The Carpal device can be used for a number of conditions affecting the Carpus such as:
- Hyper-extension instability
- Varus/ valgus deformity
- Medial and lateral collateral ligament injury
- Neurological positioning control
- Post-op arthrodesis support
- Osteosarcoma palliative care
- Post limb-spare surgery
Is the Carpus Orthosis The Right Solution For Your Dog?
Injury to the carpus (wrist) can be complex because the joint itself is complex. The carpus is composed of 3 joints, 7 carpal bones, 2 antebrachial bones (radius and ulna), and 4 or 5 metacarpal bones. There are multiple ligaments holding this structure together. Injuries can occur at any of the 3 joints (antebrachiocarpal, middle carpal, or carpometacarpal); additionally any of these bones can be displaced (luxated) or fractured.
Clinical signs of carpal injury include lameness, swelling, and mal-alignment. Mal-alignment can include hyperextension and/or increased angling of the paw toward the midline (varus) or away from the midline (valgus). Minor injuries will resolve with rest and a temporary splint. More severe injuries require surgery or an orthosis. Common surgical approaches include repair of large ligament injuries when possible, screw fixation of fractures of the large carpal bones, partial or complete fusing of the carpus (arthrodesis) so that it no longer bends (articulates). Orthosis options include devices with and without paw segments and devices that bend and those that don’t. The design of the device depends on the type and severity of injury. An orthosis is considered an excellent option when surgery is not appropriate, not necessary, or not possible. It is also used to support some surgical procedures as a splint alternative, because it can be removed for daily examination of the incision and can get wet!
Because an orthosis is not the correct therapy for all patients, before choosing an orthosis the following points are important to keep in mind:
- Device design is paramount to success. Careful consideration is taken in prescribing a device and its specific components. Important clinical variables surround use of a paw segment and whether articulation by way of hinges is possible.
- The paw segment is required in the following circumstances: short or fractured metatarsal bones, instability of middle or distal tarsal joint, severe hyperextension or more than one plane of instability, excessive dewclaws, deranged digits, flexor tendon failure or clawing at the digits, wounds associated with the paw. Without a paw segment these patients are at risk for poor control of their pathology and most importantly, serious skin trauma/wounds due to uncontrolled pressure and friction.
- Articulation (hinging) is ideal whenever possible in order to provide as close to normal limb use as possible. Articulation is possible at the carpus and the paw. When an orthosis is intended as an alternative to arthrodesis, the articulated carpus device is a tremendous advantage. With this design, the carpus can flex if appropriate and yet be limited to flexion within safe parameters only; this is called an arthrodesis-on-demand. Articulation cannot be provided under the following circumstances: severe carpal malalignment, bone tumors near the carpus, metacarpal fractures, and non-reducible carpal bone luxation. When articulation is not possible patients will not have a completely normal gait in the device; however, an orthosis can provide significant improvement as a part of an overall treatment plan
- The device MUST be put on and removed daily: The orthosis stabilises the tarsus from the outside, while surgery does so from the inside. Therefore it is important to follow the exact wearing schedule provided by OrthoPets. Wearing schedules vary with type of injury.
- Wearing in period: A typical tarsal device requires an initial wearing in period of 2-4 weeks, to allow the skin to become accustomed, just like getting a pair of orthotics in your shoes. After this, the device can be worn all day like a pair of shoes, and needs to be removed overnight.
- Adjustments are expected and are a normal part of the custom orthosis process: The device is custom-made for your dog. Every effort is made to accurately fit the device and 2 follow up appointments are recommended within the first month of fitting, in order to meet the requirements for an appropriate fit. These appointments are at the Orthopets Melbourne clinic at Dogs In Motion(fitting day and one additional appointment). There are 2 free adjustments (plus consultation fees) within the first 2 months(excluding shipping for out of state patients). After this time adjustment fees will be charged. For out of state patients the device can be posted to us for adjustment and will then be shipped back to you. Please contact us first if you feel your device needs and adjustment so we can get as much information as possible prior to receiving the device. Sometimes it’s just a fitting issue that can be resolved after we see video of you putting the device on and your pet moving in the device. This will also save you time. Importantly, your dog is much more active at home than at the veterinary clinic. Increased activity and activity intensity can expose fitting issues requiring further adjustment. Additional adjustments if needed are most commonly required in the first few months and as time goes on (see importance of follow-up #5). Please follow all instructions with regard to monitoring the leg and contact us and your veterinarian promptly if you have concerns.
