Front Matter

Chapter 12 Disorders of the Canine Thoracic Limb: Diagnosis and Treatment 323

biological therapies, followed by a custom
orthosis and rehabilitative therapy. In cases
such as carpal hyperextension or irreparable
fractures, carpal fusion (arthrodesis) may be
needed. Depending on the area of injury either
a partial carpal arthrodesis or a pancarpal
arthrodesis (Figure 12.31) may be needed.
Pathological changes involving the middle
carpal or carpometacarpal joint, or disruption
of the palmar ligaments, can be stabilized with
a partial carpal arthrodesis. This allows for
stabilization of the joint while maintaining the
motion of the radiocarpal joint. When there is
instability of the radiocarpal joint, pancarpal
arthrodesis is usually indicated. The procedure
of arthrodesis can be performed by long‐term
stabilization with an external skeletal fixator,
plate and screws or internal pins and wire. One
author (DD) prefers to perform a minimally
invasive pancarpal arthrodesis with a pancar­
pal arthrodesis plate and fluoroscopic‐guided
assistance. Because this approach causes less
tissue trauma to the patient resulting in less
morbidity and quicker return to weight bearing.
This is completed by making three small inci­
sions: one incision at the carpus to allow removal
of the articular cartilage and placement of a bone
graft (Figure 12.32), and then two stab incisions
for placement of the plate (Figure 12.33). There

is debate regarding postoperative external

coaptation with splinting following carpal

arthrodesis; however, most surgeons still prefer

to immobilize the fixation for at least 4–8 weeks

following repair to prevent cycling

of  the  implants and premature breakdown.

Radiographs should be performed, initially

every 4 weeks, until 16 weeks after arthrodesis,

and then every 8 weeks until fusion is noted.

Typically, fusion times range from 20 to 24

weeks postoperatively; however, patients are

slowly returned to normal function beginning

16 weeks postoperatively. It is currently

unknown if implant removal is needed follow­

ing fusion in working dogs or canine athletes.

In one author’s (DD) opinion the implants can

remain unless problems occur such as implant

breakdown, pain if the carpus hits objects while

working or performing, or evidence of postop­

erative infection.

Figure 12.31 Postoperative radiograph of a pancarpal
arthrodesis for a severe radiocarpal luxation.
Figure 12.26(A) shows the preoperative image.

Figure 12.32 Image of a minimally invasive pancarpal

arthrodesis. The first small incision over the carpus has

been made, the articular cartilage has been removed and

a bone graft has been packed into the carpus to promote

fusion.