Surgical stabilisation versus external coaptation for treatment of metacarpal/metatarsal bone fractures in dogs

PICO questionIn dogs with metacarpal and metatarsal fractures, does open reduction and surgical stabilisation compared to closed reduction and external coaptation (non-surgical stabilisation) lead to an improved likelihood of bone union and resolution of lameness? Clinical bottom line Category of researchTreatment. Number and type of study designs reviewedFive retrospective studies that directly compared surgical intervention to conservative management of metabone fractures were critically reviewed. Strength of evidenceWeak. Outcomes reportedExternal coaptation may lead to successful clinical outcomes when there is minimal displacement of the metabone fractures but malunion may be more likely when using external coaptation. Clinical outcomes may be similar in many of these patients whether we treat surgically or non-surgically, but surgery seems to be more prudent when there is a high degree of displacement. It would seem that cases that require surgery are more likely to have a higher complication rate, but this is likely due to their more complicated nature. Potentially bone plates are superior to intramedullary pinning if surgery is chosen and open reduction and surgical intervention may be more likely to result in radiographic synostosis however this may be clinically insignificant regarding functional outcome. ConclusionStrong evidence-based treatment guidelines are lacking in this area so surgical intervention of metabone fractures cannot be definitively recommended over closed reduction and external coaptation in the current literature review.