Fractures of the metabones and phalanges in dogs and cats

Abstract

Metabone and phalangeal fractures are common in dogs and cats and are most often caused by external trauma, although stress fractures frequently occur in racing Greyhounds. Fractures of the metabones and phalanges are commonly open, due to the paucity of overlying soft tissue. The diagnosis can usually be made based on a thorough orthopaedic examination and radiography of the affected area, often including oblique and traction views. Although controversial, general indications for surgery include fractures of both the third and fourth metabones, and basilar, articular, distal diaphyseal and open fractures of any of the metabones. Surgical management is also recommended for unstable fractures of the phalanges or fractures of the head or base, as long as the fragment size is sufficiently large for implant purchase. For fractures of either the metabones or phalanges, surgical treatment is generally recommended for sporting and racing dogs, in order to facilitate a full return to function. Treatment options include external coaptation; intramedullary pinning; tension band, cerclage or interfragmentary wiring; lag screws; bone plates; and external skeletal fixation. Prospective randomised controlled studies comparing treatment options for metabone and phalangeal fractures are required before recommendations regarding the optimum treatment modality can be made.