TARSOCRURAL LUXATION - Love My Pet

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stressing the joint, in both flexion and extension since it is necessary to establish whether one orboth components of each collateral ligament is/are injured.Radiography may be helpful in showing the presence of avulsion fractures and joint spacewidening due to instability, which might require stressed views to become apparent. It may alsoshow the extent of bone loss in "shearing" injuries, although this is usually known after clinicalexamination.TreatmentNon-surgical management is indicated in cases with only partial rupture of a collateral ligamentor an avulsion fracture of a malleolus, which is amenable to closed reduction. The application ofa cast for 6 to 8 weeks may allow satisfactory healing and a return to normal function.Surgical management is indicated in the following situations :-(a) Where avulsion fractures of the medial and/or lateral malleoli are responsible for theinstability and the fragment is considered large enough to accomodate implants. Surgicalmanagement may involve re-attachment of the fragment using a lagged bonescrew or pin and tension band wire.(b) If the injury involves complete rupture of the collateral ligament, and itis treated early, it may be possible to suture the two ends together using anappropriate material such as monofilament nylon or polydioxanone (PDS,Eticon Ltd.). Injuries to the local tendons should also be evaluated andsutured appropriately. Postoperatively, a cast should be applied to the hockfor 6 to 8 weeks.Tarsocrural Luxation - 2
(c) If the instability is marked and/or conservative management has failed then it may not bepossible to reconstruct the ligaments due to thedegree of tearing or fibrosis. In such cases it may benecessary to place prosthetic collateral ligaments ofmonofilament nylon, braided polyester (Ethibond,Ethicon Ltd.) or wire. Many techniques have beendescribed to achieve this (Holt, 1976; Holt, 1977),whereby bone tunnels or bone screws have beenused to anchor the prosthesis in place. The earliermethods described did not really take into accountthe collateral ligaments having two components andthus may not have been able to stabilise the joint inboth flexion and extension. A more recentlydeveloped method (Aron & Purinton, 1985)addresses this problem and is probably the best oneto use, particularly in patients that are large enoughto allow placement of the bone screws. On themedial side, a screw is placed in the medialmalleolus and then two are placed in the talus, one proximally and one distally, thus allowingplacement of a long and a short collateral ligament. The technique is the same on the lateralaspect except that the screws are placed into the lateral malleolus and calcaneus in a similarfashion. Whichever method is used, the hock should be supported with a cast for 4 to 8 weekspostoperatively.Such injuries in cats can prove problematic to treat because placement of implants to supportcollateral prostheses is difficult (due to size) and maintaining external coaptation can also befrustrating. The use of a transarticular pin may be considered whilst soft tissue healing takesplace. Such a pin is placed from the proximal tibia and across the joint with the latter held inreduction and at a functional angle.Tarsocrural Luxation - 3
Page 1: TARSOCRURAL LUXATIONSteven J Butter
Page 5 and 6: pin, placed through the talus and u
Page 7: STOLL, S.G., SINIBALDI, K.R., DeANG

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