Front Matter

Chapter 12 Disorders of the Canine Thoracic Limb: Diagnosis and Treatment 327

luxation is not seen, a penetrating foreign body
or ligamentous injury should be considered.
Diagnostic musculoskeletal ultrasound can be
used to determine the presence and severity
(grade 1–3) of a ligamentous injury.

Treatment

Treatment of digit fractures is commonly con­
servative, using a splint and bandage for 6–8
weeks. For external coaptation alone to be suc­
cessful, the fracture must be stabilized a joint
above and a joint below the fracture. It can be
challenging to fully immobilize digit fractures,
resulting in micro‐motion, which may delay
healing. Radiographs should be taken every 4
weeks to ensure appropriate healing. Fractures
that fail to heal with conservative management,
as well as those in large patients, in those with
multiple digit fractures, or in canine athletes
and working dogs may benefit from surgical
fixation (Figure 12.38). Following surgical fixa­
tion, external coaptation with a splint is recom­
mended to protect the repair. In patients with
failed conservative or surgical treatment or for
fractures of digit P3, digit amputation can be
considered.
Ligamentous injuries to the digits are com­
mon in working and sporting dogs. The diag­
nosis can be suspected if other orthopedic

conditions have been ruled out. The authors

prefer to confirm the diagnosis with diagnos­

tic musculoskeletal ultrasound. Treatment of

ligamentous injuries is typically conservative

in nature with rest, analgesics, and external

coaptation with a splint. Unfortunately, liga­

mentous injuries tend to heal poorly and

require a significant amount of time to form

appropriate fibrous tissue (approximately

2–4 months). To mitigate the morbidity asso­

ciated with external coaptation and splints, a

novel digital wrap can be used (Figure 12.39).

The wrap consists of two to three layers of an

elastic, nonstick wrap such as Vet‐Wrap®. It

is placed with enough tension to restrict lat­

eral toe movement, but not so tight as to

cause abrasions or swelling. In most cases the

wrap is placed on both feet so that the dog

does not focus on the injured limb and chew

at the bandage (an E‐collar may be needed in

some patients). In cases where healing is not

progressing as expected or the tissues fail to

heal, ultrasound‐guided or fluoroscope‐

guided injections of biological therapies or

steroids can be used to aid in providing com­

fort and facilitate tissue healing.

Figure 12.38 Postoperative radiograph of the same
patient from Figure 12.37. The fracture was stabilized
with a 1.0 mm lag screw and two cerclage wires. Figure 12.39^ Image of a digital wrap to prevent
additional damage and allow healing following a grade 2
digital collateral ligament injury. Note that the wrap is
placed on both front feet although the injury was
localized to the right thoracic limb. Source: Image
courtesy of Dr. Deb Canapp.