To amputate or not?

Re: To amputate or not?

Utlendigur — Mon, 18 Feb 2013 14:37:34 GMT

[quote user="Gerry Henry"]hard to say whether it extended into the joint [/quote]

[quote user="Gerry Henry"]on that basis, an old healing fracture involving the joint[/quote]

First phrase implies uncertainty, second doesn't. You can see the xray and decide how certain you are - we can't. My interpretation of your original post was that you only had conscious xrays of a wriggly kitten, with uncertain duration of lameness and because of finances further xrays were not going to be done - waiting a week or two to see if it uses the leg in that case is not unreasonable. But if you have already decided on the "right" answer why ask?...or at least ask a precise question.

Nb for info, the only condylar fracture I have seen in a kitten, I amputated the leg the day after xray because I felt it was unlikely to heal acceptably. Recent distal humeral fracture in a tiny kitten I treated surgically. Both did well.

Re: To amputate or not?

Gerry Henry — Mon, 18 Feb 2013 12:40:12 GMT

Perhaps you might read the original post - Two conscious X rays showed a healing distal humeral fracture, hard to say whether it extended into the joint but the lateral condyle looked displaced to me. My feelings are that this is an old, healing fracture involving the joint, the clients have very limited funds - so you have been asked to give an opinion on that basis, an old healing fracture involving the joint, which, I'm not surprised to say, was confirmed this morning. The joint is grossly abnormal but stable, however the kitten won't use it so any discussion of 'how to repair it' is academic, nature has repaired it, badly. The question, the original question, is given this scenario would the general concensus be to amputate or to leave.

Re: To amputate or not?

Utlendigur — Sun, 17 Feb 2013 23:15:21 GMT

[quote user="robloxley"]You say they have very limited funds and ask for opinions for what to do based on some limited information, but after some answers then say more radiographs are going to be taken that should make the decision pretty clear. So I slightly wonder why bother asking the original question?[/quote]

I agree. It might have been more helpful to ask how people would treat a definite condylar fracture in a kitten (age might also be helpful), rather than introduce all the uncertainty. My reading of the original post was that there was an uncertain history as to duration and merely a suspicion of joint involvement on what were possibly/likely non-diagnostic xrays - very different scenario!

Re: To amputate or not?

Rob Loxley — Sun, 17 Feb 2013 22:33:22 GMT

[quote user="Gerry Henry"]

Couldn't have put it better myself, that gets you five stars.

[/quote]

You say they have very limited funds and ask for opinions for what to do based on some limited information, but after some answers then say more radiographs are going to be taken that should make the decision pretty clear. So I slightly wonder why bother asking the original question?

Re: To amputate or not?

David Mills — Sun, 17 Feb 2013 22:00:35 GMT

[quote user="jamie winstone"]

Talk about worst case scenarios.

[/quote]

Not really. I was simply responding to the details available - i.e. suspicion of joint +/- condylar involvement. In which case the option to wait and see, I think (and the textbooks say), would be a poor one for the kitten. Long recovery, likely painful if only meloxicam used, and with at best a severely compromised joint.

[quote user="jamie winstone"]

I wonder how many cases in the RSPCA clinic are brought in having had an early fracture that has healed so well that nobody even mentions it.

[/quote]

Quite possibly. Long bone fractures one can be far more free and easy with. But this has suspicions of being a little more complicated than that.

[quote user="jamie winstone"]

These cases just get forgotten whereas kittens with a persistent lameness are anecdotal proof that amputation was always the best option.

[/quote]

You're assuming a lot here, and a little offensively really, unless of course you work in a charity clinic and this is your personal experience. I agree that amputation is a far more readily considered option than in private practice. But this is because of, generally, poor owner compliance, cost, and the high number of strays we see which essentially require a 'patch up and rehome' treatment. We'd love to fix all these. But it isn't possible. So rather than this becoming a self-fulfilling prophecy, it's actually the safest and cheapest option with acceptable welfare implications in the vast majority of cases.

[quote user="jamie winstone"]

Kittens don't read text books and often do remarkably well, (and very quickly) without veterinary interference.

