Broken Metatarsals in Dogs 101
September 24, 2012 7:06 AM   Subscribe

Fractured metatarsals in dogs. My dog has broken three metatarsals in one hind paw - the fractures are straight across in the same line. We've been advised to see an orthopedic vet to discuss surgery vs. splinting. What should we know going into this meeting? Can you suggest good questions to ask? Can this kind of injury be caused by stress, i.e. jumping on a hard surface?

Our dog was at a kennel (thankfully attached to a veterinary clinic) for a few days. One day into his stay, they were concerned about a limp, did a manual exam, and discovered that his paw was extremely painful. X-rays show that he has three broken metatarsals in one hind paw. The fractures are all in one straight line across his foot.

The kennel claims to have no idea how this happened. Nobody saw anything out of the ordinary happen while the dogs were playing, and nobody noticed him getting a paw stuck or stepped on. According to the vet, one of the employees went to take him from his cage out to the yard for supervised play group, she noticed him limping, watched for a few minutes, and called the vet to take a look. The vet's theory is that it is basically a "stress fracture" caused by repeated jumping up in the indoor cage, on the hard floor. Our dog does jump quite a bit (not on people, just in excitement) and I'm wondering if this is indeed possible.

This kennel is known to be excellent, and we've had a very good relationship with them. He frequently goes to "doggie day care" there, and has boarded numerous times. Each dog has an indoor/outdoor space, it has a very stable set of employees, and it's attached to a well-known and well-regarded veterinary clinic. Our dog is a bit of a jerk, but they've handled him well, and he has come to really like most of them. He's been going there for years, and they know which dogs he gets along with, and can tell when just needs to be alone with no other dogs. I'm highly involved with dog training and dog rescue, and am very apprehensive about most dog boarding places for being too frou-frou (and humanizing) or too wild (and domineering). This is one of the first places that has not raised my spidey sense, at all.

In other words, when they say they have no idea how it happened, I really have no reason *not* to trust them. But there was something about the vet's non-stop and frantic chattering about the situation, and his later offer of a slimy apology without actually apologizing ("While we cannot identify anything that occurred because of negligence or other harm, we're of course sorry that it happened here, etc.") that made me question the story a bit. While I was in the vet waiting room, a kennel worker brought over our dog bed and leash. She kind of mumbled "he's being so brave" and took off - even though we've interacted with her lots before.

I don't want to obsess about how it happened. I know that "these things happen" especially with dogs. We might never know what caused it. But I'd love a sense of whether or not this story is even plausible.

The vet said the fractured ends of the bones are overlapping a bit, and that with more than one fracture, he recommends seeing an orthopedic vet. We have an appointment for Monday. He's currently in a splint / cast to immobilize his paw. At our appointment tomorrow, we will be discussing surgery vs. immobilization. There seems to be a recommendation that more than 1-2 metatarsal fractures requires surgery. Others say that immobilization is best unless the paw is seriously disfigured or crushed. The surgeries have mixed outcomes, and can have some real trouble healing because of reduced blood flow in dog paws. Exterior immobilization (splint and cast) can have mixed results too.

1. Can stress from jumping cause *three* simultaneous metatarsal fractures? Most studies and anecdotes seem to show fractures caused by trauma - an object being dropped on the paw, or stuck in a door, or run over, or some other specific traumatic accident. I couldn't find any mention of a stress fracture causing three simultaneous breaks. What's the likelihood this was caused by jumping?

2. What kinds of questions should we be asking the orthopedic vet? If you've had a dog who had surgery, what do you wish you'd known ahead of time?

3. Any tips on keeping an active dog semi-immobilized for months?

4. Any tips on pain management for dogs? Other supplements?

Thanks for any suggestions in terms of our initial meeting with the vet, or in terms of long-term care for our little furry friend.

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posted by anonymous to Pets & Animals (3 answers total)
You brought a healthy dog to a kennel and they returned the dog with three broken toes, all broken in a line which suggests that a door was closed on his foot or a uniform object like a brick was dropped on it. I would not be satisfied with their explanation, and I would want to know whether they plan to cover any or all of the bills.

I am not a vet! I don't know if it could be caused by jumping, but I've never heard of that. I know we've got vets around so hopefully you'll get a good answer. I hope he feels better soon!
posted by Glinn at 9:51 AM on September 24, 2012

I'm sorry that this happened to your dog. It's hard, as an owner, to know exactly what to do. I recently had to deal with a sudden-onset problem in my 8-year-old Westie. He developed a sudden limp/lameness in one leg which turned out to be a CCL tear (the best way to put this was his knee blew out). Hopefully, my experience with getting this fixed can help in your questions about keeping the dog immobilized, pain management, etc.

