Introduction: An 8 1/2yo M Kelpie was referred with progressive LHS palmigrade carpal collapse. An avid ball chaser, we initially managed him conservatively for 6 months with rest and ice packing. He continued to deteriorate and we subsequently recommended LHS panarthrodesis. After successful recovery he re-presented two years later with similar clinical signs in the RHS forelimb.
Examination: General examination was unremarkable. The patient was NWB in the LHS forelimb. The rest of the limb wa sunremarkable. The LHS carpus was swollen, painful and unstable in hyperextension. Marked effusion was noted in the radiocarpal/intercarpal region.
Operative Management: The patient was premedicated with acepromazine and methadone before being induced for anaesthesia with propofol and maintained on isoflurane. Intraoperative patient monitoring included SpO2, ETCO2,BP Temp, HR. He was placed on IV fluids and administered cefazolin.
A offset curvilinear dorsal incision to the carpus was made. Periosteal elevation of the distal radius and central metacarpal was performed.
Strict vascular preservation was employed and the joint capsule resected with a number 11 blade from three levels. We used a Stryker high speed neurosurgical bur to removal all the cartilage from the carpometacarpal, middle and radiocarpal joints. A cancellous bone graft was harvested rom the ipsilateral proximal humerus and packed directly into the joint spaces. We used Hyprotect implants to double plate the carpus with active compression.
Careful lavage and suction was used before routine closure. No releasing incisions were employed. The RHS was arthrodesed two years later.
Diagnostic Imaging: Plain radiographs confirmed carpal trauma and carpal hyperextension injury. Subjacent joint swelling and thickening were present.
Client Discussion: We discussed carpal arthrodesis and complications such as cryptic plate infection, screw loosening and breakage, plate failure, wound swelling and metacarpal fracture. Fusion of joints is a slow process and requires a gentle recovery balancing initial extended confinement with progressive loading and exercise.
Outcome: The patient was discharged in a modified Robert Jones bandage for 2 weeks. We elected not to use ½.
Discussion: Pancarpal arthrodesis can result in very good outcomes for dogs and cats but is only applied when conservative options are exhausted. Some dogs can have surprisingly good outcomes with extended careful ice packing for 6 weeks.
The major risk with the surgery is transloca tion of natural skin bacteria through the wound in the first 3-4weeks causing a cryptic plate infection. Whilst plates can be removed after 12 months in certain cases, this can be risky in others.
Particular attention to asepsis and hound are needed throughout the process. We use perioperative antibiosis, iodine impregnated “second skin” Ioban, meticulous soft tissue handling and use of newer implants and suture. We use the Hyprotect silver ion formula coated implants and antibiotic eluting sutures.
Silver ion impregnated nano particles on biomaterials disrupt the bacterial cell wall and cytoplasmic membrane. They denature ribosomes and inhibit protein synthesis.
We have trialed a range of pancarpal techniques over the years including plating dorsally and medially as well as the newer split/offset angled distal screws but have found plate cyclic failure and breakage an issue.
