498 © Schattauer 2009
Carpal arthrodesis in cats
Long-term functional outcome
I. Calvo1; M. Farrell1; D. Chase1; J. Aisa2; R. Rayward2; S. Carmichael1
1Universityof Glasgow, Faculty of Veterinary Medicine, Division of Companion Animal Sciences, Bearsden, Glasgow,
UK; 2Davies Veterinary Specialists, Manor Farm Business Park, Higham Gobion, Hertfordshire, UK
Keywords
Cat, arthrodesis, carpus, feline, carpal
Summary
Pancarpal and partial carpal arthrodesis
were performed in 22 carpi (20 cats) using
various surgical methods. Short and long-
term outcomes were assessed using a retro-
spective review of the case notes and via
owner questionnaires. Carpal arthrodesis
was associated with complications that did
not affect the functional outcome, and in
most cases, did not necessitate major revi-
sion surgery. Following arthrodesis, the cats
did not jump as high, and showed a reduc-
tion in their willingness to jump and climb.
Based on our results, carpal arthrodesis is a
suitable salvage surgery to treat severe
carpal injuries in the cat.
Correspondence to
Ignacio Calvo, Ldo Vet, CertSAS, MRCVS
University of Glasgow Veterinary School
Division of Companion Animal Sciences
Small Animal Hospital
Bearsden Road, Bearsden
Glasgow, UK, G61 1QH
Phone: +44 141 330 5848
Fax: +44 141 330 3663
E-mail: i.calvo@vet.gla.ac.uk
Vet Comp Orthop Traumatol 2009; 22: 498–504
doi:10.3415/VCOT-08-08-0076
Received: August 14, 2008
Accepted: June 17, 2009
Pre-published online: October 29, 2009
Introduction
Carpal arthrodesis is a relatively common and
well documented procedure in dogs (1–5).
The most common indication for carpal
arthrodesis in dogs is traumatic carpal hyper-
extension that results in chronic instability
and pain (1). Other indications include end-
stage degenerative, immune-mediated or
septic arthritis, intra-articular fractures, se-
Vet Comp Orthop Traumatol 6/2009
vere shearing injuries and some peripheral
nerve injuries (6). However, literature de-
scribing carpal arthrodesis in cats is scarce.
We were able to identify only three reports
documenting feline pancarpal arthrodesis
(PCA), including one case of antebrachio-
metacarpal arthrodesis in a cat with carpal
agenesis (6–8). One case series describing
partial carpal arthrodesis (ParCA) using a
cross-pin technique in both dogs and cats in-
cluded two cases of feline partial carpal arth-
rodesis, however no long-term follow-up in-
formation was available (9). We are unaware
of any publications describing the optimal
technique or long-term outcome after carpal
arthrodesis in cats..
Cats have greater ranges of forelimb pro-
nation and supination than dogs (10). This
difference in pronation and supination is
likely to be important for functions such as
hunting and grooming in cats. Supination is
considered by some as an important compo-
nent of normal feline limb function. Feline
carpal arthrodesis has been criticised in prin-
ciple as it may lead to a loss of normal joint
function, in particular supination and pro-
nation (11). However, the long-term effects of
carpal arthrodesis on the normal habits of
cats are currently unknown.
This study documents a retrospective re-
view of the case histories of 20 cats with vari-
ous carpal disorders that were treated by PCA
or ParCA. We describe the clinical findings of
the injuries, the surgical technique used and
the long-term outcomes of carpal arthrodesis
for this population of cats.
Materials and methods
Study population
Selection criteria included cats which had
undergone PCA or ParCA between 1993 to
2008 at the Glasgow University Veterinary
School, Davies Veterinary Specialist and The
Clinical Communication
Ohio State University College of Veterinary
Medicine. Short-term outcome inclusion
criteria included the availability of informa-
tion and radiographs for the preoperative and
immediate postoperative time periods as well
as radiographic follow-up six to eight weeks
post-operative. Long-term outcome was as-
sessed by owner questionnaire; a minimum
period of six months between surgery and
questionnaire completion was required. The
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sex, age at time of surgery, presenting lame-
ness, level of the instability, surgical tech-
nique used, follow-up time, and compli-
cations for each cat were recorded. The level
of carpal instability was assessed from pre-
operative neutral and stressed (carpal hyper-
extension) radiographs.
