Pelvic and femoral fractures

Re: Pelvic and femoral fractures

David Mills — Fri, 08 Jun 2012 21:07:09 GMT

[quote user="Malcolm Ness"]

Almost all diaphyseal fractures can be repaired with an expectation of a return to full function.

Cases involving a single fracture on a single limb are much the most common and (relatively) very straight forward to manage - the fact that our patients have 3 good limbs means that we "get away" with some fracture repairs of questionable quality. However, that is emphatically NOT the case when a second limb is involved when it becomes essential to fix the fracture such that the patient can weight-bear confidently from day 1.

In David's case, single session fixation of all the relevant fractures would have been indicated. A decision would be taken on the almost amputated limb - if saveable the tibia would be fixed (? bilateral ex fix) but this would mean that the ipselateral femur (Plate rod - a plate alone would be marginally strrong enough) AND the ipselateral ischium (DCP or locking plate) would also need to be repaired. Amputation would not impair the other side and might be cost-effective. The other side would require a good repair of the femur (again a plate-rod would be advisable) and good fixation of the ilium (DCP or locking plate) AND the SI (2 long screws) would be required. I would hope, and expect, to see the dog up and about within 48 hours of surgery.

These cases cannot be done on the cheap and any attempt to compromise or cut corners will very likely end in tears. They are not for the occasional surgeon and the "step up" in difficulty from a single leg fracture to a multiple limb fracture case cannot be over stated.

[/quote]

Thanks for this, very informative. No one was available at our place for the surgery and referral not an option so PTS was the only real option in this case - certainly not something I would have attempted. Very interesting that these things can be fixed and the expected rapid return to weight bearing if done properly. Surprisingly, this dog had been hit on the back end and apart from a few cuts to the body was unharmed otherwise. Tibia was completely fractured, leg only attached by skin.

If I can locate them I'll try to post the rads this weekend for interest.

Re: Pelvic and femoral fractures

Gillian Mostyn — Fri, 08 Jun 2012 19:13:10 GMT

phew - you had me worried for a minute there.....

Re: Pelvic and femoral fractures

Michael Woodhouse — Fri, 08 Jun 2012 19:10:53 GMT

[quote user="Gillian Mostyn"]I really hope you missed the fact that the other hindlimb had a femoral fracture.[/quote]

Yes I did.

Re: Pelvic and femoral fractures

Louise6732 — Fri, 08 Jun 2012 18:45:01 GMT

[quote user="Gillian Mostyn"]

[quote user="Michael Woodhouse"]Amputate the dangling leg. 6 weeks cage confinement and NSAIDS and you'd be amazed. [/quote]

Not sure why I'm bothering to reply to this, but seriously?

I really hope you missed the fact that the other hindlimb had a femoral fracture.

[/quote]

Gillian, my thoughts too!

Re: Pelvic and femoral fractures

Gillian Mostyn — Fri, 08 Jun 2012 14:35:09 GMT

[quote user="Michael Woodhouse"]Amputate the dangling leg. 6 weeks cage confinement and NSAIDS and you'd be amazed. [/quote]

Not sure why I'm bothering to reply to this, but seriously?

I really hope you missed the fact that the other hindlimb had a femoral fracture.

Re: Pelvic and femoral fractures

Hannah Wynne Richards — Fri, 08 Jun 2012 13:01:43 GMT

My options to the owner would have been refer or euthanase-as I know my surgery wouldn'thave been up to this so I would have increased the animals suffering unnecessarily if I had tried it Sounds like an horrendous injury David's problem is that working for Blue Cross he's limited to in-house expertise so don't feel bad about euthanasing

Wynne

Re: Pelvic and femoral fractures

Mark Holmes — Fri, 08 Jun 2012 10:52:36 GMT

[quote user="Malcolm Ness"]

Almost all diaphyseal fractures can be repaired with an expectation of a return to full function.

[/quote]

Over and above the technical aspects of a multiple limb repair the mental taxation for the vet must very demanding if you are not very familiar with the surgery and also and possibly more significantly the duration of surgery. To me it is one thing to fix a frature fresh but then to start a repair drained is a quite different matter altogether.

I do the occasional fracture repair and have so far been successful but frankly the thought of starting again on the other limb would probably drive me to tears... a bit like turning a dental over. aaaahhhhh!

Re: Pelvic and femoral fractures

Malcolm Ness — Fri, 08 Jun 2012 10:28:54 GMT

Almost all diaphyseal fractures can be repaired with an expectation of a return to full function.

Re: Pelvic and femoral fractures

Michael Woodhouse — Fri, 08 Jun 2012 10:26:21 GMT

Amputate the dangling leg. 6 weeks cage confinement and NSAIDS and you'd be amazed.

Re: Pelvic and femoral fractures

Alet Engelbrecht — Fri, 08 Jun 2012 08:45:37 GMT

Eish! To quote my countrymen...

A case for the bionic vet?

Re: Pelvic and femoral fractures

Alastair Franklin — Fri, 08 Jun 2012 08:34:53 GMT

No reason why not, assuming no other major injuries (eg to the forelimbs). Human orthopods do some amazing stuff, but bodies (human and dog) can show remarkable healing ability with time, patience and an appropriate helping hand. Given the severe injuries sustained I'd be worried about ruling out other issues though.

Would be nice to see the rads, however in theory could do a unilateral amputation to tidy up the first limb, then plate for the remaining femur. Ischium can usually be left alone (since effectively non-load bearing) provided not causing any obstruction. SI fracture/luxation (I assume this is the case rather than sacral fracture) could in theory be left as is if minimally displaced and no neuro issues, but would be far preferable to fix to enable earlier weight bearing. Cage restriction then restricted activity for a few weeks and provided can urinate and defaecate ok should have a decent QOL.

Saying that though, this would be reasonably long haul and major costs. Also, I wouldn't be too keen on this if it was an obese Bernese, but fair game if its a small-medium breed and good owners. For the record, i have been directly involved with similar-sounding cases, with some decent degrees of success. However, in many cases euth is a sensible and realistic option for owners.