Case Reports

Case Report: Bode the SPCA dog’s tarsal arthrodesis

Posted on in Broken bone, Case Reports, Radiographs 3 Comments

Case Report: Bode the SPCA dog’s tarsal arthrodesis

 

Bode cast4

Bode sporting a dapper blue collar with matching leash and cast.
Photo Credit: Soundingsoul Photography

 

Bode is a sweet dog. He was turned over to the SPCA after it was learned that he had been limping around on a dislocated tarsus (ankle) for over a month.  His story spread across social media, with people from all over donating money to his cause.

 

 

Together with donations from local veterinary teams, he was able to undergo the treatment he needed – first to address his infected wound and painful abscessing teeth, then to fix the tarsus itself.

SPCA Bode luxated tarsus AP

Front view of dislocated tarsus.

 

 

 

 

 

Because the tarsus had been dislocated for so long, the joint cartilage was dead.  That meant there was no hope of saving the joint without leaving Bode a legacy of chronic arthritis and ongoing pain.  Instead, the decision was made to perform a tarsal arthrodesis, or to fuse the joint.  It would mean that Bode would always have a hitch when he walked, but that he would also be forever pain free in that joint.

SPCA Bode tarsal luxation lat view

Side view of dislocated tarsus.

 

 

 

 

 

 

 

 

 

 

 

 

 

These radiographs were taken when Bode was first diagnosed. The first one is a front view, and the second one is a side view of the dislocated tarsus.

 

 

SPCA Bode luxated tarsus AP graphics

Front view of dislocated tarsus (ankle) with coloured lines to show how the joint surfaces should be lining up.

 

 

 

 

 

 

 

 

 

For clarity, I’ve added fancy graphics.  These are the same two radiographs, but with the joint surfaces highlighted.  The red line traces along the end of the tibia, and the green line traces the joint surface of the talus, one of the ankle bones.

 

The first part of the surgery involved breaking down the extensive scar tissue that had formed after a month of no treatment.  Only then could the two bones be put back together.  Once that was completed, a fair amount of bone and scar tissue had to be chiselled from the tibia to make a flat surface.  It is along this surface that the stabilizing implant would be placed.

Side view of dislocated tarsus (ankle) with coloured lines to show how the joint surfaces should be lining up.

Side view of dislocated tarsus (ankle) with coloured lines to show how the joint surfaces should be lining up.

 

 

 

 

 

 

 

 

 

Once that was done, all the joint cartilage was removed and small holes were drilled into the underlying bone to stimulate repair.  A hole was also drilled in the top of the tibia and a cancellous bone graft was collected – a harvest of marrow rich in the cells needed to grow new bone – and placed in the joint spaces.  Once that was complete, the stabilizing metal implant was applied.

 

 

Side view taken immediately after tarsal arthrodesis surgery showing application of a specially designed plate for tarsal arthodesis.

Side view taken immediately after tarsal arthrodesis surgery showing application of a specially designed plate for tarsal arthodesis.

 

 

 

 

 

 

 

 

This radiograph was taken immediately after surgery.  It is a side view with a special “banana plate” applied to the tarsus with nine screws.  If you look at the top of the tibia, you can see the hole through which the bone graft was collected.

Post surgical side view of tarsal arthrodesis with graphics higlighting old joint space and bone graft collection site.

Post surgical side view of tarsal arthrodesis with graphics higlighting old joint space and bone graft collection site.

 

 

 

 

 

 

Here is the same radiograph again with more fancy graphics – the purple area represents where the remnants of the old joint space used to be.  The cancellous bone graft selection site is highlighted in red

For the next 8 weeks, Bode moved into the house of an SPCA representative.  He wore a cast to support the implant while healing began and was under strict exercise restriction.

Side view of tarsal arthrodesis taken 8 weeks after surgery.

Side view of tarsal arthrodesis taken 8 weeks after surgery.

