What are Pancarpal Arthrodesis?
The fusion of low motion joints in the carpal joints of your dog is referred to as pancarpal arthrodesis. These joints are low motion joints, that do not require articulation to allow reasonable gait and movement in your dog. When disease or injury occurs to the carpal joints that can not be repaired or resolved by other medical methods, surgical arthrodesis with the application of surgical plates and bony fusion of the joint surfaces can be achieved with pancarpal arthrodesis in your dog. By fusing the joint, pain-free movement can be achieved for your dog. Treating injury or osteoarthritis of the low motion carpal joints is achieved in the antebrachial, middle carpal and carpometacarpal joints by encouraging bone growth and fusion to occur on the joint surfaces while stabilizing them with surgical plates. This procedure is performed under general anesthetic by your veterinarian.
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Pancarpal Arthrodesis Procedure in Dogs
Fixation of surgical plates may be external or internal to the joint, depending on the type of damage or disease, and what method will be most effective. A variety of different size plates are available and the correct size needs to be selected in order for fixation to be successful. Radiographs taken prior to surgery will be used to plan the surgical procedure and address approach and appropriate plates to be used.
Prior to surgery you will be required to fast your dog so as not to cause complications with the administration of general anesthetic. Your dog will be sedated, given intravenous anesthetic and then intubated and anesthesia maintained by gas. The area to be incised on the forelimb dorsal to the carpal joints is shaved and antiseptically cleaned prior to incision. Surgical drapes are used to maintain a sterile surgical site. A dorsal incision is made distal to the antebrachium and extending to the distal metacarpi. Subcutaneous tissue is incised and blood vessels are moved aside. Muscles are manipulated aside to reach the intercarpal and carpometacarpal joints Joint capsules of the radiocarpal, middle carpal and carpometacarpal joints are severed and articular cartilage destroyed and removed with use of a surgical drill or other surgical instruments. Forage may be created by drilling holes in the subchondral bones to provide vascular access to the newly forming, fusing bone. Cancellous bone grafts taken from another part of the body, usually the humerus of the same leg, are inserted into the joint spaces. The forelimb is positioned into a normal standing angle prior to insertion of surgical plates. A curved compression plate is affixed with surgical screws to the radius, radial carpal bone, and metacarpal bones. Tissues are sutured and the leg is supported with a splint bandage. Your dog will be allowed to recover from anesthetic in the veterinary hospital. Your dog may be hospitalized for 24 to 48 hours if medical conditions warrant this or may be released the same day.
Efficacy of Pancarpal Arthrodesis in Dogs
Pancarpal joint fusion relieves pain and discomfort in the affected limb and allows adequate movement and functioning for your dog to resume normal activities such as running, jumping and playing. Overactivity should be discouraged during recovery for best results. If plates are not adequately sized, or articular cartilage is not adequately removed, failure of the fusion can occur and instability results.
Pancarpal Arthrodesis Recovery in Dogs
An aluminum bandage splint is usually placed for three to four weeks to provide stabilization and protect joint and incision. The bandage will need to be maintained as directed by your veterinarian. Bandages are usually changed weekly, and the surgical incision should be checked more frequently to ensure infection or wound dehiscence has not occurred. Bandaging should stay clean and dry. You will need to check for cast and bandage sores and to ensure circulation is adequate. Sutures will be removed in 10 to 14 days by your veterinarian. Analgesics will be prescribed post-surgery and antibiotics and anti inflammatories if deemed necessary. Activity should be restricted to limited walks on a leash. Arthrodesis will be confirmed by follow-up radiograph at four and eight weeks post-surgery by your veterinarian. An e-collar may be used to prevent your dog interfering with the bandage or surgical wound. Partial weight bearing on the limb usually resumes in one to two weeks, with full weight bearing at two to four months.
Cost of Pancarpal Arthrodesis in Dogs
The cost of pancarpal arthrodesis in dogs varies depending on the cost of living in your area. Pricing will be reflective of radiographs, anesthetic, procedure, and medications required during recovery. The price of this procedure can range from $1,000 to $5,000. Specialized surgical plates and customization may also contribute to variations in cost.
Dog Pancarpal Arthrodesis Considerations
Arthrodesis procedures can be prone to complications such as septicemia in the joints, or failure of plates. Proper treatment with antibiotics, careful surgical procedures, and careful fitting and customization of surgical plates can prevent these complications from occurring. Other limbs and joints need to compensate until healing occurs, and this puts added strain on them. If disease or disorder is present in other limbs this will create issues and arthrodesis of joints may not be appropriate. Plates may need to be removed after healing occurs if complications occur such as cold sensitivity, infection, irritation, or strain from plate placement.
Pancarpal Arthrodesis Prevention in Dogs
Carpal injuries from hyperextensions during activity or accidents such as falls or motor vehicle accidents are common in dogs. Ensuring your dog’s environment is safe from hazards and that they are not left unsupervised or loose outside will greatly reduce the likelihood they will be involved in household accidents, motor vehicle accidents, or fights with other animals, resulting in injury to the carpal joints. In addition, early intervention when osteoarthritis presents may allow other options for treatment that may prevent surgical intervention being necessary.
Pancarpal Arthrodesis Questions and Advice from Veterinary Professionals
My dog over extended her wrist joint and no cannot bear weight on it. Our local vet refused to put a splint on her. Should I be insisting a splint be put on or should I be looking into arthrodesis surgery?
In some mild cases of hyperextension, rest really works wonders and your Veterinarian may be taking a wait and see approach. Depending on the severity management techniques like splinting may be unrewarding; without examining Reese I cannot give an opinion for a treatment plan, but if there is a severe injury which wouldn’t respond to management (rest, splinting etc…) then arthrodesis surgery or another surgery may be a way forward. If you have concerns, getting a second opinion wouldn’t hurt and may give you more information. Regards Dr Callum Turner DVM
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