New reader Kirsten sends in this question from Italy...
I stumbled across your blog while researching how to help our cat who has the same exact fracture as the boxer puppy in your entry from June 2, 2009. We live in Italy where they still use old 1950s style radiators for heating - a favorite winter hang-out spot for our cats. 11 days ago, I hear our 6 year old cat screaming from the kitchen and ran in to find him hanging from the top of radiator by his back left paw which had somehow gotten caught in a hole on the top of the radiator.
Since it was Sunday at 10pm, I immediately called the vet, gave him a tranquilizer (Acepromazine - vet's advice) and waited until the morning to take him in. An x-ray showed that all four of his metacarpals were broken with one really displaced. The vet casted him, gave him Tramadol and scheduled surgery in 2 days. We gave him Arnica and Tramadol injections the next day, Arnica the second day and brought him to have surgery that day.
Surgery went well, two rods were placed in the middle two bones, and he had a big bandage for 5 days. He had the bandage taken off two days ago and is now wearing an Elizabethan collar. In the past 24 hours, I've noticed one of the outside metacarpals without a rod is looking really displaced, just as it was before surgery. The vet said that the middle two bones needed to be stabalized, but the other two outside bones would fall into place and heal perfectly.
My question is whether those outside two bones really are falling into place or should they also have rods placed? I'm calling the vet tomorrow morning, but I'm really interested in an American vet's opinion and to hear what you have to say considering you had another case almost identical (granted it was a dog =) ).
Thanks for anything you can tell me!
Kirsten, I'm sorry to hear about your kitty! Your vet is going to be the best one to judge what is going on in this case since he/she can actually see the paw. I am also hesitant to second-guess another vet when I'm not directly involved in the case. However, I can talk about how I would handle things.
The decision of whether or not to do surgery is dependent on the individual case, taking into account the pet's size, activity, displacement of the bone, and the financial ability of the owner. A small pet like a cat may not need surgery, and might be able to be managed with a long-term splint (4-6 weeks). It can also be difficult to properly place pins in bones the size of a cat's metacarpals. However, a good surgeon with the right equipment could do so, and surgical stabilization normally gives the best chance for a full recovery.
One of the keys is to maintain immobilization of the bones. If only some of the bones are surgically fixed, then I would recommend keeping a splint of some sort on for the full six-week healing period. Your vet may have different experience and other reasons for setting the paw differently. There are also times when a doctor does everything appropriately, but complications still happen. In any case, it does sound like the bones are displaced, and you should certainly take him in for a follow-up. He may need to have further surgery or have a splint or cast placed. A lack of stabilization was a problem with the dog case you're referring to. The client didn't have surgery performed, didn't keep the dog calm enough, and didn't come in for appropriate rechecks, leading to some serious problems with healing.
Be sure to ask questions of your vet, and be an informed owner. If your vet has lots of experience doing a repair this way and it typically heals well, then I would agree that this is an acceptable way to do it but you're seeing some complications. Good luck!