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com

Companion Animals

Management and treatment

of feline tarsal injuries
Elvin Kulendra, Gareth Arthurs

Feline tarsal injuries are common, particularly in male cats, and can result from dog
bites, road traffic accidents or falls from heights. Complete physical and orthopaedic
examinations are required to reliably identify all injuries in these cases, but life-
threatening injuries must take precedence over orthopaedic trauma. This article
Elvin Kulendra qualified discusses the management and treatment of injuries to the feline tarsus.
from the Royal Veterinary
College (RVC) in 2006. He
completed an internship
in small animal medicine
and surgery at the RVC Anatomy Patient evaluation
before working in practice
The feline tarsus is a complex structure that consists of the Tarsal injuries can result from dog bites, road traffic
for a year. In 2008 he
tibia, fibula and seven tarsal and four metatarsal bones, accidents or falls from heights. Tarsal injuries in male
returned to the RVC to
along with the ligaments and fibrocartilage that keep these cats are overrepresented compared to female cats;
complete a residency in
bones together and aligned correctly (Fig 1). The five main tomcats have a wide home range and roam in search of
small animal surgery. He
articulations of the feline tarsus are the tarsocrural joint oestrus females (Owen 2000, Rochlitz 2003). Complete
holds the RCVS certificate
(between the tibia/fibula and talus), the talocentral joint physical and orthopaedic examinations are mandatory
in veterinary diagnostic (between the distal talus and the central tarsal bone), the to reliably identify all injuries in these cases, but the
imaging, is a diplomate of calcaneoquartal joint (between the distal calcaneus and recognition and management of all life-threatening
the European College of the fourth tarsal bone), the centrodistal joint (between injuries must take precedence over orthopaedic trauma.
Veterinary Surgeons and the central tarsal bone and tarsal bones 1 to 3) and the Common thoracic injuries include pulmonary contusions,
a European specialist in tarsometatarsal joint (between the metatarsus and tarsal diaphragmatic rupture, pneumothorax and haemothorax
small animal surgery. bones 1 to 4) (Fig 2). The joints between adjacent tarsal (Fig 5). The extent of pulmonary contusions may not
bones are known as the intertarsal joints. The tarsocrural manifest radiographically until 24 to 48 hours following
joint is the high motion joint of the hock that accounts for trauma.
the majority of hock extension and flexion; the remaining
joints are low motion joints with only minimal extension and
flexion (Voss and others 2009).
Wound management, including shear
injury
Numerous short ligaments span the small bones of the The feline tarsus is prone to severe shear injuries and
tarsus. The distal tibia and fibula are connected to each fractures, due to the paucity of soft tissue protection
other by the tibiofibular ligament. The distal aspect of the in this area (Earley and Dee 1980). Following patient
fibula is known as the lateral malleolus, and the distomedial stabilisation, basic first aid treatment is applied to
aspect of the tibia is known as the medial malleolus. distal limb wounds, including shear injuries. The patient
is made comfortable using appropriate analgesia,
The medial and lateral malleoli appose the trochlea of the including opioid and/or non-steroidal anti-inflammatory
talus and contribute to the tarsocrural joint. The malleoli drugs (NSAID), sedation or a general anaesthetic as
Gareth Arthurs qualified extend distally beyond the surface of the trochlea of the appropriate, depending on the status at presentation.
from the University talus and prevent lateral and medial translation of the talus Sterile gel is applied directly to the wound and the
of Cambridge in 1996. relative to the tibia and fibula. The malleoli are the point of surrounding area is clipped generously. The wound
He has been an RCVS origin of the medial and lateral collateral ligaments. Unlike itself should be flushed with isotonic fluid, such as 0.9
diplomate and recognised dogs, cats do not have long collateral ligaments, only per cent saline or compound sodium lactate solution.
specialist in small animal short ones, and the medial and lateral (short) collateral This can be achieved using a 20 ml syringe, three way
surgery (orthopaedics) ligaments consist of straight and oblique branches. The tap and 18 gauge needle (Anderson 2009). Following
since 2007. He currently oblique branch of the medial collateral ligament is known wound flushing, a bacteriology swab should be taken and
as the tibiotalar portion and is partially hidden deep to treatment with a broad-spectrum bactericidal antibiotic
divides his time between
the medial malleolus. The straight branch of the medial such as amoxicillin and clavulanic acid can be started,
private practice,
collateral ligament is the tibiocentral ligament and inserts pending culture results. The wound can then be dressed
Cambridge veterinary
on the dorsomedial process of the central tarsal bone (Fig or the injuries stabilised and treated as appropriate.
school and Veterinary
3). Substantial costs may be involved during hospitalisation
Instrumentation.
and management of wounds associated with shearing
The lateral collateral ligament has an oblique talofibular injuries (Kulendra and others 2011). For large lesions,
ligament, the origin of which is deep to the lateral free skin grafts can be used to prevent contracture of
malleolus. The calcaneofibular ligament of the lateral the joint and speed up wound healing times. External
collateral ligament has a straight and oblique branch (Voss skeletal fixation can be applied concurrently with free
doi:10.1136/inp.g1434 and others 2009) (Fig 4). skin grafts (Fig 6).

