Abstract

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

Highlights

  • The tarsocrural joint is formed by the tibia, fibula, talus and the calcaneus [1]

  • Prosthetic ligaments were significantly associated with major complications (p-0.017); 5/8 required subsequent removal between 105-1006 days

  • Cost was significantly associated with major complications (p-0.017) and soft tissue wounds (p-0.03)

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Summary

Introduction

Tarsocrural instability is an uncommon distal limb injury in dogs generally involving fractures of one or more of the bones contributing to the joint, varying degrees of ligament impairment, or a combination of both [1,2,3,4,5]. The tarsocrural joint is prone to fractures and shear injuries due to the paucity of soft tissue protection in this area [2, 6, 7]. Initial management of tarsocrural instability aims to limit further damage to the articular surface and supporting soft tissue structures, allowing restoration of anatomic joint alignment with stability to facilitate healing [3, 10, 11]. Management with external coaptation alone can be inconvenient, poorly tolerated and may result in coaptation driven soft tissue injuries [16]. Arthrodesis with a plate or external fixator may be used as a salvage procedure if other methods of stabilisation have failed [1, 2, 7]

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