What Is Your Diagnosis?

Alistair S. Chapnick Affiliated Veterinary Specialists, 9905 S US Hwy 17-92, Maitland, FL 32751

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 MLAS, DVM
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Jeffrey N. Peck Affiliated Veterinary Specialists, 9905 S US Hwy 17-92, Maitland, FL 32751

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 DVM, DACVS

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History

A 9-year-old male neutered Miniature Schnauzer was evaluated for a left forelimb lameness of 3 days' duration. The dog became acutely lame while running in the owner's backyard. When examined, the dog was non–weight bearing on the left forelimb. The left carpus was swollen, and signs of pain were elicited on palpation. There was decreased range of flexion and extension of the carpus, compared with clinically normal dogs of the same size, and there was slight carpal valgus. Radiographic views of the carpal area were obtained (Figure 1).

Figure 1—
Figure 1—

Lateromedial (A) and dorsopalmar (B) radiographic views of the left carpal joint of 9-year-old neutered male miniature Schnauzer evaluated for a left forelimb lameness of 3 days' duration.

Citation: Journal of the American Veterinary Medical Association 231, 4; 10.2460/javma.231.4.525

Determine whether additional imaging studies are required, or make your diagnosis from Figure 1—then turn the page

Figure 2—
Figure 2—

Postoperative lateromedial (A) and dorsopalmar (B) radiographic views of the same left carpal joint as in Figure 1. Proper surgical alignment of the radial carpal bone was confirmed.

Citation: Journal of the American Veterinary Medical Association 231, 4; 10.2460/javma.231.4.525

Radiographic Findings and Interpretation

Moderate soft tissue swelling and widening of the antebrachiocarpal joint is evident in both the lateromedial and dorsopalmar radiographic images, and the radial carpal bone is displaced proximomedially. At surgery, the radial carpal bone was reduced to its normal position, using a K-wire and augmented with a synthetic medial radial collateral ligament.

Postoperative radiography confirmed that the radial carpal bone had been replaced to its normal anatomic position and that a single transarticular K-wire had been placed from the proximomedial aspect of the radial carpal bone to the lateral aspect of the distal row of carpal bones (Figure 2).

Comments

Luxation of the radial carpal bone is an uncommon condition in dogs and cats.1 To our knowledge, there is only a single report2 of its occurrence and management in a cat. It can occur after a fall or jump and can cause substantial lameness. Swelling may be evident, and the joint is not easy to flex or extend. Radiographically, the radial carpal bone is pivoted 90° dorsopalmar and displaced medially relative to its normal anatomic position. In the dog of this report, the carpal valgus was attributed to the radial carpal bone luxation and a concurrent tear of the short radial collateral ligament and joint capsule.

There are several ligaments associated with the radial carpal bone. The short radial collateral ligament has oblique and straight portions. The straight portion originates proximal to the styloid process of the radius and extends distally to insert on the medial aspect of the radial carpal bone. The oblique portion extends from the styloid process to the palmaromedial aspect of the radial carpal bone.

Treatment options include either closed reduction or open reduction and fixation. Closed reduction along with splinting can be attempted in a small-breed dog or a cat; however, it is reportedly unlikely to achieve long-term stabilization in a larger dog.1 Open reduction and internal fixation are achieved through a dorsal approach to the carpus.

In the dog of this report, the carpal joint was immobilized with a support splint extending to the elbow joint for 6 weeks after surgery. The prognosis for return to function was good because the dog was not a working or agility dog.

  • 1

    Piermattei DL, Flo GL, DeCamp C. Luxation of radial carpal bone. In:Brinker WO, Piermattei DL, Flo GL, ed.Handbook of small animal orthopedics and fracture repair. 4th ed.St Louis: Saunders, 2006;388389.

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  • 2

    Pitcher GD. Luxation of the radial carpal bone in a cat. J Small Anim Pract 1996;37:292295.

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