 

 

These last two radiographs were taken approximately eight weeks after arthrodesis surgery, and show good healing.  The joint space is no longer visible.  The healing bone is not yet at full strength, but it has starting to share some of the work so Bode no longer needs a cast.  He is still restricted to leash walks, and isn’t out of the woods yet, but he is on his way to a full recovery.

Front view of tarsal arthrodesis taken 8 weeks after surgery.

Front view of tarsal arthrodesis taken 8 weeks after surgery.

 

 

 

 

 

 

The muscles in Bode’s leg are very weak and severely atrophied, so he has been prescribed a comprehensive rehabilitation program to speed his recovery.  It will teach him that he can use the leg without pain, build muscle mass, and speed his return to an active lifestyle.

Thank-you to all those who stepped up to help this wonderful dog.

 

 


How long does it take for a broken bone to heal?

Posted on in Broken bone, Case Reports, Radiographs 14 Comments

How long does it take for a broken bone to heal?

 

I’m frequently asked how long it takes for a broken bone to heal, especially by owners who are dreading the prospect of keeping their hyperactive dog on short leash walks.

Bone healing time varies depending on several factors including the age of the dog or cat, the location and complexity of the fracture, the amount of associated soft tissue damage, and the type of repair that was performed.

Wire in femur

Residual wire in old fracture: This was a dog who presented for evaluation of the cruciate ligament (notice the effusion and arthrtis in the knee joint). As an incidental finding it looks like this dog had a femoral fracture when it was quite young. The original repair was likely a pin and wire, with the pin being removed afterward. As the bone grew, it engulfed the wire, which is why the diameter of the wire loop is less than that of the adult bone.

Age: Younger dogs or cats heal faster. They are already producing new bone in order to grow, and the cellular /chemical processes for growing bone are the same as those needed to heal a fracture; enzymatic momentum is on their side. Juvenile pets heal broken bones 2-4 weeks faster than adult pets.

Fracture location: Regions with an abundant blood supply heal faster. Some regions are easier to immobilize than others and immobilization acclerates repair.

Fracture complexity: A simple two piece fracture with no displacement of the bone ends and no disruption of the surrounding soft tissue is going to heal much faster than a high energy fracture with many broken fragments that are widely displaced. Infection slows the healing process even further.

Associated soft tissue damage: Again, regions with an abundant blood supply heal faster. Soft tissue damage compromises blood supply during the initial healing stages. Extensive soft tissue damage in a region that already had minimal soft tissue (e.g.: the front leg just above the wrist) doubly complicates healing.

Healed Femoral Fracture

This is another view of the same dog. Notice that the associated hip dysplasia. Unilateral hip dysplasia can be the result of injury during puppyhood and failure to properly weight bear on the limb as the hip joint is developing. A comprehensive rehabilitation program that encourages early and full weight bearing after surgery may reduce the chance of this happening.

Type of repair: A perfect repair immobilizes the bone without disrupting any of the surrounding soft tissue. This is not always possible to achieve, but it is something that surgeons strive for. In developing a treatment plan and/or discussing your therapeutic options (e.g.: casting or splinting vs. surgical repair), your surgeon will automatically gravitate toward the therapy that will offer the most rapid healing.

For most adult dogs or cats, broken bone healing time is 8 to 12 weeks.  In puppies or kittens, broken bone healing time is 6 to 9 weeks.  Complicated fractures can take as much as 16 weeks.

Delayed Union and Non-Union Fractures.

If a fracture is not healing as fast as expected, it is called a “delayed union” and may just need more time. If that same fracture is given more time and nothing changes, it is called a Non-Union.

Non-Unions require further intervention, which usually means more surgery. Supplementing or changing the type of repair, stimulating blood flow by debriding tissue, and/or adding a bone graft are typical treatments.


