Ins & Outs of Tarsometatarsal Arthrodesis

Tarsometatarsal joint luxation or subluxation occurs from disruption of the dorsal or plantar ligaments, with or without involvement of the collateral ligaments. Arthrodesis, the most common recommendation for managing this condition, can be achieved by using an intramedullary Steinmann pin and 2 cross pins; pin and tension band combination; linear or circular external fixation; or lateral, medial, or plantar bone plate fixation.

Tarsometatarsal intramedullary pin stabilization was used in 12 dogs and 3 cats with tarsometatarsal instability. Arthrodesis was achieved using intramedullary pins or wires traversing the metatarsal bones through the distal tarsal bones after the articular surfaces were removed. Patients were treated with bone regeneration material in the joint space after cartilage debridement and additional stabilization provided by external coaptation. Pins were removed after radiographic evidence of arthrodesis. Of the 13 patients available for follow-up (mean, 107 weeks), 12 were apparently healthy; 1 dog walked normally but favored the leg when running. In contrast to implants, intramedullary pins required minimum tension for skin closure. Complications for tarsometatarsal arthrodesis include pin migration, implant breakage, pain, or degenerative joint disease, but these were not observed in this study.

CommentaryAlthough it is an uncommon injury, tarsometatarsal luxation can result in profound lameness. Treatment other than surgical arthrodesis is rarely successful. This report elucidated a previously unreported technique for surgical stabilization of the tarsometatarsal joint. As with any procedure to achieve tarsometatarsal arthrodesis, adherence to the other general principles of arthrodesis (removal of articular cartilage and use of bone regeneration material) as well as postoperative external coaptation to protect the internal fixation are essential.—Arthur A. Fettig, DVM, DACVS

SourceTarsometatarsal arthrodesis using tarsometatarsal intramedullary pin stabilization. Chow EP, Balfour RJ. VET SURG 41:733-737, 2012.