Tarsocrural Instability in Cats: Combined Internal Repair and Transarticular External Skeletal Fixation

Jean-Guillaume Grand,Meike Hammer,Iban Irubetagoyena

doi:10.1055/s-0040-1716350

Jean-Guillaume Grand, Meike Hammer + Show 1 more

Open Access

https://doi.org/10.1055/s-0040-1716350

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Journal: VCOT Open	Publication Date: Jul 1, 2020
Citations: 1	License type: CC BY 4.0

Affiliation: Clinique de l'Yvette

Abstract

Abstract Objective The aim of this study was to report outcomes after combined internal repair and transarticular external skeletal fixation (TESF) for the treatment of tarsocrural joint instabilities (TCI) in cats. Materials and Methods Open reduction of the tarsal joint was performed followed by combined (1) internal repair (tibial/ fibular malleolar osteosynthesis or primary ligament suture and/or prosthetic ligament repair) and (2) temporary TESF. Stability of the tarsus was determined at short-term follow-up (4–8 weeks postoperatively). Short-term complications were evaluated and midterm outcome assessed by an owner telephone questionnaire. Results Fourteen cats were included of which nine had open TCI. Median time for frame removal was 47 days. Eleven patients had satisfactory stability of the tarsus at short-term follow-up. Catastrophic complications occurred in three cats consisting of extensive skin necrosis of the paw with subsequent hindlimb amputation in two and multiple digit amputations in one cat. Major complications occurred in one cat with persistent TCI requiring pantarsal arthrodesis. Nine cat owners indicated a ‘full or acceptable’ outcome at midterm (median, 1.5 years). Conclusion Close monitoring in the postoperative period until TESF removal is important for early identification of complications. Despite good joint stability at short-term, persistent or recurrent lameness at midterm can occur.

Highlights

Major complications occurred in one cat with persistent Tarsocrural joint instabilities (TCI) requiring pantarsal arthrodesis
Close monitoring in the postoperative period until transarticular external skeletal fixation (TESF) removal is important for early identification of complications
The remaining seven cases were due to domestic accident (n 1⁄4 3), unknown trauma (n 1⁄4 2), dog bite (n 1⁄4 1) and fall (n 1⁄4 1)

Summary

Introduction

Tarsocrural joint instabilities (TCI) involve malleolar fractures, collateral ligament ruptures and shearing injuries.[1,2,3] Reconstruction of the articular surface, restoration of anatomic joint alignment and joint stabilization are paramount to optimize outcome and limit the development of osteoarthritis.[4]Reduction of malleolar fractures is typically achieved by open reduction and internal fixation (ORIF) using pins and a tension band wire or a small lag screw.[4,5] Treatment modalities for collateral ligament ruptures include open reduction and internal stabilization using primary ligament suture and/or prosthetic ligament reconstruction, external coaptation, transarticular external skeletal fixation (TESF) or a combination of these.[1,2,3,6,7,8]Primary ligament suture should be attempted whenever possible.[9]. Tarsocrural joint instabilities (TCI) involve malleolar fractures, collateral ligament ruptures and shearing injuries.[1,2,3] Reconstruction of the articular surface, restoration of anatomic joint alignment and joint stabilization are paramount to optimize outcome and limit the development of osteoarthritis.[4]. Reduction of malleolar fractures is typically achieved by open reduction and internal fixation (ORIF) using pins and a tension band wire or a small lag screw.[4,5] Treatment modalities for collateral ligament ruptures include open reduction and internal stabilization using primary ligament suture and/or prosthetic ligament reconstruction, external coaptation, transarticular external skeletal fixation (TESF) or a combination of these.[1,2,3,6,7,8]. Correct implant placement is received January 15, 2020 accepted after revision July 20, 2020

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