Metatarsal Fracture Repair
Alice the whippet was referred to YourVets in Smethwick after she sustained a fracture to two of her metatarsal bones by twisting her leg while jumping. The metatarsal bones are long, thin bones found between the hock joint and foot in the back leg. They can be a challenge to repair because they are very fine and delicate, so attempting to fix them with a plate and screws can cause more trauma, but putting weight through the leg can cause fracture fragments to move around, so it is essential to hold the broken edges of bone still to allow them to heal.
Figure 1: Alice the Whippet
Alice’s metatarsals were broken very close to the end of the bone. This meant they could be repaired using a technique called ‘dowel’ pinning, in which a wire with blunt ends is introduced through the fracture into the long bone fragment, pushed all the way in, then the short bone fragment distracted from the fracture site and advanced along the pin, like putting the lid on a pen. The advantage of this technique is that it reduces the fractured bone to completely straight alignment and there is no need to put any implants through the wall of the bone, where they might cause other fractures or irritate the local skin and soft tissues. The disadvantage is that wire fine enough to fit into the central canal of the narrow bones easily bends when weight is applied to the leg, so Alice also had to wear a cast for 6 weeks to provide extra support to the repair.
Figure 2: Alice’s fracture, before (top image) and after (bottom image) repair by ‘dowel’ pinning
Putting a patient in a cast or bandage does carry some risks, so owners must pay very close attention to their pets while one is in position. The skin around the metatarsals and thin, and there is no fat in the area, so if the cast doesn’t quite fit right there is a risk it could rub right through the skin and damage the tendons beneath which could cause permanent disability. The cast is padded to help prevent this, but the padding can tend to hold water if it gets wet, which could let bacteria breed causing a nasty infection, or damage the skin. If the cast is too loose there is more risk of rubbing, but if it is too tight it can compromise the blood supply to the foot. Alice’s owners did an excellent job of monitoring her cast to check it remained in position and was kept clean and dry, and Alice came to YourVets for weekly check-ups to change the bandage padding and check all was well under the cast.
Figure 3: Alice performing some physiotherapy at home with her owner
After 6 weeks, Alice’s bones had healed brilliantly and so the cast was removed. She went on to make a full recovery.
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