconstruction, or malleolar fracture repair. Immobilization with a CTS was employed for 6-8 weeks postoperatively.

72
Q

Loop modification of the traditional three-loop pulley pattern improves the biomechanical properties and resistance to 3-mm gap formation in a canine common calcanean teno-osseous avulsion model
Duffy 2022

AJVR

A

increasing loops for three-loop pulley → linear increase in strength of repair
- increased yield, peak, failure loads, construct stiffness and load to gap-formation for 6LP

73
Q

The 3-loop pulley pattern is more resistant to gap formation during tensile loading, and is quicker to place, than 2 locking-loop sutures. Gap formation can significantly delay tendon healing. Tendon repairs with a gap >3 mm are reported to be at increased risk of rupture during the first 6 weeks postoperatively.

2004 study

74
Q

Boero Baroncelli 2021 – use of temporary transarticular calcaneo-tibial locking plate

A

Goffart 2021 – UHMWPE suture for temporary tarsocrural stabilisation
→ stabilised joints at clinically relevant loads, stiffness not different to 4.5mm CTS
- 4.5mm CTS → higher load to failure

75
Q

Worth 2011

A

locking loop suture, cast +/- calcaneotibial screw
- 7/10 return to full/substantial work, moderate lameness in 2/7 that returned to work
- 71% good-excellent functional outcome
- complications: cast related 4/10, no screw-related complications

76
Q

Retrospective multicentre evaluation of common calcaneal tendon injuries in 66 cats. Part 2: treatment, complications and outcomes
Häußler 2023

A

CCT injury in 66 cats
- commonly closed (69.7%)
- most common Meutstege type IIc (partial avulsion) – typically subacute/chronic
- method of immobilisation → notable but not statistically significant influence on
complications
- more complications for TA-ESF vs CT-screw and coaptation
- complications: overall 41.3%, 33.3% minor – pin tract infection
- 7.9% major – ESF frame failure/breakage, SSI, re-rupture, calcaneal fracture
- outcome: 86% free of lameness long term → 84.9% success
- surgery → better outcome than conservative

77
Q

Roch 2008 – pantarsal or partial tarsal arthrodesis with medial or lateral plate

A

complications: major 32.5%, minor 42.5%
- pantarsal arthrodesis → higher major complication rate
- plantar necrosis most common (15%) - more with medial plating and only with
tarsometatarsal debridement
- suspected due to injury to the perforating metatarsal artery