Bilateral radiocarpal bone fractures.
Gandalf is a 3 year old, male Boxer, who was seen at SCVS a couple of months ago because he had been limping on his right front limb for a few months, suddenly after heavy exercise. Other than suffering from atopic dermatitis and being on medication to control it, he had been perfectly healthy. His lameness was not getting worse but was not improving either, becoming obvious after any type of exercise, only showing mild improvement with rest and anti- inflammatories in the past.
On physical exam, he showed a clear right front limb lameness and orthopaedic exam revealed mild swelling and discomfort on manipulation of the right carpus (wrist?), with no obvious instability. No other findings were observed. The radiographs from his local vet revealed mild soft tissue swelling on the right carpal area and a possible abnormal line over one of the bones of his wrist, the radiocarpal bone. We suggested sedation to repeat radiographs and do a CT of both wrists, to check for bony abnormalities that could be not directly visible on radiographs. These tests confirm the presence of an incomplete fissure-fracture on the left radiocarpal bone (although he had no swelling or pain on his exam) and two fissure-fracture lines on the right so that the radiocarpal bone was split in three fragments.
These fissures have been well reported in dogs and Boxer seem to be predisposed to them. They are considered to be more of a malformation of the radiocarpal bone, which never forms properly as the puppy grows, as opposed to a true fracture of a previously healthy bone.. The treatment options were discussed with the owner, recommended doing surgery to repair this fracture on the right side and prophylactically securing the left radiocarpal bone with a screw, before it develops into a full fracture. Internal fixation on his right radiocarpal bone would potentially improve his function although there was a chance that it may never resolve his lameness completely and may still lead to some degenerative arthritis in the future. The owners decided to proceed with surgery on both wrists.
For this surgery, a special kind of screws were used, which have several advantages over standard screws. These Acutrak screws have been extensively used in human orthopaedic surgery but are rarely used in veterinary surgery. Briefly, these implants compress the bony fragments together better than traditional screws, thanks to their headless design and their variable pitch thread and their use for repairing these particular fractures in dogs has been reported before.
In surgery, the left wrist was approached first and a fissure was appreciated on the dorsal surface of the radiocarpal bone. A standard Acutrack was placed to secure the fissure. The right carpus was similarly approached and the T-shape fracture reduced with a small pin and then a standard size Acutrack was placed to secure his larger fragment and a second, 12 mm micro Acutrack screw was placed to repair the smaller fragment. His post-operative radiographs and CT reveal the position of these screws across the fracture lines. Gandalf recovered uneventfully following anaesthesia and was discharged the following day, with a soft bandage on his left limb and a splinted bandage in his right limb.
He has been doing well since the surgery and, although he is still healing, his lameness has largely disappeared. We are expecting Gandalf anytime now for his long-term post-operative radiographs so that, if everything looks good, we may increase his exercise gradually to normal levels, so he can enjoy the summer running around the New Forest.
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