Clinical and radiographic aspects of metacarpal remodeling secondary to a rubber band (Latex) compression in a dog

Abstract

Background: Musculoskeletal disorders are a common complaint in veterinary small animal casuistic. Along with fractures, degenerative and of carcinogenic etiology are the most frequent and radiographic lesion pattern at these diseases is relative well defined. However, traumatic lesions, considering its innumerous possibilities, may cause unusual clinical and radiographic signs which will delay diagnosis and consequently, adequate treatment. A case of bone osteolysis caused by a compressive trauma by a rubber band is described with its clinical, laboratorial and radiographic aspects. Case: A 2-year-old female dog was attended at the Veterinary Hospital of the Dom Bosco Catholic University (UCDB), with main complaint being an unresponsive to treatment lesion at the left thoracic limb. At physical examination it was observed lameness of the left thoracic limb with an ulcerative lesion at the palmar surface. At the center of the ulcer a 0.3 cm line shaped yellow object was identified, similar to a rubber band. Traction was made and the object distended 5 cm without breaking nor leaving the injury. Showing signs of discomfort, the patient was then sedated for further manipulation. A blood sample for complete blood count and serum biochemistry was collected and radiographic image of the left carpometacarpal-phalangeal region was acquired. Blood analysis revealed moderate thrombocytopenia with an unremarkable serum biochemistry profile (alanine aminotransferase, alkaline phosphatase, creatinine and urea). It was observed metacarpals with increased radiopacity in bone tissue in the mid-diaphysis topography of the II, III, IV and V metacarpal bones, presence of bone remodeling with radiolucent area and slight bone loss (osteolysis) in the mid-diaphysis associated with discrete sclerosis of the medullary cavity of the II, III and V metacarpals. The patient was submitted to surgery and a 3 cm incision was made following the way of the foreign body, with a small traction the object was removed, confirming the presence of a rubber band. Post-surgery prescription included systemic antibiotic, non-steroidal anti-inflammatory, analgesic and topical ointment. Twenty-two days post-surgery, at revaluation, it was observed only discrete improvement of bone remodeling of V metacarpal but with complete wound healing and full recovery of the lameness. Discussion: It was unclear the reason that led to the presence of the rubber band. Unfortunately, the owner could only complaint about at wound that would not heal for weeks. The best hypothesis was the possible use of a beauty accessory after a bathing service. Considering the patient’s long hair, detachment of any accessory to a rubber band base could have gone unnoticed. Definition regarding the time period since the initial trauma would define for how long the compression was necessary to induce metacarpal remodeling, but the presence of the foreign body and consequently, continuous stimulus of inflammation, would not permit a precise definition regarding the time period of the lesion, even if histopathology was authorized. Surgical removal of the rubber band associated with non-steroidal anti-inflammatory, analgesic, systemic and topical antibiotic (ointment) was considered satisfactory, leading to considerable improvement (normal gait) of the nociception and lameness at day three post-intervention and despite persistence of the bone radiographic aspect, full recovery of the skin lesion at day twenty-two.