This special dog has got to be one of the sweetest, most easy going patients I have had. She got out of her front yard and ran into the street right in front of a car. She is only 14 lbs and could have easily been crushed to death. Instead, she presented to me in mild shock and had no use of her back end. She had feeling and some motor response but was painful and unable to hold any pressure.
She had an obvious palpable fracture involving her right pelvic limb and had road rash on her groin area and front leg.
X-rays revealed a complete fracture of her right femur, right tibia, left pubic ramus (pelvis), and right fibula. She was stabilized overnight with fluid therapy, antibiotics, pain medication, and the first laser light therapy. Surgery the next day, once anesthetized, I palpated instability in the left upper femur as well. In surgery a pin wa placed with cerclage wire to stabilize the right femur (due to the natural curvature of he distal femur- complete placement depth of the distalnpin was not ideal, but sufficient). I did not place a pin in the right tibia as there was relatively good stability, the back legs were going to be splinted and we were going to have strict cage rest. On the left femur- I found in surgery that the greater trochanter (where the major leg muscle attaches to pull the lower leg forward) had sheared odd completely. I reattached it to the femur with wire. A complete hind end bandage with splints was applied to keep minimal motion and stability and she went home in good spirits.
Over the next couple of weeks, she returned for diarrhea and severe perirectal swelling from the pelvic fracture. She also managed to chew through the bandaging on the left foot and chew on her middle two toes extensively. We partially rebamdaged her, lasered her pelvis, toes, and upper femur, and cleaned regurlarly. About 2.5 weeks postop she had developed a dehiscence on the pin leg and a sore/fleshy tissue on the left femur incision. Staples were placed to close the pin leg gap and laser was started specifically on those incisions also as more complete bandage changes were instituted. She had found a day to get her ecollar off and chew on her toes again midway through, but by the 3 week mark she was standing and slightly getting around again. Only a soft bandage was placed for the remaining 2 weeks. By the 5 week postop mark she was doing great. The bandage was removed and she was mobile! 5 week X-rays showed excellent healing in all fracture areas and the wounds were doing awesome.
Surgery January 31 - Last pictures and X-rays- March 6
35 DAYS TOTAL - 10 total lasers.
Body cast going home
Post operative radiograph.
February 9th- She decided to start chewing on her left foot - :-0
3 days later - has some good granulation starting
When I removed the complete cast at 2.5 weeks and she had some dehiscence at the left surgical site.
The right leg had excellent granulation at a mild dehiscence.
The toes were looking great 1 week later! February 16th
Good granulation on Feb 19th (3 days from last picture)
Toes almost healed February 19th (3 more days from last toes!!)
February 19th follow up radiographs- can see a Left fibular fracture
Standing on her own!!! (February 19th-just under 3 weeks from injury)
She got her e-collar off and started chewing again :-( (February 21)
Good granulation on February 21st
Left leg
Right Leg
March 6th right leg granulation
March 6 left leg granulation (staples gone)
Excellent bone healing from laser/rest on tibia, pelvis, left fibula.
The right femoral IM pin has held and there is definite bony callous developing
Here she is 35 days post hit by car - able to walk around again!!
No comments:
Post a Comment