Follow-up
Short-term clinical and radiographic exam-
ination follow-up was performed between six
and 12 weeks post-operatively. Radiographic
progression of the arthrodesis was recorded.
Radiographic evidence of fusion was defined
as obliteration of the antebrachiocarpal,
middle carpal and carpometacarpal joint
spaces in the PCA cases, and as obliteration of
the middle carpal and carpometacarpal joint
spaces in the ParCA cases (14). Progression of
the carpal arthrodesis was defined as cancel-
lous bone bridging the joint space but with
the joint space still clearly visible (14).
In order to assess the long-term outcome,
a questionnaire was sent to each of the
owners. The questionnaire was based on that
previously described by Plante and others ,
but modified according to the feline-specific
outcome questionnaire used by Clarke and
Bennett (15, 16). Information regarding life-
style and the ability to perform normal feline
activities were recorded. The answers to some
questions were recorded using a discontinu-
ous scoring system utilising a simple descrip-
tive scale (씰Table 1). Owners were asked to
 I. Calvo et al.: Carpal arthrodesis in cats 499

Table 1 Evaluation by the owner of the degree of activity. score how the activity was affected for the
most recent month. In other questions, par-
Question Answer
ticularly the ones regarding lifestyle, out-
Is there a reduced height of jump? Yes / No comes were recorded as dichotomous vari-
Is there an altered demeanor? (e.g. aggression, seeking Yes / No ables (yes or no), and applied to the most re-
seclusion, resentment of handling) cent month (씰Table 1). For the long-term
owner questionnaire, a satisfactory outcome
Does your cat require painkilling medication? Yes / No
was defined as having a combined disability
If yes: score lower than 2; a slight but frequent dif-
What is the medication? ficulty in performing normal activities. An
excellent outcome was defined as having a
How often are they required?
combined disability score lower than 1, or a
How long has your cat been on this medication? slight and occasional difficulty in performing
How much better does this medication improve your cat? normal activities.
(e.g. no effect, little better, quite a lot, back to normal)
Activities Evaluation criteria Score
Running, climbing, grooming and Able to perform the activity without difficulty. 0 Results
jumping.
Slight and occasional difficulty to perform the 1 Study population

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actvity.
(Each of the activities to be
scored) Slight but frequent difficulty to perform the 2 Twenty-two carpal arthrodeses were per-
activity. formed in 20 cats. Of the 22 arthrodeses per-
Important and permanent difficulty to perform 3 formed, two were bilateral carpal arthrodeses.
the activity. In one case, both arthrodeses were performed
together, and in the other case as two separate
Cannot perform the activity. 4
procedures that were performed one year

Table 2 Problem Internal fixation Number Complications

Summary of findings joints
and treatment for
20 cats (22 carpi) Pancarpal Hyperextension Crossed pins and stacked veterinary 3 Pin mal-positioning (1)
managed for carpal arthrodesis cuttable plate (VCP)
injuries with partial Crossed pins and stacked VCP + cast 1
and pancarpal arth-
rodesis. Crossed pins and 1.5/2.0 hybrid 1
pancarpal arthrodesis plate (HPAP)
1.5/2.0 HPAP medially 1
1.5/2.0 HPAP + cast 4
2.0/2.7 HPAP 1
Luxation / Crossed pins and stacked VCP 1 Cast removal (1)
subluxation
1.5/2.0 HPAP + cast 3
2.0/2.7 HPAP 1
Intra-articular Dynamic compression plate + 1
fracture external skeletal fixator
Carpal osteoarthritis Crossed pins 1 Pin migration
2.0/2.7 mm HPAP + cast 1 Plate loosening
Carpal agenesis Crossed pins and stacked VCP 1 Pin mal-positioning +
metacarpal (MC) fracture
Partial carpal Hyperextension Crossed pins 1 Pin migration
arthrodesis
Crossed pins + cast 1 Pin migration + MC
fracture

© Schattauer 2009 Vet Comp Orthop Traumatol 6/2009

500 I. Calvo et al.: Carpal arthrodesis in cats
apart. There was 20 cases of PCA and two of
ParCA (intercarpal and carpo-metacarpal
arthrodesis).
