The decision to perform PCA was made owing to a comminuted fracture of the intermedioradial carpal bone and antebrachiocarpal luxation resulting from jumping from a height (Fig. 1).
Medetomidine (0.01 mg/kg, intravenously [i.v.]) and Ketamine (1 mg/kg, i.v.) served as premedication. Methadone (0.2 mg/kg, i.v.), meloxicam (0.2 mg/kg, i.v.) and cefazolin (22 mg/kg, i.v.) were administered perioperatively.
General anesthesia was induced with propofol (2 mg/kg, i.v.) and maintained with isoflurane (1.0 mg/g); subsequently, skin preparation was conducted.
A dorsal approach to the distal radius, carpus, and metacarpus was performed 10.
A high-speed burr (Elan 4 BBraun, Aesculap, Tuttlingen, Germany) was used to remove the articular cartilage from the antebrachiocarpal, middle carpal, and carpometacarpal joints.
An autogenous cancellous bone graft was harvested from the ipsilateral proximal humerus and placed at the level of each joint.
A 3.5/2.7 mm CastLess PCA plate (CLP; Orthomed, Ltd., Halifax, West Yorkshire, UK) was applied to the bone, and all screw holes were filled. Four screws were placed in the radius; one screw, intermedioradial carpal bone; and three screws, metacarpal bones III and IV.
The surgical wound was closed in a layer. No bandages or splints were used postoperatively.
Postoperative radiographs were obtained in two planes. The position of the implant was considered good. The postoperative PCA angle was 2° (Fig. 2).
The canine patient was discharged the following day with a prescription for Meloxicam (0.1 mg/kg p.o. SID) and Gabapentin (10 mg/kg p.o. TID) to be administered for 1 week. No antibiotics were prescribed postoperatively. Cage rest was prescribed until re-check in 4 weeks.
Four weeks postoperatively, the dog was presented again for a planned re-check with mild front limb lameness (1/4°) on the operated leg. Clinical examination revealed mild swelling and pain during palpation of the distal antebrachium.
Radiographs of the affected front limb revealed a closed, diaphyseal, short oblique, nondisplaced fracture of the ipsilateral ulna at the level of the proximal end of the arthrodesis plate. Moderate periosteal reactions were detected at the ulna in the area of the fracture gap and ipsilateral radius at the same level (Fig. 3). The antibiogram for needle aspiration was negative.
The owner reported no history of trauma to the dog. Cage rest was recommended for another 4 weeks.
The canine patient showed no lameness, swelling, or pain in the affected front limb at a re-check 2 weeks postoperatively.
Radiographs at 8 weeks postoperatively showed no progressive healing of the ulnar fracture. Orthopedic examination was again unremarkable; therefore, the cage rest was set aside, and stepwise increasing exercise was allowed.
Radiography at 17 weeks showed a partially widened gap of the ulnar fracture, compatible with delayed union (Fig. 4). The owner reported no lameness and was satisfied with the outcome.
Unfortunately, no further follow-up was possible because the patient died for an unrelated reason 24 weeks postoperatively.