[/quote]

Fairly extreme anecdotal evidence, considering previous sentence.

I think overall in this case - with the info currently available - that the best outcome for patient and clinic is amputation. 'Tis but opinion however.

Re: To amputate or not?

jamie winstone — Sun, 17 Feb 2013 20:59:19 GMT

Talk about worst case scenarios. I wonder how many cases in the RSPCA clinic are brought in having had an early fracture that has healed so well that nobody even mentions it. There is no lameness and the loss of movement is barely noticeable. These cases just get forgotten whereas kittens with a persistent lameness are anecdotal proof that amputation was always the best option. Kittens don't read text books and often do remarkably well, (and very quickly) without veterinary interference.

I would of course agree that cats adapt to three legs very well at any age.

Re: To amputate or not?

Gerry Henry — Sun, 17 Feb 2013 19:51:01 GMT

Couldn't have put it better myself, that gets you five stars.

Re: To amputate or not?

David Mills — Sun, 17 Feb 2013 19:03:21 GMT

We see a fair few early-age injury animals being an RSPCA clinic. Our experience - low level evidence of course - is that they adapt much more quickly being 3-legged (dog or cat) than having a defunct front leg, especially growing animals.

As you say, if there's a joint involved or the lateral condyle then without meticulous repair (sounds like oo can't afford such) then amputation would, in my opinion, be preferable than a wait and see. For the long-term prognosis for a fracture involving the joint which is left to heal by self is at best an ankylosed joint with severely reduced ROM - which for a cat is about as much use as a chocolate fireguard, an inflexible peg-leg that just gets in the way and is far more liable to injury.

Re: To amputate or not?

Gerry Henry — Sun, 17 Feb 2013 18:54:06 GMT

I honestly think they do better if you remove it early. The remaining front leg seems to move medially until the animal looks as if it has central limb. Adaption is amazing and there's no need to drag the useless limb around everywhere, anyhow, time will tell.

Re: To amputate or not?

Evelyn Barbour-Hill — Sun, 17 Feb 2013 18:48:44 GMT

[quote user="Gerry Henry"]In time the limb ceases to be an asset and ends up a hindrance, remove it early and the animal becomes an agile triped, leave it on and all you're left with is a crippled quadriped. [/quote]

I see your point. I was thinking it would end up as an agile quadruped with one wonky leg, though.

Re: To amputate or not?

Gerry Henry — Sun, 17 Feb 2013 18:24:37 GMT

If the X ray under sedation on Monday confirms a healing fracture extending into the joint then i don't really see any other option. the elbow is probably the least forgiving joint, it will never be right and as the animal ages, will become less so. In time the limb ceases to be an asset and ends up a hindrance, remove it early and the animal becomes an agile triped, leave it on and all you're left with is a crippled quadriped.

Re: To amputate or not?

Rob Loxley — Sun, 17 Feb 2013 18:19:17 GMT

Without seeing the xrays/kitten, I'd go with NSAIDs and see how/if it settles; amputation always remains an option if it can't be settled with meds and time.

Re: To amputate or not?

Evelyn Barbour-Hill — Sun, 17 Feb 2013 17:45:49 GMT

My reply to your question would be "why amputate?"

I agree with the others.

Re: To amputate or not?

Utlendigur — Sun, 17 Feb 2013 12:47:04 GMT

Another vote for wait and see, especially if not particularly painful, there's evidence of healing and (I'm assuming) we're talking about a young kitten.

Re: To amputate or not?

jamie winstone — Sun, 17 Feb 2013 12:07:24 GMT

Just am opinion, I would not even consider amputation or repair at this stage. I have seen so many situations resolve with no more than conserxative treatment ending up with with no perceived pain and normal ambulation. I guess if it was in pain 3 months down the line, you would have to admit this was the wrong decision. At least one can rectify that situation.

Re: To amputate or not?

Michael Woodhouse — Sun, 17 Feb 2013 12:06:51 GMT

I'd wait, NSAIDS as needed and see. Amputation more expensive than a bottle of Loxicom. Even if left with reduced ROM it still has a limb.

If you said it was fresh break and hanging then I'd amputate.