Radiology Case Presentation

Veterinary Radiology Case Presentation
Calcaneoquartal Joint (Tarsal)

Subluxation in Cat
Valiente, Minette Ashley C. DVM-4B
OVERVIEW
• Tarsus (hock) consists of the tarsal bones and joints between
the crus and the metatarsus
• Complex joint, so many varied injuries can occur
• Subluxation and Luxation are important conditions affecting
the joints
• Disruption of the ligaments between the calcaneus and
fourth tarsal bone results in subluxation of the two bones.
SIGNALMENT
• Species: Feline
• Breed: Puspin
• Age: 3 ½ years old
• Sex: Male
• Color: Brown, gray, white
• Body weight: 3 kilograms
Figure 1. Patient named Bless with fractured left hindlimb

HISTORY
• History taking: open-ended story telling
• According to the owner they let to roam around outside the
house looking for female cat. That night he got troubled with
other male cats and went home having an impaired walk.
ETIOLOGY
• Blunt trauma
PRESENTING SIGNS
• Non-weight bearing hindlimb lameness
• Pain in the left hindlimb
PATHOPHYSIOLOGY
ANATOMY
• General
• The tarsus is a composite joint of the seven tarsal bones held together
by a variety of ligaments.
• The fibrous component of the joint capsule forms a sleeve extending
from the distal tibia and attaching at the proximal metatarsus
• This supporting sleeve contains all of the tarsal ligaments
• This complex ligamentous support is critically important to the normal function of
the joint
• Many injuries to this area involve the soft tissue supports and result from
spontaneous over-stress or direct injury from outside forces
PATHOPHYSIOLOGY
ANATOMY
• Individual Bones
• Seven individual bones are
members of the complete tarsal
joint
1) Talus (tibial tarsal bone)
2) Calcaneus (fibular tarsal
bone)
3) Central tarsal bone
4) Fourth tarsal bone
5) First tarsal bone
6) Second tarsal bone
7) Third tarsal bone
Figure 2. Bones of the left tarsus, dorsal aspect.

PATHOPHYSIOLOGY
ANATOMY
• Individual Bones
• Calcaneus
• Largest of the tarsal bones, forms
articulations with the talus and the
fourth tarsal bone, and has a
small articulations with the central
tarsal bone
• Fourth tarsal bone
• Spans the central portion of the
joint laterally, forming articulations
on the medial surface with the
central and third tarsal bones
• It articulates proximally with the
calcaneus and distally with the
fourth and fifth metatarsal bones Figure 3. The tarsal bones—calcaneus and fourth tarsal bone
PATHOPHYSIOLOGY
ANATOMY
• Articulations
• 6 main articulations *Proximal intertarsal joint
1) Tarsocrural (talocrural)
2) Talocalcaneal
3) Talocalcaneocentral
4) Calcaneoquartal
5) Centrodistal
6) Tarsometatarsal
Figure 4. The tarsal joints, plantar aspect. IV, fourth tarsal bone; III, third
tarsal bone; II, second tarsal bone.
PATHOPHYSIOLOGY
ANATOMY
• Ligamentous Support
• Lateral and medial support is
provided by lateral (fibular)
and medial (tibial) collateral
ligaments, respectively.
• The lateral (fibular) collateral
ligament has three defined
components:
1) Long lateral ligament
Figure 5. Medial and lateral ligaments of the tarsus. C, calcaneus; T, talus;
2) Calcanofibular short ligament T2, T3, T4, second, third, fourth tarsal bones; II to V, metatarsals.
3) Talofibular short component
*small avulsion fractures can
arise with detachment of these
ligaments
DIAGNOSTIC INVESTIGATION
• Careful and thorough physical examination is done because
different problems that may affect the tarsus.
• Observation and palpation for swelling and or pain due to
localize injury.
• Systematic check for palpable instability are carried out
with the joints stressed in mediolateral and dorsoplantar view
• This examination is done as the animal is sedated or anesthetized in
preparation for radiography
RADIOGRAPHY
Figure 6. The animal is in anesthesia. Positioning of the animal in lateral recumbency for
X-ray with the left hindlimb positioned
RADIOGRAPH
Figure 7. (A) Mediolateral view of the left hind limb

(B) Dorsoplantar view of the tarsus, metatarsus,
and phalanges.
A B
RADIOGRAPHIC FINDINGS
Subluxation of the Calcaneoquartal joint
• This follows trauma and can be

recognized in association with collateral
ligament rupture
• The medial ligaments are disrupted most
frequently because the medial site of the
joint is subject to greater stress
• Rupture due to sprain injury or avulsion
of the collateral ligament from the
bone produces subluxation as lateral
and medial sides are affected.
• Ligament is torn or stretched at its
Figure 8. Red circle denotes the subluxation
midportion of the Calcaneoquartal joint
TREATMENT
• Fracture
• Support by application of
cast or splint in affected
bone to restrict fracture
movement, reduce pain
and prevent further tissue
damage or possible
hemorrhage
Figure 9. Application of elastic support bandage in left hind limb

TREATMENT
• Stabilize patient
• Anti-inflammatory and
Vitamin B complex is
prescribed by a
veterinarian
Figure 10. Prescription of Tolfenamic acid and Vitamin B-Complex for

the stabilization of the patient
MANAGEMENT
• Conservative management
• Strictly cage rested to minimize movement and allow the fracture to
heal
• Ensure the bandage is kept clean and dry and possibly change when
needed
CLIENT EDUCATION
• Recommended for CBC but client
declined.
• The client is advised to restrict
spontaneous movement of the animal by
confining in a cage until complete
recovery is achieved.
• Follow up check up and follow up X-ray
after a week to asses healing progress.
• If appropriate, diet may need to be
changed where malnourishment or Figure 11. Presenting the radiograph and prescription to client
metabolic disorder is present, to ensure
strong, healthy bones of the animal.

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Veterinary Radiology Case Presentation

Calcaneoquartal Joint (Tarsal)

Figure 1. Patient named Bless with fractured left hindlimb

Figure 2. Bones of the left tarsus, dorsal aspect.

Figure 7. (A) Mediolateral view of the left hind limb

• This follows trauma and can be

Figure 9. Application of elastic support bandage in left hind limb

Figure 10. Prescription of Tolfenamic acid and Vitamin B-Complex for

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