robert jones complications 5 months on!

Re: robert jones complications 5 months on!

HMC — Tue, 06 Mar 2012 13:17:43 GMT

Would you expect the periosteal reaction on the hock to resolve once the infection has gone?

Any ideas at which stage I should repeat the rads- immediately after the abs have stopped or a bit later?

Re: robert jones complications 5 months on!

Kate Richardson — Fri, 24 Feb 2012 15:34:34 GMT

[quote user="Hannah Bose"]

Update again: the pad is healing really well- it's been three weeks of antibiotics now and he'll stay on them until the pad lesion is completely healed.

[/quote]

I would advise keeping him on the antibiotics for 4 weeks beyond the point where it looks 'normal'. Re pain relief, I think you will have to wait and see once it is healed, I would expect him to be markedly improved once he has a normal pad to walk on

Re: robert jones complications 5 months on!

HMC — Fri, 24 Feb 2012 14:10:30 GMT

Update again: the pad is healing really well- it's been three weeks of antibiotics now and he'll stay on them until the pad lesion is completely healed.

The owner had some questions for me, which I could not answer:

will the deformities (see photo below of the digits) ever sort themselves out? (I'm guessing not, but he can walk well, with only a slightly plantigrade stance; the metatarsal swelling shows no sign of improving).

will he ever come off analgesia? (I'm guessing time only will tell and I would be interested to see how he is when the pad lesion has fully healed; however, it really is healing (see photo) and he is on metacam and tramadol and still holds the paw up [but only when defecating...])

above: one digit is much longer.

below: the pad lesion is healing

help please!

Re: robert jones complications 5 months on!

HMC — Sun, 19 Feb 2012 10:17:32 GMT

interesting that babies are put in casts; I had no idea!

Re: robert jones complications 5 months on!

HMC — Sun, 19 Feb 2012 10:15:03 GMT

Here are some of the rads. The quality is bad because they're photos of rads, sorry.

Not that you can see well but there is a periosteal reaction around the tarsus and to my eyes the metatarsals look too straight/rectangular. I think I need to take the top two photos again, this time without the flash. The images don't do the dog justice- the right metatarsal region really is much thicker than the left.

But the antibiotics seem to be working.

Re: robert jones complications 5 months on!

HMC — Sun, 19 Feb 2012 10:06:36 GMT

This is how the paw looked on Friday (above) and how it looked a while ago before antibiotics (amoxy-clav and metronidazole) were started (below):

Re: robert jones complications 5 months on!

Bob Russell — Fri, 17 Feb 2012 17:42:37 GMT

[quote user="Lorna McHardy"]

[quote user="Hannah Bose"]

I just had a thought about the parallels in human medicine: would a doctor put a cast/robert jones on a baby? How would they manage a fracture in a young infant? (I cannot imagine a baby with a cast...) Would they run into the same problems we've had with this canine baby?

[/quote]

When I was getting x-rayed after twisting my ankle, I saw a very small infant on its back in a cot, with both legs cast all the way up to the hip, and held at a 90 degree angle to the body by a sort of winch. I don't even have children and I nearly cried. The child didn't look particularly upset at the time and I'm not questioning the necessity... but that struck me as an incredibly unfair thing to happen.

[/quote]

I had a cast on as a baby following a fracture. Apparently I was a little too adventurous and fell off the sofa!

Re: robert jones complications 5 months on!

argyro koukouseli — Fri, 17 Feb 2012 17:28:31 GMT

it also could be osteomyelitis.so i would start antibiotics while waiting for culture results,and make sure the metatarsal pad lession is not a fistula healing

Re: robert jones complications 5 months on!

Lorna McHardy — Fri, 17 Feb 2012 16:58:06 GMT

[quote user="Hannah Bose"]

[/quote]

Re: robert jones complications 5 months on!

Michael Woodhouse — Fri, 17 Feb 2012 16:39:43 GMT

They do cast babies. Have you ever seen a baby in a full cast with congenital hip displasia?

Re: robert jones complications 5 months on!

HMC — Fri, 17 Feb 2012 13:03:56 GMT

2nd update: the lesion near the metatarsal pad is healing slowly but surely. The pain is better on the tramadol but I've had to increase the dose today.

Anyone know a doctor to ask them? I'm curious.

Re: robert jones complications 5 months on!

HMC — Fri, 27 Jan 2012 16:47:57 GMT

Update: fna did not reveal any tissue at all so I went for the lesion on the pad - resecting the top layer for culture.

results show a profuse growth of beta-haemolytic strep, staph intermedius and bacteroides, sensitive to most antibiotics.

I am still chasing up the rads to put on here.

Re: robert jones complications 5 months on!

Malcolm Ness — Fri, 27 Jan 2012 15:27:56 GMT

Can we see some rads?

5 mths is a long time - any fracture will have healed long ago.

Why the multiple RJ dressings?

Re: robert jones complications 5 months on!

james herriot lied — Fri, 27 Jan 2012 15:19:05 GMT

Would second the query about soft tissue damage, although bandage-related problems can run pretty deep, to say the least. Points 2 and 4 for me - for ulcers like this, I've always favoured honey dressings. Other people use silver and the like, but honey for me every time.

Point 4, though - lack of pain control - is NBG at all. Push hard on this one. Whilst I have some sympathy for the owner's situation, it's not a reason to withhold pain relief. At least try the tramadol - although its use is somewhat of an argument at the mo - and if it vomits then try something else. Or else add some pardale in. Of all the issues, this for me would be the most pressing - after five months, the leg's unlikely to fall off, but a young dog in pain is storing up serious problems for later.

Re: robert jones complications 5 months on!

Mark Holmes — Fri, 27 Jan 2012 14:53:28 GMT

I would hazard a guess that maybe in addition to the greenstick fracture (or rather than a GS fracture) The dog has had some collateral ligament injuries. In my experience GS fractures invariably are better in 2-3 weeks. Persistant pain at this stage would suggest its wasn't or wasn't just a GS fracture.