Short and long-term outcome following surgical stabilization of tarsocrural instability in dogs

Summary

Objectives: To evaluate the outcome and complications following surgical stabilization of canine tarsocrural luxations.

Methods: Medical records of dogs which were surgically treated for tarsocrural joint instability between February 2007 and June 2014 were reviewed. Surgical technique, complications and long-term outcome (via questionnaire and Canine Brief Pain Inventory) were assessed.

Results: Twenty-four dogs (26 joints) were included. All injuries were traumatic. All joints had associated fractures; malleolar in 21/26 limbs (13/26 medial). 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 occurred in 24/26 limbs giving 45 distinct complications; 16 were minor, 29 major, and 31 complications were external fixator associated. Prosthetic ligaments were significantly associated with major complications (p = 0.017); five out of eight required subsequent removal between 105–1006 days. Cost was significantly associated with major complications (p = 0.017) and soft tissue wounds (p = 0.03). Long-term lameness was seen in nine of 14 dogs. There was no association between pain severity (p = 0.3) and pain interference scores (p = 0.198) when comparing stabilization methods.

Clinical significance: Complications are common; however many are external fixator related. Prosthetic ligaments are significantly associated with major complications. Regardless of technique, a degree of ongoing lameness is likely.

Keywords

Canine - tarsocrural - tibiotarsal - talocrural - instability - luxation

• References

• 1 Piermattei DL, Flo GL, DeCamp CE. Brinker, Piermattei, and Flo's Handbook of Small Animal Orthopedics and Fracture Repair. 4th ed. Missouri: Saunders/Elsevier; 2006. pg 661-713
• 2 Diamond DW, Besso J, Boudrieau RJ. Evaluation of joint stabilization for treatment of shearing injuries of the tarsus in 20 dogs. J Am Anim Hosp Assoc 1999; 35: 147-153.
• 3 Sjöström L, H'kanson N. Traumatic injuries associated with the short lateral collateral ligaments of the talocrural joint of the dog. J Small Anim Pract 1994; 35: 163-168.
• 4 Roch SP, Clements DN, Mitchell RA. et al. Complications following tarsal arthrodesis using bone plate fixation in dogs. J Small Anim Pract 2008; 49: 117-126.
• 5 McKee WM, May C, Macias C. et al. Pantarsal arthrodesis with a customised medial or lateral bone plate in 13 dogs. Vet Rec 2004; 154: 165-170.
• 6 Earley TD, Dee JF. Trauma to the carpus, tarsus, and phalanges of dogs and cats. Vet Clin N Am Small Anim Pract 1980; 10: 717-747.
• 7 Benson JA, Boudrieau RJ. Severe carpal and tarsal shearing injuries treated with an immediate arthrodesis in seven dogs. J Am Anim Hosp Assoc 2002; 38: 370-380.
• 8 Deruddere KJ, Milne ME, Wilson KM. et al. Magnetic resonance imaging, computed tomography, and gross anatomy of the canine tarsus. Vet Surg 2014; 43: 912-919.
• 9 Gielen IM, De Rycke LM, van Bree HJ. et al. Computed tomography of the tarsal joint in clinically normal dogs. Am J Vet Res 2001; 62: 1911-1915.
• 10 Jaeger GH, Wosar MA, Marcellin-Little DJ. et al. Use of hinged transarticular external fixation and adjunctive joint stabilization in dogs and cats: 14 cases (1999-2003). J Am Vet Med Assoc 2005; 227: 586-591.
• 11 Kulendra E, Grierson J, Okushima S. et al. Evaluation of the transarticular external skeletal fixator for the treatment of tarsocrural instability in 32 cats. Vet Comp Orthop Traumatol 2011; 24: 320-325.
• 12 Aron D, Purinton P. Replacement of the collateral ligaments of the canine tarsocrural joint: a proposed technique. Vet Surg 1985; 14: 178-184.
• 13 Fox SM, Guerin SR, Burbidge HM. et al. Reconstruction of the medial collateral ligament for tarsocrural luxation in the dog: a preliminary study. J Am Anim Hosp Assoc 1997; 33: 268-274.
• 14 Dyce J, Whitelock RG, Robinson KV. et al. Arthrodesis of the tarsometatarsal joint using a laterally applied plate in 10 dogs. J Small Anim Pract 1998; 39: 19-22.
• 15 Jaeger G, Roe S. Isometry of potential suture attachment sites for the medial aspect of the tibiotarsal joint. Vet Comp Orthop Traumatol 2005; 18: 73-76.
• 16 Meeson RL, Davidson C, Arthurs I G. Soft-tissue injuries associated with cast application for distal limb orthopaedic conditions. A retrospective study of sixty dogs and cats. Vet Comp Orthop Traumatol 2011; 24: 126-131.
• 17 Baltzer W, Cooley S, Warnock J. et al. Augmentation of diaphyseal fractures of the radius and ulna in toy breed dogs using a free autogenous omental graft and bone plating. Vet Comp Orthop Traumatol 2015; 28: 131-139.
• 18 Brown DC, Boston RC, Coyne JC. et al. Development and psychometric testing of an instrument designed to measure chronic pain in dogs with osteoarthritis. Am J Vet Res 2007; 68: 631-637.
• 19 Brown DC, Boston RC, Coyne JC. et al. Ability of the canine brief pain inventory to detect response to treatment in dogs with osteoarthritis. J Am Vet Med Assoc 2008; 233: 1278-1283.
• 20 Singh R, Kamal T, Roulohamin N. et al. Ankle fractures: A literature review of current treatment methods. Open Journal of Orthopedics 2014; 4: 292-303.
• 21 Donken CC, Al-Khateeb H, Verhofstad MH. et al. Surgical versus conservative interventions for treating ankle fractures in adults. Cochrane Database Syst Rev 2012; 8: CD008470.
• 22 Herscovici D, Scaduto J, Infante A. Conservative treatment of isolated fractures of the medial malleolus. J Bone Joint Surg 2007; 89: 89-93.
• 23 Fitzpatrick N, Sajik D, Farrell M. Feline pantarsal arthrodesis using pre-contoured dorsal plates applied according to the principles of percutaneous plate arthrodesis. Vet Comp Orthop Traumatol 2013; 26: 399-407.
• 24 Nielsen C, Pluhar G. Outcome following surgical repair of achilles tendon rupture and comparison between postoperative tibiotarsal immobilization methods in dogs-28 cases (1997-2004). Vet Comp Orthop Traumatol 2006; 19: 246-249.
• 25 Halling K, Lewis D, Jones R. et al. Use of circular external skeletal fixator constructs to stabilize tarsometatarsal arthrodeses in three dogs. Vet Comp Orthop Traumatol 2004; 17: 204-209.
• 26 Nicholson I, Langley-Hobbs S, Sutcliffe M. et al. Feline talocrural luxation: A cadaveric study of repair using ligament prostheses. Vet Comp Orthop Traumatol 2012; 25: 116-125.
• 27 Nicoll C, Singh A, Weese JS. Economic impact of tibial plateau leveling osteotomy surgical site infection in dogs. Vet Surg 2014; 43: 899-902.
• 28 Beever L, Bond R, Graham PA. et al. Increasing antimicrobial resistance in clinical isolates of Staphylococcus intermedius group bacteria and emergence of MRSP in the UK. Vet Rec 2015; 176: 172-172.
• 29 Beardsley S, Schrader S. Treatment of dogs with wounds of the limbs caused by shearing forces: 98 cases (1975-1993). J Am Vet Med Assoc 1995; 207: 1071-1075.