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Companion Animals

before embarking on surgical stabilisation. Treatment

options depend on the level and direction of the instability
and concurrent fractures. Stressed radiographs can be
taken by stabilising the proximal portion of the limb using
ties and/or sandbags and stress is applied to the distal limb
that is held in the stressed position using Sellotape or a tie
attached to a sandbag if necessary. Stressed radiographs
are taken in four dimensions in most cases, that is, valgus,
varus, dorsal and plantar-stressed views. Survey and
stressed radiographs of the contralateral tarsus may be
useful for comparison.

Tarsocrural joint
The tarsocrural joint is the joint between the distal tibia,
distal fibula and the talus. This joint can also be referred
to as the hock joint and is the main point of extension and
flexion of the distal pelvic limb. Tarsocrural instability is
commonly seen in distal limb injuries in cats and occurs
as a result of fractures and/or disruption of the previously
described collateral ligaments (Roch and others 2009,
Nicholson and others 2012). Because of the interdigitating
shape of the distal tibia, medial and lateral malleoli and
Fig 1: The feline tarsus consists of the tibia, fibula and seven tarsal and four metatarsal the trochlea of the talus, complete luxation requires either
bones, along with the ligaments and fibrocartilage that keep these bones together and malleolar fracture or multi-ligamentous injury (Schmokel
aligned and others 1994) (Fig 7). Collateral ligament sprains are
more common than avulsion fractures of the origin site
of the ligaments, and collateral ligament sprains more
commonly affect the medial than the lateral side (Fig 8).
Due to the lack of surrounding soft tissue, the joint is also
more prone to developing open fracture/luxations; about
65 per cent of tarsal injuries in cats are associated with
open fracture luxations (Owen 2000).

Several options have been reported for treatment of

tarsocrural luxations. Treatment options include primary
repair of the ligaments, prosthetic ligaments, external
coaptation and transarticular external skeletal fixator
(TESF) application. Salvage options include pantarsal
arthrodesis or amputation (Schmokel and others 1994,
Roch and others 2009). Primary repair of the ligamentous
structures can be difficult to impossible as the ligaments
are very small, shredded and/or very difficult to identify. In
addition, the tibiotalar and talofibular collateral ligaments
are concealed deep beneath the medial and the lateral
malleoli making access difficult or impossible. Prosthetic
ligaments can be used to restore joint stability that is
lost as a consequence of collateral ligament damage;
the prosthetic ligaments are secured using either suture
anchors or screws with washers. Alternatively, bone
tunnels can be used to secure the suture material instead
Fig 2: The joints that make up the five main articulations of the feline tarsus
of metal implants such as screws or suture anchors
(Nicholson and others 2012). Simple ruptures of the
collateral ligaments can be treated with suture prosthesis
and external coaptation, but the degree of soft tissue injury
Preoperative radiographic
may influence outcome with this technique (Schmokel
examination 1994).
Following sedation or general anaesthesia, careful palpation
of the tarsus gives an indication of the level and nature of In cases where skin wounds are present over the medial
instability present, after which radiographs are necessary and lateral malleoli, bone tunnels may be advantageous
to accurately characterise and define the instability. The compared to screws or suture anchors, in order to minimise
normal tarsus of the cat will inherently have a degree of laxity the rate of postoperative infection associated with metal
present compared to dogs. If there are no tarsal injuries implants. Staphylococcus aureus is a common cause of
in the contralateral limb it can be used for comparison. orthopaedic infections, as a result of contamination from
Standard dorsoplantar and mediolateral radiographs the skin, and the use of metal implants, soft tissue injury or
give an initial overview and indication of gross fractures dissection can potentiate infection (Dunning 2003).
and instabilities present. However, subsequent oblique
radiographs or, more usually, stressed radiographs are External coaptation can be used to manage tarsocrural
required to demonstrate all injuries present. It is essential to instability, but it is inconvenient and cumbersome for
fully understand the nature and extent of fracture/instability wound management, is often poorly tolerated and can lead

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Companion Animals

application of a padded support dressing, such as a

modified Robert Jones dressing, may be considered for
three to four weeks postoperatively.