The first thing I'd do if I were you is get a second opinion. Take the x-rays. Bring the dog in and explain that you want a second opinion. I wouldn't even necessarily start with an orthopedic doctor, either. What does that regular doctor say about the injury, its speculative origins, etc? If the doctor says yes, orthopedic surgeon, then I'd go to an ortho.

What does the 2nd opinion doctor say about other ways to manage the injury/healing? I suspect the answers will depend on the age and size of the dog--with my 8-year-old Westie, we needed to correct the injury surgically to spare him intense pain the rest of his life (we expect another 7-8 years from him). There were a number of options, and we decided on replacing the blown out ligament a surgical nylon suture, instead of a more complicated bone-cut and re-positioning. We did this because at about 20 lbs, he was a good candidate for this correction. He is low to the ground, doesn't do a lot of jumping, and didn't necessarily need the reinforcement of a cut and screwing procedure. And, we had his normal vet do the operation--not an orthopedic vet. After speaking with him at length, and speaking with his staff about other cases he'd handled--I determined we would not really gain much, if anything, from going to a specialist.

Keeping a dog immobilized is a challenge, but can be done. We had to keep our Westie crated all day for about 8 weeks post-op. He is used to sleeping on the bed with us at night, and to prevent accidential re-injury, we actually moved the mattress to the floor and slept like that for a couple of months so he wouldn't jump down off the bed. We had to ice his surgical site and massage his knee/flex his leg while he was on walking restriction for about 2 weeks. This was hard, and it required one of us to work at home at all times the first week to 10 days. And carrying him up/down stairs was tiring. His mental challenge was worse, I think: he really wanted to go outside and just sit and enjoy his yard, as he was apt to do. But he had to be short-leashed for all of his outside treks, which were all bathroom walks. If you have ever had to care for an infant, it was much like that--constant attention and supervision, plus intense care.

Pain needs to be managed. A dog in pain can turn aggressive. Your goal, of course, is to keep him comfortable. We used a combination of things: medication (tramadol), the surgery, icing, massage, and also k-laser treatments of the surgical site. We didn't have any problems with our Westie's pain level--he was comfortable during his recovery--but I would ask the vet what the expectance of recurrance or "phantom" type pain is (when the dog is recovered), and what happens if the course of treatment isn't working.

We immediately put both of our dogs on Dasuquin for joint mobility; not sure if it would be helpful in your specific injury, but it has rave reviews for keeping dogs spry into their elder years.

One more tip: some dogs don't like those cones (e-collars) they have to wear to keep from bothering a surgical site. For my Westie, it was no big deal. But for our goldendoodle, who later that year had to have a tumor removed from her neck, you'd put the cone on her and she'd just hang her head and refuse to move. There are inflatable cones that work really well for about $30 at Petsmart.

Best of luck.
posted by FergieBelle at 10:03 AM on September 24, 2012

IANYV, I'm just a lowly former vet nurse. But I've worked with an excellent orthopaedic specialist and have dealt with a lot of owners facing months of kennel rest for their dogs.

Here is what I would do if I were you:

1. If this is really bothering you get a second opinion. I don't know about the US, but in the UK you are entitled to have your dog's x-rays and medical history sent to another practice for evaluation. That's the only way you'll be able to confirm whether the explanation adds up. FWIW however I have doubts as to whether you'd get a satisfactory answer, just judging by the nature of the injury. But if it puts your mind at ease then go for it.

2. Ask the orthopaedic vet about how to keep the wound clean, whether follow-up therapy will be necessary to prevent arthritis down the line. Find out how often he should be seen for follow-ups. Try to get his instructions down in writing so you don't forget anything.

3. Choose a crate that's easy for you to move around your home. Let your dog be around you during social times, talk to him, interact, etc. It will help stop him from getting bored. Also try investing a food puzzle, like a Kong stuffed full of peanut butter or hard to get treats. Stick to routines as best you can: take him out or feed at the same times everyday. That should help him settle into crate life a little bit better.

4. Your vet should give you all the pain relief you need, along with instructions for any additional care you can give. I'm sure you know never to give more than what's prescribed. Don't diagnose pain yourself - the first few days post-op may be stressful, and could cause him to act like he's in pain when he's not. It's hard to judge, but try to keep track of potential pain symptoms as the days go on by pain scoring. That way you'll have a better idea of whether he's getting better or staying the same. For the first few nights, make sure he's got a nice comfortable bed and light blanket. You'd be amazed how much that can help keep dogs comfortable and calm. If you really think the drugs you've been prescribed aren't working, then call the vet before you give anything else.

Hope that helps. Good luck.
posted by wigsnatcher at 10:47 AM on September 24, 2012 [1 favorite]

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