| Population: |
Dogs weighing between 1.4–35 kg with fractures in the metacarpals or metatarsals in one leg (1986–1996) all meeting the metabone empirical “surgical criteria” of one or more of the following:
All cases came from a single institution, the University of Pennsylvania (USA).
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| Sample size: |
25 dogs. |
| Intervention details: |
Fracture displacement ranged from none to severe and there were two cases of open fracture. No dogs had other orthopaedic trauma or disease. All owners were encouraged to have surgical fixation due to aforementioned recommendations. Follow up was 9–68 months.
Surgical or conservative treatment was assigned based on each owner’s decision, which divided the cases into 2 groups.
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| Study design: |
Retrospective case series. |
| Outcome Studied: |
Outcomes were determined with a combination of preprepared telephone questionnaires (n = 25) and recheck examinations within the hospital (n = 19) to determine the dog’s clinical outcome at follow up times of 9–68 months after injury. Scores were given as:
1 (Completely normal) 2 (Imperfect result).
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| Main Findings (relevant to PICO question): |
The outcome was not statistically affected by surgery or conservative treatment. Owners/clinicians rated perfect results in 9/16 (56%) of conservatively managed cases and 7/9 (77%) of surgically managed cases. To keep scoring consistent if either client or vet gave the patient an imperfect score, they were allocated an overall score of a 2 (imperfect result). All 9 surgical cases had clinician rechecks whereas only 10/16 conservatively managed cases had clinician rechecks. Age and weight were not deemed statistically significant in either group though the conservatively managed group was on average younger and lighter (28 months vs. 42 months and 12 kg vs. 16 kg). Fracture displacement was not statistically significant between both groups. 2 dogs in each group had at least one articular fracture and all four cases recovered completely so this was not deemed statistically significant. Fracture configuration (complete vs. comminuted/open vs. closed) had no significant influence on outcomes in either of the two groups, however there were only two open fractures. The number of metabones fractured also had no significant statistical influence on outcomes in either group. The conservative group consisted of cases with 2–4 metabone fractures and the surgical group consisted of cases with 2–4 metabone fractures. Overall recovery time was longer in the surgically treated group: conservative – mean 7.1 weeks, median 7 weeks; surgical – mean 27.6 weeks, median 12 weeks. Surgical implants required removal in 4/5 IM pin cases and the ESF case. Reasons not reported.
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| Limitations: |
Retrospective case series are a weaker form of study regarding strength and quality of evidence. Surgical vs. conservative treatment was assigned based on the owners’ decisions so it was not a randomised or blinded study. The predicted success of the fracture management choice still could have been influenced by the surgeon even though all cases were recommended to have surgery. The cases included in this study are from between 28–36 years ago. Advances in surgical treatments have progressed in this time. Small sample size. The significance of open vs. closed fractures could not be assessed due to only one open fracture in each group. Compliance with conservative group was reported to be low with regard to splint changes and hospital follow up in person which could have affected outcomes. Studies relying on owners making the final assessments can be highly inaccurate. Some of the follow up in person veterinary assessments in the conservative group were reported, by the author, to be too early in the recovery period to give an accurate final outcome in these cases. The surgical intervention technique was not standardised so comparing surgery to conservative management is difficult given there can be very varied outcomes between different surgical approaches. Follow up radiographic assessment was not consistently performed.
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