- Follow-up is critical to success: An orthosis is considered a “durable medical device.” This means that proper use is necessary to meet therapeutic goals and to ensure its safe application over the lifetime of your dog. In the first few months of fitting your veterinary team with the help of your OrthoPets case manager will work with you coaching with regard to device use and rehabilitation. Annual to twice annual appointments are advised depending on age and activity of your dog. At these appointments your OrthoPets case manager will thoroughly assess your dog’s orthopedic condition and evaluate the condition and fit of the device. Recommendations will be made for continued success in the device.
- Rehabilitation, the first key for success: Most dogs adapt quickly to wearing an orthosis. Behavioral techniques can facilitate this. Also your dog will need to learn basic skills while wearing the device. These include: transitions (sitting, lying down, and getting up), stairs, getting into vehicles safely, managing on different types of surfaces (ground, carpet, hardwood floor, etc.). Finally, orthopedic injury leads to compensatory abnormal movement and associated muscle strain and weakness. The best way to ensure the highest level of success is to follow the recommended rehabilitation schedule and techniques. Each patient’s condition and abilities are unique and as such an individualised rehabilitation program is needed. Your physiotherapist at Dogs In Motion Canine Rehabilitation Centre will design a tarsus device specific plan for your dog. If you are not located nearby, we can put you in touch with an animal physiotherapist / rehabilitation therapist in your area
- A proactive approach to arthritis management is the second key to long-term success: If the joint itself is injured rather than a ligament alone, osteoarthritis may develop. Just as rehabilitation is important, arthritis management is key as well. Steps taken early and continued throughout your dog’s lifetime will make a difference in terms of regaining and maintaining comfort and an active life-style well into the senior years. Your pet’s veterinarian and animal physiotherapist can create an individualised, integrative arthritis management plan for your animal.
- The Process: In order to make a device that fits your pet’s leg perfectly, a fibreglass impression must be made of the limb. Please ensure you watch the casting video first prior to commencing (http://vimeo.com/24063805). If the cast is not done correctly, we will ask you to repeat it, to avoid unnecessary adjustments having to be made down the track. Some measurement forms will also need to be completed by your pet’s vet. The fibreglass cast impression and forms need to be sent to Orthopets Australia for final checking. If the cast needs to be repeated, or additional information is required, we will contact you and let you know. If the cast is completed correctly and we receive all the additional information, we will then contact you for payment prior to shipping to the USA. Once the cast reaches the USA, it will be manufactured and returned to us here at Orthopets Australia, before being sent on to you, or fitted in our clinic. This process typically takes 3 weeks. If you require a rush service there is an additional fee. This generally reduces the whole process down to 2 weeks.
- Pricing:These are prescriptive devices so fees will vary from case to case. Please contact us for a quote.
- Payment: Payment of the total fee is required prior to shipping the cast impression to the USA. Once the cast impression reaches the USA and your individual orthosis / prosthesis design is decided, we will contact you if any additional small fee is required. Payment can be made by credit card, EFTPOS or direct debit.
- Questions: Please don’t hesitate to contact us if you have any questions.
To Complete Your Order Please Complete The Following:
If you would like to make an appointment in our clinic to have your dog assessed and cast for an OrthoPets custom device, please call us for an appointment on 03 9553 0896.
You do NOT need to complete any forms or watch the video prior to this appointment but we will need a medical history from your pet's vet.
If you cant come to our clinic due to distance, you will need to download and complete all the forms below and have your pet's vet or animal physiotherapist complete the cast impression and measurements of the limb
- Download the Checklist
- Download and complete a Patient Referral Form
- Download and complete a Customer_Contract
- Download and read through the Carpus Fibreglass Casting Impression Instructions
- Download and complete the Carpus & Paw Measurement Form
- Download and complete the Transfer Form to choose your device colour
- Please watch the video below before making your cast impression