Pancarpal Arthrodesis

Pancarpal arthrodesis is surgical fusion of the wrist joint (carpus). The most common reasons to do this operation are fractures of the carpus, instability of the carpus, and pain or inflammation of the carpus, usually when no better treatment option exists. It is the definitive solution, is a “salvage” surgery and is not reversible — it is typically performed when all other treatment options have been exhausted or are thought not to be suitable.

Alternatives to consider before pancarpal arthrodesis include:

• Conservative management — exercise restriction and pain-killer anti-inflammatory drugs to control the problem as best as possible. Usually the problem is not going to get better by itself, but if your dog is coping well with this, it is a reasonable option.
• A brace for the carpal joint — to help support the joint and limit instability and pain. These can work well in some dogs, but other dogs and owners find them fiddly and that the brace does not work so well. Sometimes they don't fit as well as they should, can slip and cause rub sores, and some dogs do not tolerate them. A brace can be worth a try, but you have to accept it may not work as well as hoped for.

Outcome after pancarpal arthrodesis is expected to be excellent, with normal or near normal limb function expected. A subtle mechanical lameness is permanent as the wrist joint can no longer flex and extend.

All surgical procedures have the potential for complications. The published complication rate for pancarpal arthrodesis in dogs is just under 20%, of which infection is the most common complication. At Arthurs Veterinary Specialists, we estimate our complication rate to be less than 10%. Of the dogs that get infected, 50% respond positively to antibiotics and resolve completely; the other 50% are more problematic and may need implant removal, which can then expose the arthrodesis site to late failure — although this is a very uncommon, near worst case scenario. The absolute worst case scenario would be uncontrollable infection eventually necessitating amputation, but this would be extremely rare.