All but one of the cats were Domestic
Short Haired cats, of which 12 were male and
eight were female . The mean age at the time
of surgery was 5.2 years (range 0.8 to 12
years). The initial problem, surgical pro-
cedure, implants used, and complications are
summarised in 씰Table 2.
Presenting problem
Arthrodesis was performed to treat (a) trau-
matic carpal hyperextension, with or without
collateral ligament involvement (n = 13), (b)
traumatic luxation-subluxation (n = 5), (c)
comminuted intra-articular fracture (n = 1),
(d) carpal agenesis (n = 1) (7) and (e) carpal
osteoarthritis (OA) of unknown cause
(n = 2).
The level of instability was (a) unknown in
two carpi, (b) carpo-metacarpal in eight
carpi, (c) antebrachio–carpal in eight carpi,
and (d) affecting all levels of the carpus in
four carpi (씰Fig. 1).
Indication for the arthrodesis and level of
instability are recorded in 씰Table 2.
Surgical technique
Pancarpal arthrodesis was achieved using a
number of different techniques: In 19 carpi
PCA was performed using dorsally (18 carpi)
or medially (1 carpus) applied plates. Hybrid
PCA platesa, Veterinary cuttable plates
(VCP)b and Dynamic compression plates
(DCP)b were used as implants, either alone or
augmented with one or two crossed Kirsch-
ner wiresa, an external skeletal fixatorc (씰Fig.
2), or a rigid tubular cast. Pancarpal arthrode-
sis was also performed in one carpus with two
crossed 2 mm Ellis pinsa. Partial carpal arth-
rodesis was performed in two carpi with
crossed Kirschner wires anchored proximally
in the radio-carpal and ulnar-carpal bones.
After induction of general anaesthesia and
routine aseptic skin preparation, a cranio-
a Augmentation of dorsal plate fixation was
Veterinary Instrumentation, Sheffield, UK
b
Synthes, Oberdorf, Switzerland
c
IMEX, Longview, Texas, USA
Vet Comp Orthop Traumatol 6/2009
Fig. 1 Medio-lateral stressed (hyperextension)
carpal radiographs of case 1 showing marked
carpo-metacarpal hyperextension.
medial approach to the distal antebrachium
and carpus was performed, as previously de-
scribed (6, 12). Standard methods were used
to remove all of the articular cartilage from
the joint levels included in the arthrodesis.
Cancellous bone graft was harvested from the
ipsilateral proximal humerus or ilial wing and
applied to each affected level.
When a plate was selected, at least four
screws were placed in the radius, one screw in
the radial carpal bone and four screws in the
third metacarpal bone. The radial carpal
bone screw was always placed first. In the ma-
jority of the cases, the size of the plate was
chosen so that not more than 50% of the di-
ameter of the third metacarpal bone was oc-
cupied by a screw, and that a minimum of
50% of the length of the third metacarpal
bone was covered by the plate. The screws oc-
cupied more than 50% of the diameter in
only two of 19 carpi, and the plate covered less
than 50% in only one of the 19 carpi.
performed by different methods. When a
single Kirschner-wire was used, it was applied
from the ulnar styloid process and anchored
in the second metacarpal bone, or it was
driven from the fourth or fifth metacarpal
bone and anchored in the radius. When an
external skeletal fixator was chosen to sup-
port the dorsal plate fixation, a modified type
II transarticular fixator (1 full-pin and 1 half-
pin above and below the joint) was used.
In the PCA performed with crossed Ellis
pins, the pins were driven from the second
and fourth metacarpal bones and anchored
in the distal ulna and radius, respectively. The
crossed pins used for the ParCA were driven
from the second and fourth metacarpal bones
and anchored in the ulnar-carpal bone and
radial-carpal bone, respectively.
Medial plating was performed in a single
case. A similar technique to that described by
Guerrero and Montavon was used (13). In
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this cat, amputation of the first digit was not
required to facilitate medial plating . The
plate was contoured in its cranial-caudal axis
to achieve 10 degrees carpal extension.
