Pantarsal arthrodesis with a customized titanium medial plate in a dog

Abstract

Background: Tibiotarsal joint luxations are mostly traumatic and due to automobile accidents. The arthrodesis of this joint is considered the fnal solution for trauma with ligament lesions without repair, luxations without possibility of joint recovery and chronic joint diseases. The direction to which the joint is dislocated is associated with the forces of trauma, and bilateral ligament injuries are not uncommon. However, the medial ligaments are more frequently injured. The aim of this study is to describe the performance of pantarsal arthrodesis using a customized titanium plate for application to the medial surface of the joint. Case:An undefned breed dog, weighing 21.5 kg, was attended at the Veterinary Hospital of the Federal University of Lavras (UFLA) with history of trauma and injury in the right pelvic limb. After physical and radiographic examinations it was diagnosed with an exposed luxation of the tibiotarsal joint and tissue loss in the region. The tibiotarsal region was cleaned and a bandage was made daily until the frst surgical procedure, which occurred fve days later. Initially, it was treated without success with the use of a transarticular external fxator1. Subsequently, pantarsal arthrodesis was performed using a customized titanium angled plate (Made by a private manufacturer based on the functional angulation of the tibiotarsal joint of the contralateral limb). The joint was accessed for exposure of the distal portion of the tibia, tarsal and metatarsals bones. Wear of the articular surfaces was performed and then the customized angulation plate for pantarsal arthrodesis was placed on the medial side of the joint. Bicortical drillings were performed, starting with the proximal orifce. According to the holes of the plate, fve 3.5 mm diameter screws1 (four at the distal tibia and one at the tarsus) and four 2.7 mm diameter screws were used in the metatarsal bones. Two isolated 3.5 mm diameter screws were also used, one inserted through the tibiotarsal joint and another connecting the calcaneus to the distal tibia. Muscle fascia, subcutaneous tissue and skin sutures were performed in a conventional manner. In the postoperative period, surgical wound cleaning and partial activities restrictions were recommended for 30 days. After 10 and 45 days of the surgical procedure, the animal appeared for clinical and orthopedic reassessment. The patient showed functional support of the limb and the radiographic exams revealed a proliferative bone reaction in the interarticular regions. Discussion: The present report describes the use of a specifc type of plate for pantarsal arthrodesis that has gained prominence in international veterinary orthopedics and is increasingly being used. In Brazil, the angled plate for medial application still has limited manufacturing, and its importation entails high costs and delay in delivery, which makes diffcult its use depending on the fnancial conditions of the owner and the possibility of waiting to perform the procedure. In the present report, 10 days after the surgical intervention, the animal already had partial support of the injured limb and surgical wound with good healing. In the orthopedic examination at 45 postoperative days, the animal showed satisfactory support and functional use of the member submitted to arthrodesis. It was concluded that the personalized plate for pantarsal arthrodesis proved to be a satisfactory method, which promoted adequate interarticular stability and favored bone proliferation and fusion. Keywords: dislocation, tibiotarsal joint, traction injury