X-rays: Normal Hips vs Severe Dog Hip Dysplasia

Posted on in Case Reports, Dog Hip Dysplasia, Radiographs, Uncategorized 2 Comments

X-rays of Normal Dog Hip Joints

and those with Severe Dog Hip Dysplasia

 

Dog hip dysplasia is a malformation of the hip joint – instead of a nice round ball fitting smoothly into a deep socket, the joint contains a shallow socket and irregularly shaped ball.  These malformations cause uneven contact between the joint surfaces, as well as compromised stability.  Arthritis is an expected outcome from having dog hip dysplasia.

The root cause of dog hip dysplasia is genetic, but over feeding, and either over or under exercising can also contribute to its manifestation.  In cases of unilateral (one sided) dog hip dysplasia, one has to wonder if underlying sports injury causing muscle imbalances during the puppy’s crucial developmental period of life is playing a role.

Posted below are radiographs of normal and abnormal hips.  In an effort to highlight the relevant features, I have once again called upon my limited photoshop skills.
normal hips rads

 

This first x-ray is of a dog with normal hips.  The ball is round and fits well into a deep socket

 

 

 

normal hips rads graphics

 

 

 

Here is the same x-ray again, this time with fancy graphics.  The red line highlights the socket and the green line outlines the femoral head (ball) and neck.  Notice the hourglass appearance of the thin femoral neck.  The region of solid green colour represents the part of the femoral head that is buried within the socket.

 

 

Dog Hip Dysplasia

 

 

This is an x-ray of a dog that has severe hip dysplasia.  Notice the areas of roughened bone, with spurs off the top of the socket and extra calcified masses.  These regions of extra bone growth indicate degenerative arthritic change.  Both the ball and the socket are irregularly shaped and fit together poorly.  There is poor coverage of the femoral head.

 

 

Humphrey's hips graphics

 Here is the same x-ray again, this time with fancy graphics.  The femoral head and neck are outlined in green.  Notice how thickened this femoral neck is compared to the normal dog hip x-rays above.  The region of solid green colour reflects the amount of femoral head that is seated within the socket.  Notice how much flatter these femoral heads are, and how much poorer the amount of seating is on this x-ray compared to that of the normal dog hip x-ray.  The green or red circles with no colouring in the centre represent abnormal calcified masses.

 

Despite these horrific looking x-rays, with minimal treatment this dog is leading an active, pain free life, with only the occasional use of prescription medication.  He recently earned his CKC TD tracking title at 7 years of age.  His hips and low back are getting stronger with time.

severe hip dysplasia pre-op

 

 

 

This next x-ray shows such severe dog hip dysplasia that no fancy graphics are needed – the ball and socket are so poorly formed that they aren’t even touching.  Notice all regions of roughened bone that indicate advanced arthritis.  This dog is relying entirely on muscular support for these hips.

 

 

severe hip dysplasia post op

 

 

 

 

Here is the same patient again, this time after receiving total hip replacement surgery.

 

 

  

Although this case was clearly surgical, the vast majority of dog hip dysplasia cases can lead active happy lives with non-surgical therapy.  Key components of non-surgical therapy include:

  • Treat the inflamed joint itself using nutriceuticals (glucosamine, omega-3’s etc.), a structured exercise program to build hip strength and stability, manual therapy (e.g.: mobilizations), acupuncture, anti-inflammatories etc.

 

  • Address secondary sources of pain – myofascial trigger points, sacro-iliac and/or low back pain, pinched nerves etc. etc.  More often than not, it is these secondary sources of pain that are limiting the dog’s quality of life.  If anti-inflammatories aren’t making a huge improvement in comfort, then the likelihood of secondary pain arising from somewhere besides the hip joint is very very high.  Treating secondary sources of pain is as important as treating the hip joint itself.  Chiropractic adjustments and/or physiotherapy style mobilizations are the single most effective tool for treating secondary muscle pain, pinched nerves, reduced mobility etc.

 

  • Keep the rest of the body as fit, strong, and comfortable as possible so that it can better compensate for the poor hips.

 

With the above treatment, most dogs with hip dysplasia can lead active comfortable lives without the need for surgery. If you would like to learn about dog hip dysplasia, click here.