Short-term outcome
Radiographic images were taken immediately
postoperatively in all cases (씰Fig. 3). All
carpi showed progression at six weeks and
one case showed radiographic evidence of
complete arthrodesis at this time. Radio-
graphs taken at 12 weeks, postoperative,
(씰Fig. 4) were available for five carpi (four
cats); three carpi had complete arthrodesis at
this time.
Nine complications were reported in
seven cases, with two cases having two com-
plications. Only one case required major revi-
sion surgery (plate removal as result of im-
plant loosening). The remaining compli-
cations were managed with minimal inter-
vention. In three cases, migrated pins were re-
moved under sedation, two mal-positioned
pins were left in situ, two cats had metacarpal
fractures and one cat had premature removal
of the cast (Table 2).
Long-term outcome
Long-term outcome was assessed by owner
questionnaire. Eleven owner questionnaires
out of 20 were returned (55% response rate).
Nine of the cats were alive when the owners
© Schattauer 2009

A) B)
Fig. 2 (A) Dorso-palmar and (B) medio-lateral
carpal radiographs of case 9 taken immediately
post-operatively. This gun shot injury was treated
by pancarpal arthrodesis with fixation achieved
using a nine-hole, 1.5 mm dynamic compression
plate augmented with a type II transarticular
external skeletal fixator.
received the questionnaire. Follow-up du-
ration ranged from six months to six years
(mean 2.93 years). A summary of the re-
sponses to the questionnaire is shown in
씰Table 3. Reduced height of jump was pres-
ent in 10 out of 11 cats and altered demean-
our (going outside less often) was reported in
two of the 11 cats. Other commonly affected
activities were climbing and jumping, with
median scores of 1 (range 0–3). Grooming
was not affected at all, and running was
slightly affected, with a median score of 0
(range 0–2). The best possible score for each
of these outcome criteria was 0 and the worst
was 4. Analgesic medications were not being
administered to any of the cats.
© Schattauer 2009
A)
Fig. 3 (A) Dorso-palmar and (B) medio-lateral carpal radiographs of case 1 taken immediately post-
operatively. Fixation was achieved using a stacked nine-hole veterinary cuttable plate, augmented with
a 0.9 mm Kirschner-wire.
Discussion
This is the first study to specifically evaluate
the surgical technique, complications and
long-term outcome of feline carpal arthrode-
sis. We describe the results of 22 carpal arth-
rodeses in 20 cats. In this clinical communi-
cation, several different techniques were em-
ployed, although application of a dorsal plate
was the most common. Overall, an excellent
long-term outcome was achieved in seven of
the 11 cats, with the remainder achieving a
satisfactory result. Although eight of the 20
cats experienced a short-term complication,
in the long-term, there was minimal effect on
lifestyle, with only the height of jump being
markedly affected and the ability to jump and
climb being mildly affected in the majority of
cases. Other factors such us running, groom-
I. Calvo et al.: Carpal arthrodesis in cats 501
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B)
ing and demeanour were minimally in-
fluenced by carpal arthrodesis. Only two cases
were treated by ParCA, and the outcome in
these two cases was considered excellent.
Indications for carpal arthrodesis in our
population included ligamentous injuries
(hyperextension and luxation-subluxations),
comminuted intra-articular fractures, ad-
vanced osteoarthritis, and carpal agenesis.
Other proposed indicators previously re-
ported included severe shearing injuries,
chronic septic arthritis and some peripheral
nerve injuries (6). Several case reports have
documented successful management of feline
carpal luxation in the absence of carpal hy-
perextension by primary ligament repair aug-
mented by transarticular skeletal fixation or
external co-aptation (11, 17). In those studies
it was suggested that PCA should be avoided
Vet Comp Orthop Traumatol 6/2009
502 I. Calvo et al.: Carpal arthrodesis in cats
A)
Fig. 4 (A) Dorso-palmar and (B) medio-lateral carpal radiographs of case 1 taken 12 weeks post-
operatively. Radiographically complete arthrodesis is observed at the carpo-metacarpal joints.
in the cat due to a proposed reduction in pro-
nation and supination, both of which are
thought to be important functions for nor-
mal feline ambulation, playing and grooming
(11). However, our results suggest that carpal
arthrodesis in the cat is a suitable treatment
associated with minimal disability and excel-
lent success rates.