TESF is typically used to achieve tarsal stabilisation either

on its own, or to protect surgical stabilisation techniques
such as prosthetic ligament placement. Use of a TESF to
protect a surgical stabilisation is frequently a matter of
surgeon preference, because rigid immobilisation with a
TESF may not be necessary if the tarsocrural instability
is sufficiently and reliably stabilised using internal fixation
techniques such as K-wires, lag screws, pin and tension
bands, or prosthetic ligaments. A variety of configurations
of TESFs can be used, including type I (uniplanar, unilateral
with or without a triangulation cross bar) or type II TESF
(uniplanar, bilateral, Fig 10), but TESF can be cumbersome
for cats, particularly when larger TESF frames are used.
To minimise TESF frame size, the sturdier but bulkier type
II TESF frame can be substituted with a type I TESF plus
triangulation cross bar. A minimum of three pins above
and below the tarsus is recommended (Kulendra and
Fig 3: The medial collateral ligament consists of: the tibiotalar ligament, partially others 2011). TESF is effective in achieving hock stability in
hidden deep to the medial malleolus, and the tibiocentral ligament, which inserts on the cats with tarsocrural luxation as it allows either malleolar
dorsomedial process of the central tarsal bone fracture healing or fibrous scar tissue to form across the
joint in the region of the ruptured collateral ligaments.

In cats, the hock should be fixed at an angle of approximately

100 to 110 degrees with a TESF (Voss and others 2009).
Short-term rigid joint stabilisation allows limited flexion and
extension of the tarsus, achieving adequate joint stability.
However, longer-term rigid fixation can have deleterious
effects on joint physiology, because immobilisation of the
joint can lead to loss of synovial fluid production, bone
mineral content and bone mineral density, and loss of range
of movement (Jaeger and others 2005). Typically, TESFs are
maintained for a period of four to eight weeks; malleolar
fracture healing in cats has been shown to be complete in
80 per cent of cases between four and eight weeks (Earley
and Dee 1980, Jaeger and others 2005). Re-mobilisation of
the joint after TESF removal may allow reversal of some of
the negative effects of rigid joint immobilisation, but some
of the deleterious changes to the joint will be permanent.
However, the clinical outcome of cats treated with TESF
is often very good with 85 per cent of owners reporting
excellent satisfaction following treatment (Kulendra and
others 2011). To overcome the problem of bone mineral and
Fig 4: The lateral collateral ligament consists of the oblique talofibular ligament and the articular cartilage degradation, hinged TESF can be used to
calcaneofibular ligament, which is made up of an oblique and a straight branch
achieve joint stability with controlled limited joint movement
in the normal plane; for example, flexion and extension
only. The hinged TESF has been used in the management of
tarsal injuries in cats and dogs. The loss in range-of-motion
to significant morbidity in the form of pressure sores; up to of the joint with a hinged TESF was 28 per cent compared to
63 per cent of animals that have casts applied may develop the normal contralateral limb and, following removal of the
soft tissue-associated injuries (Meeson and others 2011). hinged TESF, loss of range-of-motion was reduced to 16 per
cent (Jaeger and others 2005).
Stabilisation of malleolar fractures can be achieved with
Kirschner wires (K-wires) (Fig 9), pin and tension band With appropriate treatment and management of cases of
technique or lag screws (Piermattei and others 2006). tarsocrural fracture luxation/instability, the prognosis for
In feline patients, the fragments of fractured bone are these injuries can be good to excellent. However, it should
often very small; therefore, stabilisation with implants, be recognised that in patients with associated soft tissue
particularly lag screws, may prove difficult and often risks injuries, a longer duration of hospitalisation and greater
further fracturing of the bone. As malleolar fractures financial commitment is often necessary (Roch and others
involve the articular surfaces of the tarsocrural joint, it 2009, Kulendra and others 2011) .
is important that the basic principles of articular fracture
repair are observed, that is, rigid fixation, compression and
Tarsometatarsal and calcaneoquartal
accurate reduction so that normal anatomical alignment
is established and bone healing occurs without callus
joint
formation (Schwarz 2005). Depending on the size of the Numerous plantar ligaments are located on the plantar
malleolar fragment, one or more K-wires can be used. (tension) aspect of the tarsus. One of the main plantar
Following internal fixation and tarsocrural stabilisation, ligaments originates from the distal aspect of the

