Othopaedics

Orthopaedics is the branch of surgery dealing with the bones and joints of the skeleton. The most dramatic orthopaedic cases are fractured bones, but there are many other problems especially to do with joints which need orthopaedic assessment and sometimes surgery. Two recent cases are described below, the first a fracture of the radius and ulna in a young lurcher, the second a dislocated hip in a border collie.

We have a special interest in orthopaedic surgery and have modern 'ASIF' instruments and implants (bone plates, screws, etc) originally developed for human surgery. This is backed up a high level of surgical expertise and regular professional courses.

 

Click here to follow the repair of this fracture of the radius and ulna

Click here to follow the repair of this double hip dislocation

 

Case 1

This 10 month old lurcher was presented at the surgery after yelping in pain and going suddenly completely lame on her right fore leg after jumping into a clump of bracken on a fell walk. On arrival at the surgery the patient was showing signs of shock and an intra-venous drip was started and pain relief and antibiotics administered. X-Rays of the affected leg showed fractures of both the radius and ulna (the two bones of the forearm). These radiographs are shown below.

Please note there follow some pictures taken
during the operation  (with blood etc....) !!
 


A lateral view of the right antebrachium

A dorso-ventral view of the right antebrachium

This fracture was complicated by the presence of several small bone fragments, one of which can be clearly seen in the dorso-ventral radiograph above. Move the mouse over the image to highlight the fragment. These tiny fragments are too small to reattach and leave deficeits (or gaps) at the bone ends which make the fracture less stable when repaired. A strong repair is therefore needed and a bone plate was chosen.

 

 

 

 

 

 

 

 

 

 

When the operation was over further X-Rays were taken to assess the repair.
The lateral view is shown below.

 

 

Several interesting features of the repair are shown by this X-Ray -

  • Each screw passes through both sides of the bone but is not too long - you can see the different lengths of screw used as the width of bone varies.

  • You can see how the plate has been slightly bent to accurately match the natural slight curvature of the radius

  • One of the screws is placed at an angle - this was necessary to avoid the damaged area of bone at the fracture itself. Without solid bone to grip the screw wouldn't be strong. If good placement of the screw had been impossible this screw hole in the plate would have had to have been left empty - this would have weakened the plate which may have then broken.

  • The area of bone loss at the fracture site is caused by the loss of tiny fragments of bone too small to re-attach. Move the mouse over the image to highlight. This gap will fill in with new bone as the fracture heals.

  • The second bone (the ulna) has not been repaired although it has been reduced (realigned). Because the radius is now stable the ulna will be able to heal on it's own. Note how this bone also has a slightly larger fragment at the fracture site.

 

After the operation the leg was dressed for a few days with a support bandage. Here she is back at home with one of her owners.
 

 

Hydrotherapy is an excellent form of exercise for dogs recovering from fractures. It provides work for the muscles which prevents wastage, and excellent movement for the joints which prevents them stiffening up, all without excessive force being applied to the fracture site. A small amount of controlled strain will actually encourage healing.
 

 

8 weeks later further X-Rays were taken to assess progress.
The lateral view is shown below.
 

 

The fracture is healing well so far. New bone (called callus) can be seen at both fracture sites, most obviously on the ulna (the lower bone in the X-Ray). This new bone crosses the fracture and with time remodels to recreate the original cylindrical form of the bone. Callus has filled in the gap at the fracture site originally visible on the radius, and this extra new bone makes the area look whiter (this means the bone is denser) - this is very obvious in comparison with the post-op X-Ray above.

Even in a very young dog like this the fracture site will not fully heal for many months - the bone plate must stay on for at least 6 months. In older dogs this period is well over one year. In most cases the plate is in fact left in place permanently as it rarely causes any problem for the dog and requires another operation to remove.

 

 

Case 2

This 6 year older male border collie was presented at the surgery after being struck by a car during a walk. On initial examination he was pale and collapsed, breathing very quickly and unable to stand on his back legs. There were multiple grazes and cuts affecting the head, chest and back legs especially the left hock (ankle). First aid treatment included pain relief, antibiotics, an intra-venous drip and oxygen therapy while an initial assessment of the dog's injuries was made. This included X-Rays of the chest, hips and left hock. These X-rays are shown below.
 

 

 

 

 

 

 

 

 

 

 

 

 

The patient back in his kennel after the placement of the hip external fixator. He was walking on this leg the same afternoon. Two further operations were needed, firstly on the other hip and secondly on the badly damaged hock joint.