Feline carpal multi-ligamentous injury
has been associated with ‘high rise syndrome’
(jumping from heights) or direct trauma (6,
18,19). In our study, the aetiology remained
obscure for the majority of cats with carpal
Vet Comp Orthop Traumatol 6/2009
B)
hyperextension and luxation-subluxation. In
only two cases of carpal hyperextension was
the cat witnessed sustaining the injury during
a fall from a height. In our population, no bi-
lateral hyperextension injuries occurred as a
result of ‘high rise syndrome’. The single case
that presented with bilateral carpal instability
was a consequence of gun shot injury.
To select the proper treatment, particularly
in hyperextension injuries, it is important to
know at which joint level the injury occurred
(20). Previous reports regarding hyperexten-
sion injuries in dogs are not homogenous. Re-
Table 3 Long-term results of pancarpal and
partial carpal arthrodesis assessed by owner
questionnaire ( See Table 1 for details of the
numerical rating scale).
Activity Median score
per activity
Jumping 1 (range 0-3)
Running 0 (range 0-2)
Grooming 0 (range 0-0)
Climbing 1 (range 0-3)
Reduced height of 10/11
jump
Altered demeanour 02/11 (less keen to go
out)
Painkilling 0/11
medication
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ported involvement of the antebrachio-carpal
joint ranges from 10%-56%, with the re-
mainder of cases involving the middle carpal,
carpo-metacarpal or a combination of both
levels (1, 4, 20). When hyperextension and lu-
xation-subluxation injuries were considered
separately in our population of cats, the ante-
brachio-carpal joint was involved in eight of
18 carpi, eight of 18 cases involved the carpo-
metacarpal joint, and the precise level of car-
pal hyperextension was unknown in two out
of 18 cases. The proportion of affected ante-
brachio-carpal and carpo-metacarpal levels
correlated with that reported in previous ca-
nine literature. However, the isolated involve-
ment of the middle carpal joint reported in
dogs, with an incidence rate ranging from
10–22% (1,4), was not recognized in our
population. Previous feline case reports re-
garding carpal ligamentous injuries have de-
scribed anatomical differences between the
feline and canine antebrachio-carpal liga-
ments, such as the absence of a straight com-
ponent in the medial collateral ligament of the
cat (11, 17) . However, we are unaware of any
specific studies regarding the differences in fe-
line anatomy at the level of the intercarpal or
carpo-metacarpal joint. Further anatomical
studies are warranted in order to assess if the
lack of isolated middle carpal instability is a
result of an anatomical variation compared to
the canine carpus.
There is controversy in the dog as to
whether or not pancarpal arthrodesis is pre-
© Schattauer 2009

ferable to partial carpal arthrodesis in middle
carpal and carpo-metacarpal injuries. Several
studies have reported outcome after canine
partial carpal arthrodesis, but surgical tech-
niques in each study varied significantly. Sat-
isfactory results, as assessed by owner ques-
tionnaire, ranged from 50% to 100% (1, 5, 9).
We are unaware of any study reporting long-
term evaluation of partial carpal arthrodesis
in the feline patient. Based on the high pro-
portion of carpo-metacarpal instabilities ob-
served in our population, and the encour-
aging results of our two cases treated with
ParCA, further investigation regarding out-
come of partial carpal arthrodesis in the cat is
warranted.
Although surgical technique for canine
carpal arthrodesis has been described in de-
tail, little data exists regarding the surgical
technique for this procedure in cats (1, 3,4).
