Front Matter

Chapter 12 Disorders of the Canine Thoracic Limb: Diagnosis and Treatment 325

chronic cases soft tissue calcification (Cake &
Read, 1995).

Treatment

Specific treatment options for metacarpal frac­
tures are based more on clinical intuition than on
concrete data because of the paucity in the scien­
tific literature. Current guidelines have been
adopted from human literature on metatarsal
fractures. Surgical management is recommended
if two or more metacarpal fractures are present
in the same manus, if the fractures involve both
of the primary weight‐bearing bones (metacar­
pals III and IV), if the fractures are articular, if the
fracture fragments are displaced more than 50%,
if the fracture involves the base of metacarpal II
or V, and/or if the  patient is a large breed, ath­
letic, working, or show dog (Wernham & Roush
2010). Conservative treatment consists of a splint
and bandage using a modified Robert Jones
bandage. Attempts to improve alignment and
apposition of the fractures should be made prior
to external coaptation. Radiographs should be
taken every 4 weeks until clinical union; if there
is evidence of delayed union, malunion, or non­
union, then surgical fixation may need to be
performed.

Surgical fixation of metacarpal fractures is

largely similar to any other bony fixation. For

avulsion fractures of the base of metacarpals II

and V, lag screw fixation with an antirotational

pin or a tension band fixation can be used. It is

important to surgically stabilize these fractures

as they serve as an insertion site of collateral

ligaments and failure to repair can result in

varus or valgus malunions. Diaphyseal frac­

tures can be stabilized with intramedullary

Kirschner wires or plate fixation (Figure 12.36).

One author (DD) prefers to use 1.1 mm plates or

1.5 mm locking plates for metacarpal fractures.

To date there is only one study comparing long‐

term outcome for the treatment of sesamoid

disease (Mathews et al., 2001). The most com­

monly affected breed in that study was the

Rottweiler,  followed by the Labrador Retriever

and Australian Cattle Dog. A better clinical

outcome with significantly fewer degenera­

tive changes was found in those patients that

were  treated conservatively versus surgically

(Mathews et al., 2001). Conservative management

consists of exercise restriction for 6–8 weeks along

with analgesics as needed. A splint or bandage

could be applied but the efficacy of external

coaptation is unknown. Surgery is limited to

removal of the fragment or the entire sesamoid.

Figure 12.35 Radiograph of a 1‐year‐old Dalmatian

with evidence of a sesamoid fracture (arrow). If needed,

oblique views can be obtained to further identify

sesamoid fracture(s)/fragmentation. Source: Image

courtesy of Dr. Aldo Vezzoni.

Figure 12.34 Radiograph of a dog with a proximal
diaphyseal long oblique fracture of metacarpal V. The
patient also sustained fractures of carpal bone II and digit
I, and a carpometacarpal luxation at metacarpals II–IV.
Source: Image courtesy of Dr. Justin Harper.