Hi Christopher, welcome. Sorry your post took so long to get approved. Your future posts won't need to wait for approval so post away!

I'm sorry your dog has been in this situation, poor guy. He sounds like an otherwise spry and healthy pup! I see why you are hesitant to do either procedure.

Others have faced this decision before. All the complications and issue you point out about arthrodesis are spot on.

You can see what one of the world's best board certified vet surgeons, Dr. Sherman Canapp and his vet rehab therapist wife/practice partner has to say about arthrodesis, in this interview, Pet Prosthetics and Braces Questions and Answers, Part 2. 

Keep in mind that they were discussing the procedure for a dog who was already a Tripawd, but the issues they point out are the same for a four-legged dog.

[0:50:53] What about joint fusion surgery for a rear-leg Tripawd with arthritis?

DR. SHERMAN CANAPP: Just say no.

DR. DEBRA CANAPP: Just say no. Do everything you possibly can to avoid it. I mean there is a place for arthrodesis but I think we’ve done maybe like count on one, maybe one and a half hands, because we really tried to avoid it.

DR. SHERMAN CANAPP: Line up 10 surgeons giving a 10 different answers but I tend to be very conservative and holistic and think outside the box. You can always do surgery but you can’t undo surgery. And whether you’re fusing a wrist or fusing an ankle or a carpus or tarsus, they are plagued with complications. Complications of joint fusion surgery include:

• You are mobilizing this limb. You don’t have a whole lot of soft tissue here, your wrist or your ankle so it rubs on the soft tissues. They can break them down.
• The screws can fall out. They can get infected.
• It’s cold-sensitivity. You’re out in the snow or in the cold, you have no soft tissues here when they are walking and the metal very quickly gets cold. They can break.

I had one where I did a carpal fusion. The dog was in a cabin with his owner up in Vermont. There was a bear. The dog tried to get the bear. The plate broke in half. Things can happen. There are so many great orthopedic devices now. These support wraps and hinged wraps and braces and things that if it was my own dog, I would try 19 different ones of those before I would ever throw a plate in my dog’s ankle or wrist. 

I just would not do them anymore. I have seen so many complications, and not necessarily my complications. I never say, “Oh, I’m a carpal surgeon.” I see – we all have – I’ve had mine.

When you do this also, again, you’re putting metal and they swell, so they need to be ready to have leeches available because if you have too much swelling in the wrist like a tourniquet, all of a sudden, you can lose toes, you can have skin slough.

Joint fusions: just say No

The bottom line is, I’m not a big fan. Now, the surgeon she is probably chatting with is a probably a huge fan maybe because they have done it a million of these.

I just would rather go with an orthotic, perhaps some sort of device that gives some support but doesn’t fully lock out the wrist or the ankle. Because it’s like a spinal fusion, you fuse here, we have domino effect. All of a sudden, you have an issue here. You fuse here, domino effect. The same with fusions in the back, spinal surgeons are so quick to fuse on the human side where you could have it just as good outcome with PT.

I would rather this person, and thank you for being a VOSM patient, I would rather you try a bunch of different support wraps before you think about fusion.