Simpson and Goldsmid described a case of
feline PCA using a 1.5 mm dorsally-applied
eight-hole AOd miniplate, augmented with a
splint for six weeks (6). Denny and Barr sug-
gested the use of crossed Kirschner wires or
VCP, but no clinical case details were pres-
ented (1). External fixation has also been sug-
gested for use in cats requiring carpal arth-
rodesis after suffering from ‘high rise syn-
drome’, but again no clinical data was pres-
ented (9). In our population, carpal arthrode-
sis was performed using different implants
and surgical techniques. The use of a dorsal
plate alone, or a plate augmented with exter-
nal co-aptation, cross-pins or a transarticular
external skeletal fixator all resulted in a good
functional outcome. Medial plating and
cross-pin fixation were also employed suc-
cessfully. The rationale for augmented dorsal
plate fixation is that the plate is not posi-
tioned on the tension side, and therefore it is
theoretically more susceptible to bending
forces (21). The rationale for medial plating is
that the sagittal plane bending moment is ap-
plied to the edge of the plate resulting in in-
creased area moment of inertia, thus enhanc-
ing resistance to these bending forces (13). As
far as we know, there have not been any
studies performed in the feline patient in
order to assess the requirement for augmen-
tation when dorsal plating is performed. For
the cases in our population where augmen-
d Arbeitsgemeinschaft für Osteosynthesefragen
© Schattauer 2009
tation was prematurely removed or was not
used, complications were not associated with
a decreased functional outcome where long-
term data were available.
When choosing the implant size, one of
the limiting factors is the size of the screw that
can be placed in the metacarpal bone (2, 6). A
previous study assessing risk factors for meta-
carpal fractures associated with PCA in dogs
found no statistically significant correlation
between the ratio of bone-screw diameter to
bone diameter between dogs with and with-
out metacarpal fractures, although it was sug-
gested that improperly placed screws which
occupy close to 45 % of the bone may be a risk
factor for metacarpal bone fracture (22). A
recommendation not to exceed 30% of the
metacarpal width has also been mentioned in
the feline literature (6). In an anatomical
study, Simpson found that the diameter of the
feline third metacarpal bone ranged from
3.15 mm to 4.13 mm (6). A 1.5 mm bone
screw would occupy 36 to 47 % of the width
of the third metacarpal bone, and a 2 mm
bone screw would occupy 48.4 to 63.5% of
the width of this bone. In our study, 2 mm
screws were applied to the metacarpal bones
in three cases without complications (in two
of these cases, the screws occupied more than
50% of the third metacarpal bone). In the
single cat that had a PCA associated metacar-
pal fracture, the screw occupied 50% of the
third metacarpal bone. A previous study
compared the holding power of 2.0 mm and
1.5 mm screws and concluded that the hold-
ing power of the 1.5 mm and 2 mm screws
were not significantly different (23). There-
fore, as a precaution, we recommend use of
1.5 mm metacarpal screws which should oc-
cupy less than 50% of the diameter of the
third metacarpal bone in most cases. Another
factor to take into consideration is plate
length, particularly regarding metacarpal
bone coverage. Whitelock and others demon-
strated an increased risk of metacarpal frac-
tures following arthrodesis in dogs if the plate
extended less than 50% of the third metacar-
pal bone (22). In the single case that fractured
in our population, the plate extension was
slightly less than 50%.
Our complication rate was 35% (9 com-
plications in 20 cats). However, the occur-
rence of complications was not associated
with poor functional outcome in the cases
available for long-term follow-up. The only
I. Calvo et al.: Carpal arthrodesis in cats 503
significant complication requiring major sur-
gical revision was multiple screw loosening
that required plate and screw removal. Pre-
vious studies regarding PCA in dogs reported
a requirement for plate removal in seven to
33% of operated cases (1, 2,4). Our results
compare favorably with the canine literature
and suggest that plate removal may be less
likely to be performed in the feline patient.
Metacarpal fracture was diagnosed in two
cases. One case was a re-fracture of a concur-
rent metacarpal fracture after implant re-
moval. In the other case, a healed fracture
centered on the distal hole was incidentally
observed on radiographic follow-up. Our
most common complication was pin mi-
gration in five out of the nine cases that were
augmented or treated with pins. Our results
do not compare favorably with previous re-
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ports where implant migration in the canine
patient occurred in 20 to 30% of cases (4, 9).
