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Tarsal fractures: part 2

02 April 2020
Clinical
20 mins read
02 April 2020
Volume 25 · Issue 3
Figure 1. Mediolateral and plantarodorsal views of the tarsus of a 5-year old Labrador Retriever that presented after a road traffic accident non-weight bearing on the hind limb. The calcaneal tuber is fractured transversely at its base with moderate proximal and plantar displacement. Many pinpoint bone fragments are present at the fracture site dorsally. There is mild swelling of the plantar tarsal region.
Figure 1. Mediolateral and plantarodorsal views of the tarsus of a 5-year old Labrador Retriever that presented after a road traffic accident non-weight bearing on the hind limb. The calcaneal tuber is fractured transversely at its base with moderate proximal and plantar displacement. Many pinpoint bone fragments are present at the fracture site dorsally. There is mild swelling of the plantar tarsal region.

Abstract

Both calcaneal and central tarsal bone fractures are commonly encountered in the racing greyhound. While isolated fractures of the numbered tarsal bones are uncommon, malleolar fractures are encountered frequently in small animal practice. Fractures of the central tarsal bone or calcaneal fractures in both dogs and cats may be either fatigue or stress fractures, or associated with Knees and Teeth Syndrome, which may alter the typically expected presentation and prompt assessment for additional fractures, both in the tarsus and elsewhere. Surgical stabilisation is often the treatment of choice, particularly for fractures with an articular component. In many cases, surgical stabilisation leads to a positive outcome, with Greyhounds often being able to return to racing. However, it is important to be aware that fractures in non-racing dogs tend to be more complex and that this good prognosis may not be appropriate to extrapolate. Depending on the nature and severity of injuries, joint preservation may not always be a realistic goal. If the joint cannot be preserved, arthrodesis may become necessary.

In the first article of this two-part series discussing tarsal fractures (Perry, 2020), the surgically-relevant anatomy of the tarsus was reviewed, the diagnostic imaging techniques commonly used were evaluated and the diagnosis and treatment of talar fractures was discussed. This article concentrates on the diagnosis and treatment of calcaneal fractures; central tarsal bone fractures; isolated fractures of the numbered tarsal bones; and malleolar fractures.

The calcaneus is the largest and longest bone of the tarsus (Evans, 1993). The distal half of the bone is wide transversely and possesses three facets and two processes whereby it is fitted with the talus to form a very stable joint. The tuber calcanei serves for the insertion of the calcanean tendon. Its slightly bulbous free end contains the medial and lateral processes which are separated by a wide groove. A jutting shelf, the sustentaculum tali, leaves the medial side of the bone. On the plantar side of this process is a wide shallow groove over which the tendon of the flexor hallucis longus glides. On the dorsomedial side is a concave oval facet, the facies articularis talus media, for articulation with the middle articular surface of the talus. The dorsal articular surface, facies articularis talaris dorsalis, is convex, as it articulates with the comparable concave surface of the talus. The most distal and smallest articular surface on the dorsal part of the bone is the facies articularis talaris distalis. This surface is confluent with a small articular facet for the central tarsal on the distal surface. Between the middle and distal articular surfaces is the calcanean sulcus. This sulcus concurs with a similar one on the talus to form the tarsal sinus. On the distal end of the calcaneus is a large flat facies articularis cuboidea, for articulation mainly with the central tarsal bone and by a small facet with the talus (Evans, 1993).

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cat
calcaneal fracture
central tarsal bone fracture
dog
fracture
tarsus