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(a) (b)

Fig 5: Lateral (a) and dorsoventral (b) thoracic radiographs of a cat with tarsal trauma
and concurrent diaphragmatic rupture; there is loss of the diaphragmatic outline, border
effacement of the cardiac silhouette, evidence of a pleural effusion and displacement of
gas-filled intestinal loops into the hemithorax

calcaneus and inserts on the fourth tarsal bone and the

base of the fourth metatarsal bone (Voss and others
2009). Numerous short ligaments also span the individual
tarsal joints. Injury to the main plantar ligaments results
in calcaneoquartal subluxation and a plantigrade stance
(Fig 11). Conservative management of such injuries is
unsuccessful because of the high tensile forces generated
by weight bearing that exceed the breaking strength of
healing fibrous scar tissue. It is important to differentiate recommended for medial, lateral and plantar instability.
between calcaneoquartal luxation and damage to Sacrifice of the low motion intertarsal and tarsometatarsal
the common calcaneal (Achilles) tendon. In cases of joints by performing partial tarsal arthrodesis results in
calcaneoquartal luxation, cats typically present with excellent functional outcome for both calcaneoquartal
a tarsus that is unstable mid body; instability is present and tarsometatarsal injuries. Tarsal fracture/instability
on tarsal flexion and extension when the calcaneal tuber requiring calcaneoquartal and/or tarsometatarsal
is grasped with one hand and the proximal metatarsus arthrodeses are usually achieved by application of a
with the other. By comparison, disruption to the common laterally positioned dynamic compression plate or hybrid
calcaneal tendon results in hock hyperflexion, the tarsus arthrodesis plate. Alternatively, calcaneoquartal plantar
can be flexed and extended independently when the stifle is instability can be stabilised using a pin or lag screw placed
maintained in extension and there is a palpable soft tissue through the calcaneus into the fourth tarsal bone and a
swelling or defect of the distal common calcaneal tendon. plantarly placed tension band. Dorsal plating with the
ComPact Unilock 2.0/2.4 plate has been reported to treat
Injury to the short distal plantar ligaments can result in dorsal tarsal instability with concurrent medial or lateral
tarsometatarsal luxation, though this is relatively unusual instability. In specific circumstances of dorsal instability,
without concurrent fracture of either the distal (numbered) early implant removal may preserve joint function rather
tarsal or proximal metatarsal bones. Surgical treatment is than achieving arthrodesis (Voss and others 2004).

(a) (b) (c)

Fig 6: The feline tarsus is prone to severe shear injuries and fractures (a). For large lesions, skin grafts can be used to prevent contracture of the joint (b)
and speed up wound healing (c)

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If only dorsal instability is present, conservative

management may be a viable option as long as the tarsus
is relatively stable because, during weight bearing, the
dorsal aspect of the tarsus is compressed and therefore
stable. Such injuries can fibrose and heal with external
coaptation alone. Medial, lateral and plantar instability
must be ruled out with appropriate preoperative imaging
and careful physical examination.

Talocalcaneal joint
Talocalcaneal luxation is a relatively uncommon injury in
which dorsal displacement of the distal head of the talus
occurs as a result of concurrent talocentral and talo-
calcaneal subluxation (Fig 12). This injury is a result of
disruption to the talocalcaneal and talocentral intertarsal
ligaments. It is important to perform stressed radiographs
to rule out concurrent instability of the tarsus. Surgical
treatment involves placement of a positional screw from
the talus into the calcaneus or talocentral arthrodesis
(Voss and others 2009).

Salvage procedures
Depending on the nature and severity of injuries, and
other factors such as owners financial constraints
and willingness to consider the possibility of multiple
surgical procedures, joint preservation may not always
be a realistic goal. If the joint cannot be preserved, then
salvage procedures to consider include either pelvic limb
Fig 7: Tarsocrural luxation with associated lateral and medial malleolar amputation or arthrodesis. An arthrodesis is defined as
fractures and damage to the tibiofibular ligament. Note the gas in the soft the irreversible surgical fusion of two or more bones
tissues distal to the craniodistal tibia, indicating an open fracture of a joint (Johnson and others 2005). If the tarsocrural
joint requires arthrodesis then a pantarsal arthrodesis
should be performed (all joints at all levels of the tarsus)
(a) (b) because arthrodesis of the tarsocrural joint alone has
been shown to lead to a poorer functional outcome
compared to pantarsal arthrodesis (Gorse and others
1991). The tarsocrural joint is the high motion joint of the
tarsus and fusion of this joint alone results in excessive
strain on the remaining low motion tarsal joints, which
are not designed to tolerate higher ranges of movement.