Surprisingly, in those reports, pins were used
as the primary method of stabilisation where-
as in our population, the main use was for
augmentation of dorsal plating. If pin mi-
gration was a consequence of residual motion
at the arthrodesis site, resulting in implant
micromotion, our results suggest that there is
some degree of residual instability after dor-
sal plating. This theory would support the use
of augmentation when dorsal plating is
chosen. However, there were dorsally-plated
cases without augmentation that proceeded
to arthrodesis without complication, suggest-
ing that any micromotion present is within
tolerable strain limits for arthrodesis. Pin mi-
gration was treated by pin removal under se-
dation, and did not affect the ultimate out-
come of those cases. Augmentation of plate
fixation with cross-pins was performed in
order to obviate the use of external co-ap-
tation. This decision was based on the pre-
conceived difficulties in maintaining cast
support in cats. However, premature cast re-
moval was only reported in one cat. Surpris-
ingly, no other cast-associated morbidity was
reported, which compares favorably to canine
carpal arthrodesis reports in which cast re-
lated complications have been reported in
35 % of cases (9). The majority of casts were
managed at the referring practices. It is there-
fore possible that some bandage-associated
morbidity was not reported in our results.
Our lack of radiographic evidence of arth-
rodesis at six to eight weeks correlates with
Vet Comp Orthop Traumatol 6/2009
504 I. Calvo et al.: Carpal arthrodesis in cats
previous reports of PCA in dogs (3, 14). Re-
ports regarding canine ParCA suggest that
radiographic arthrodesis is achieved earlier
than in PCA, with radiographic fusion
achieved in a mean of 7.6 to nine weeks (5, 9).
Two cats were included in one of the previous
studies achieving radiographic fusion at six
and nine weeks (9). One of our two ParCA
showed radiographic evidence of arthrodesis
at six weeks. Further research regarding time
to arthrodesis and where PCA and ParCa in
the feline patient is compared is necessary.
Long-term outcome revealed a reduced
height of jump in 10 out of 11 cats. Jumping
and climbing were the activities most likely to
be affected after carpal arthrodesis. Previous
reports have stated that feline carpal arth-
rodesis would lead to a loss of normal joint
function, in particular supination and pro-
nation. Loss of pronation and supination
could influence the cats’ ability to adapt the
paw position, therefore influencing the cats’
climbing or landing skills. However, none of
the owners thought that ability to groom was
affected by carpal arthrodesis. Unwillingness
to jump and reduced height of jump (71%)
have also been reported to be affected in a
population of cats suffering from osteoar-
thritis (16). Other clinical parameters such as
seeking seclusion, resentment of handling or
vocalisation if handled were also present.
None of these signs were reported in our
study. Demeanor was affected in two out of 11
cats, and was defined by the owners as their
cats being less willing to go outdoors. Both
these cats also had a decreased height of
jump, and some degree of disability whilst
jumping and climbing.
Overall disability was considered minimal
(0.81; worst possible score 4). An excellent
outcome was achieved in seven out of 11 cats
and a satisfactory result was achieved in the
remainder. According to the owner question-
naire, none of the patients were being treated
with analgesic medication. One of the main
limitations of our long-term assessment was
the lack of veterinary examination. Assess-
ment of pain in cats is difficult since they ap-
pear to be less demonstrative when they are
experiencing pain compared to dogs (16). It
may therefore be possible that the require-
Vet Comp Orthop Traumatol 6/2009
ment for analgesic medication was underesti-
mated.
In view of our results, carpal arthrodesis is
a suitable salvage option to treat severe carpal
injuries in the cat. It is associated with com-
plications that did not result in poor func-
tional outcome, and did not require major
surgical revision during the available long-
term follow-up period. Although the re-
sponse rate to the owner questionnaire was
good (55%),non-response reduced the effec-
tive sample size available for the assessment of
long-term functional outcome (24). The need
for augmentation when dorsal plating is used
is questionable, and ParCA should be con-
sidered when carpo-metacarpal instability is
present in isolation. Owners should be in-
formed about the possibility of their cat ex-
periencing a reduction in height of jump, and
to expect some mild disability during jump-
ing and climbing. No superior surgical tech-
nique was encountered, however a small
study population was a significant limitation
of this study, and some techniques were used
in single cases only.
Acknowledgements
We would like to thank Prof. Kenneth
Johnson from the University of Sydney for
the contribution of two cases to this clinical
communication.
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© Schattauer 2009