Tarsal fractures: part 1
Abstract
While fractures of the tarsal bones may not be common in non-racing dog and cat populations, an awareness of these injuries and the gold-standard treatment thereof remains important. Failure to diagnose these fractures and pursue appropriate treatment can have devastating consequences for long-term limb use; racing dogs may fail to return to racing and potentially be condemned to euthanasia while non-racing dogs may go on to suffer debilitating osteoarthritis. For many tarsal fractures, surgical stabilisation is indicated and in order to plan this, an accurate diagnosis must be made. While various radiographic views may assist in achieving this diagnosis, computed tomography is more sensitive for detection and classification of tarsal fractures. Fractures of the talus are generally classified as articular fractures of the body or non-articular fractures of the head or neck. Treatment of talar fractures depends on the site of the fracture and degree of comminution, with intra-articular and certain extra-articular fractures necessitating anatomical reconstruction with a lag screw or multiple K-wires. The prognosis is variable depending on fracture type and accuracy of reduction, but following articular fracture management, most patients will suffer from clinically relevant osteoarthritis later in life.
The tarsus acts as a shock absorber and lacks support and protection from surrounding muscle, which makes it prone to injury (Jaegar and Canapp, 2008). However, with the exception of the calcaneus, tarsal fractures are not common in the pet population. Conversely, fractures of the tarsus are seen commonly in working breeds, most commonly involving the calcaneus, the central tarsal bone, the numbered tarsal bones and the talus (Dee, 2005). Many fractures of the tarsal bones are managed surgically as the gold standard of treatment, and a fundamental prerequisite to this is achieving an accurate diagnosis, which can be challenging in the absence of advanced imaging techniques. Surgery of the tarsal bones that is well planned and technically well executed is often associated with an excellent prognosis; unfortunately, surgeries that fall short of these standards may be disastrous for limb function (Dee, 2005). In this, the first part of a two part series, the surgically-relevant anatomy of the tarsus is reviewed, the diagnostic imaging techniques commonly used are evaluated and the diagnosis and treatment of talar fractures are discussed.
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