Indications for pantarsal arthrodesis include

unreconstructable articular fractures of the tibia or talus,
tarsocrural luxations that cannot be stabilised, severe
instability of the tarsus and end stage degenerative joint
disease. Less common indications include treatment
of postural deformities secondary to peripheral tibial
or peroneal nerve damage, and loss of integrity of the
common calcaneal tendon (Vannini and Bonath 2005).
Arthrodesis is accomplished by removal of all articular
cartilage, using either a burr or curettage, and bone
grafting to promote rapid and complete healing of the joint.
Sources of autologous bone graft include the proximal
tibia, ilial wing, proximal humerus and distal femur.
Alternatively, commercial sources of feline allograft
have recently become available, including osteoinductive
demineralised bone matrix (Veterinary Tissue Bank). For
pantarsal arthrodesis, the tarsus is set at a functional
angle; the recommended angle varies depending on the
reference source, and can be judged from the normal
standing angle of the contralateral healthy pelvic limb
and is typically 100 to 125 degrees (Vannini and Bonath
2005, Voss and others 2009). Finally, the tarsus is rigidly
Fig 8: Dorsoplantar radiographs of the tarsus shows soft tissue swelling immobilised by internal or external fixation.
over the medial and lateral aspect of the tarsocrural joint, with a small
mineralised fragment adjacent to the medial talar ridge (neutral view [b]).
The valgus (lateral) stressed radiograph (a) shows widening of the medial Pantarsal arthrodesis is commonly performed by
aspect of the tarsocrural joint, indicating medial instability because of application of a plate to the medial aspect of the tibia
damage to the medial collateral ligament or a medial fracture and tarsus. Significant bending forces are concentrated

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(a) (b)

Fig 9: Stabilisation of
malleolar fractures can
be achieved with pin and
tension band technique
or lag screws, or with
Kirschner wires (K-wires)
as shown in (a) and (b)

at the hock, which increases the chances of implant

failure. Failure to incorporate the calcaneus into the
(b)
pantarsal arthrodesis can lead to incomplete fusion of
the talocalcaneal and calcaneoquartal joints and either
lameness or arthrodesis failure. To prevent this, the
mechanical strength of the plate can be augmented by
application of a positional screw between the tibia and
calcaneous or an intramedullary pin placed across the
tarsocrural joint and up through the tibia (Kirsch and
others 2005). Alternatives include a dorsally or laterally
applied plate to the tarsus. A novel dorsally applied
precontoured plate has been described; despite the plate
being biomechanically weak as it is on the compression
surface rather than the tension surface of the joint, initial
results have been promising (Fitzpatrick and others
2010). If infection or wounds are present, then an external

(a)

Fig 10: A uniplanar, unilateral type I TESF (a) and a uniplanar, bilateral type II TESF (b).
TESF is typically used to achieve tarsal stabilisation either on its own, or to protect
surgical stabilisation techniques, such as prosthetic ligament placement

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(a) (b) Summary

Before considering and addressing tarsal injuries, it is
important that the patient is fully assessed so that life-
threatening injuries are recognised and treatment of these
is prioritised. Once the patient is stabilised and judged to
be well enough to undergo anaesthesia, full diagnostics and
definitive treatment of tarsal injuries can be performed.
Following a thorough physical and orthopaedic examination,
survey, stressed and oblique radiographs can be used to
identify fractures, luxations and the level and direction of
instabilities present. Following identification of the nature
of the injuries, it is possible to formulate an appropriate plan
for management of these cases.

