There are four larger bones of the hind and forelimb paws called the metatarsals and metacarpals, respectively. A set of three smaller bones is attached to each of the metatarsal and metacarpal bones, which form the toes, also known as the digits. These toe bones are called phalanges.
The most common cause of phalangeal fractures include being stepped on, being hit by a car, getting the toe caught in a slatted floor (deck) or fence, or stubbing the toe. Sometimes the injury will result in an open wound over the fracture in which dirt and hair usually are driven into the tissues. This could potentially result in infection and delayed healing of the fracture.
The clinical signs of a phalangeal fracture include lameness, swelling and abnormal movement of the affected digit (instability). In order to diagnose a fracture, X-rays of the affected area are needed. Prior to anesthesia and surgery, blood work is done in order to evaluate the health of the internal organs.
There are three treatment options for phalangeal fractures: primary surgical repair, splinting/casting, and amputation of the digit. Surgery involves realigning the fractured bones and securing them in place with a combination of plates, screws, pins and wires. Depending on the type of surgical repair used, a splint may be needed for four to five weeks after surgery. Casting the paw for eight to ten weeks after surgery is another option. Toe fractures that are treated by casting frequently heal with only a fibrous tissue; therefore, successful bony union may not occur. Some dogs will tolerate this and still do well.
In the event that your companion is still painful due to failure of bony healing, amputation of the digit can be performed. If the most inner or outer toes are amputated, limb function is generally unaffected. Amputation of one or both of the middle two toes may impede function or cause lameness, as these bear most of the weight. Your companion’s surgeon will make a recommendation for the best treatment option.
Surgical repair of a phalanges fracture with implants allows for the best outcome. Uncommon complications following surgery include infection, failure of healing to take place, breakage of the metal implants and cold sensitivity.