References
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DUNNING, D. (2003) Surgical wound infection and the use of
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Ed D. Slatter. Saunders Elsevier. p 119
EARLEY, T. D. & Dee, J. F. (1980) Trauma to the carpus, tarsus,
and phalanges of dogs and cats. Veterinary Clinics of North
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FITZPATRICK, N., STAPLEY, B. & YEADON, R. (2010) Pantarsal
Fig 11: The mediolateral radiograph (a) shows soft tissue swelling, widening and
arthrodesis in 11 cats using a novel dorsal plate: technique and
subluxation of the calcaneoquartal joint (CQ) compared to the normal tarsus (b).
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rather than internal fixation, but joint compression (one
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(b)
Complications associated with pantarsal arthrodesis
include implant loosening, implant breakage and
osteomyelitis. In the dog, the very serious postoperative
complication of plantar soft tissue necrosis can result
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suggested to be because of damage to the perforating
metatarsal artery as it courses in between the proximal
aspect of metatarsals 2 and 3 (Roch and others 2008).
Although this complication has not been reported in the
cat, the anatomy between the two species is sufficiently
similar to speculate that plantar necrosis may occur
in the cat as well. Alternatively, if plantar necrosis is
instead a soft tissue dressing-associated injury, cats
would be equally susceptible to this injury as dogs. Other
complications include surgical site infection and failure
to achieve arthrodesis.

(a)

Fig 12: Mediolateral (a)

and dorsopalmar (b)
radiographs of the tarsus.
Radiographs show dorsal
displacement of the talus
with concurrent talocentral
luxation and talocalcaenal
subluxation. There is also a
small chip fracture visible
adjacent to the cranial
aspect of the distal tibia

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in dogs. American Journal of Veterinary Research 66, 125-131 VOSS, K., LANGLEY-HOBBS, S. J. & MONTOVAN, P. M. (2009)
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injuries associated with cast application for distal limb orthopaedic Further reading
conditions. A retrospective study of sixty dogs and cats. Veterinary MCLENNAN, M. J. (2007) Ankylosis of tarsometatarsal luxations
and Comparative Orthopaedic Traumatology 24, 126-131 using external fixation. Journal of Small Animal Practice 48, 508-513
NICHOLSON, I., LANGLEY-
HOBBS, S., SUTCLIFFE,
M., JEFFREY, N. & RADKE,
H. (2012) Feline talocrural
luxation: a cadaveric study
of repair using ligament
prostheses. Veterinary and
Comparative Orthopaedic
Traumatology 25, 116-125
OWEN, M. A. (2000) Use of
contoured bar transhock
external fixators in 17 cats.
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Companion Animals

Self-assessment test:
diagnosis and treatment of
feline tarsal injuries
A one-year-old female neutered domestic
shorthair (DSH) cat presents to your clinic non-
weight-bearing on the right pelvic leg. The cat
has been missing for the last three days. There
is marked pain, malalignment and crepitus at
the level of the tarsus. Physical examination
and thoracic radiographs were unremarkable.
Survey radiographs of the tarsus can be seen
on the right. Classify the nature of the injury and
outline an appropriate treatment plan.

A model answer can be found on page 132

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Companion Animals

Model answer to the diagnosis and treatment of feline tarsal injuries self-assessment test
A dorsoplantar and mediolateral radiograph of the tarsus reveals marked lateral and
caudal displacement of the distal limb. The tarsocrural joint remains intact, but a
physeal fracture (Salter Harris type I) of the distal tibia and a distal diaphyseal fracture
of the fibula are present; as a result, there is most likely injury to the tibiofibular
ligament. The medial aspect of the distal tibial metaphysis appears to be just beneath
the skin; there is no evidence of gas in the soft tissues, suggesting the fracture is
closed, but the skin in the region should be carefully checked for wounds. Treatment
options to consider include placement of a crossed K-wire (one each medially and one
laterally) and/or a intramedullary fibular K-wire driven distal to proximal. Alternatively,
an external skeletal fixator could be applied after fracture reduction, but this will
immobilise the hock joint and, therefore, would not be ideal.

Following surgical stabilisation, consider a postoperative dressing to control soft

tissue swelling for one week, and for four weeks postoperatively to provide support to
the surgical repair. In addition, cage rest for the first four to six weeks until follow up
radiographs are performed should be advised.

In this case, a medial and lateral K-wire were placed in the medial and lateral malleoli
(crossed K-wire). Following placement of the K-wires, the joint was assessed for
any instability intraoperatively and none was found. The foot was placed in a support
dressing with a medial and lateral finger splint for four weeks. The implants were left
in situ as the cat had very little residual growth. After four weeks, the dressing was
removed and the cats lameness had resolved.

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Management and treatment of feline tarsal

injuries
Elvin Kulendra and Gareth Arthurs

In Practice 2014 36: 119-132

doi: 10.1136/inp.g1434

Updated information and services can be found at:

http://inpractice.bmj.com/content/36/3/119.full.html

These include:
References This article cites 14 articles, 2 of which can be accessed free at:
http://inpractice.bmj.com/content/36/3/119.full.html#ref-list-1

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