cost of plating a fracture

Re: cost of plating a fracture

Gillian Mostyn — Tue, 21 May 2013 07:51:28 GMT

Alls well that ends well.

Re: cost of plating a fracture

CatherineThomas — Mon, 20 May 2013 21:01:54 GMT

I know we could have plated it in less time probably (well my colleague could have). But the owners had already decided that they didn't want to risk the possibility of it failing.

Re: cost of plating a fracture

Michael Woodhouse — Mon, 20 May 2013 20:57:58 GMT

I'd have plated the leg for less than that!

Re: cost of plating a fracture

CatherineThomas — Mon, 20 May 2013 20:55:16 GMT

Thanks for everyone's replies.

Fortunately after thinking about it over the weekend the owner's realised that they didn't want to be parted from their dog and have found £500 to pay for surgery. They had also researched it on-line and had seen that 3 legged dogs do well so decided that they wanted to go for amputation so that there are likely to be less post-operative complications.

So she is now recovering after I amputated the leg this morning.

Re: cost of plating a fracture

Gillian Mostyn — Mon, 20 May 2013 10:13:44 GMT

[quote user="Gerry Henry"]quicker to plate[/quote]

Not in my hands.........I haven't ever placed a plate! I would offer to send to a different local first opinion vet if costs were limited but it would still cost substantially more.

Re: cost of plating a fracture

Braden Collins — Mon, 20 May 2013 06:22:43 GMT

Do you have all the instruments you need to do the job well? If the repair fails, what would the salvage options be, and who would pay for them? You need to have all this worked out before you go forward. I would be prepared for a delayed union or nonunion in a dog like this (happens often enough that you need to have options available just in case). As a boss I would hate to have this in the paper. It will attract a lot more problem clients than good clients, and you will start to have people expecting the same for them. In cases like this if there is an obvious fracture that can be diagnosed without X-rays and the client has very limited funds, I would normally steer them straight to amputation and skip the xrays as you could potentially "fix" their dog within a much smaller budget range. Better to spend money on treatment than diagnostics when it is very limited.

Re: cost of plating a fracture

Gerry Henry — Sun, 19 May 2013 20:55:43 GMT

quicker to plate, better outcome - probably - dog has 4 legs, minimal cost.

Re: cost of plating a fracture

Gillian Mostyn — Sun, 19 May 2013 19:59:43 GMT

I agree with David () - I would be amputating, and charging the owner under £200. Not an ideal situation, but welfare-wise, probably in the best interests of the dog.

Re: cost of plating a fracture

Evelyn Barbour-Hill — Sun, 19 May 2013 19:52:14 GMT

[quote user="Gillian Mostyn"]

[quote user="CatherineThomas"]She had obviously put a lot of thought into it while the dog was with us to be x-rayed.[/quote]

Yep - goes along the lines of:

'do I want to spend lots of money now and for the next few weeks on my dog, with the possibility of it always having knackered leg and needing more money spending on it in the future?'

'no'

[/quote]

Which seems quite reasonable to me.

Re: cost of plating a fracture

Gerry Henry — Sun, 19 May 2013 18:55:54 GMT

mid shaft radial #, easy peasy, forty minutes if you hang about, half an hour if you don't, plate it, it'll be fine.

Re: cost of plating a fracture

David Mills — Sun, 19 May 2013 18:18:11 GMT

[quote user="CatherineThomas"]

Actually the owner does seem quite sensible in this respect. One of the reasons she gave for asking for the dog to be put to sleep was that even if they could just about scrape together enough money for the surgery they wouldn't have anything left in the case that there were any complications that needed further treatment. And this was before I'd even had a chance to discuss the likely outcomes and possible complicactions. She had obviously put a lot of thought into it while the dog was with us to be x-rayed.

[/quote]

The procedure with the highest success rate in this situation, and guaranteed (as far as possible) success, where the owner gets to keep the dog, would therefore be amputation; this should also be the cheapest option. Dogs generally don't need 4 legs, especially toy ones.

I'd be very careful with this one - give an inch, and the owner will be more willing to play the impecunious card in the future. And likely tell their mates.

Re: cost of plating a fracture

Gillian Mostyn — Sun, 19 May 2013 17:03:50 GMT

[quote user="CatherineThomas"]She had obviously put a lot of thought into it while the dog was with us to be x-rayed.[/quote]

Yep - goes along the lines of:

'do I want to spend lots of money now and for the next few weeks on my dog, with the possibility of it always having knackered leg and needing more money spending on it in the future?'

'no'

I'm sorry to be the only one who is hard, but people have made me this way.....

Oh, and I have not yet had to PTS due to this kind of situation, but I have threatened it a lot. Occasionally I have rehomed but not without the owner knowing what I thought of them......I certainly wouldn't like them to get another pet. Ever. (Just curious - does this owner have any other pets?) But I can see how it would be a good training opportunity.. as long as the person involved has an adequate level of experience with a decent chance of a good outcome.)

Re: cost of plating a fracture

CatherineThomas — Sun, 19 May 2013 15:37:13 GMT

Re: cost of plating a fracture

Mark Rowland — Sun, 19 May 2013 15:06:35 GMT

[quote user="John Flynn"]

[quote user="Mark Rowland"]In the right situation immobilisation can be just as good and was for many years before we got so good at orthopaedics.[/quote]

And in toy-breed, adult dogs with radial/ulna fractures there was an irritatingly high failure rate.

If this was a Pom pup, then I would say slap on some lolly-pop sticks and come back when it's healed (well, maybe a weekly check...), but in an adult Pom I honestly think, in a situation where bone-plating equipment and basic surgery/DIY skills are available, that the balance between time/material-costs/complications/success rate comes out easily in favour of slapping on a plate in this fracture. (Without the plating facilities, then I would use some K-wires and hoof acrylic in preference to a cast for this).

[/quote]

Yep some background reading confirms you are correct, hands held up ...

However the owner still needs to be informed of the costs of referral if this goes south after being done on the cheap as the milk of human kindness may be thrown back with interest should problems arise

Re: cost of plating a fracture

Mark Rowland — Sun, 19 May 2013 14:47:41 GMT

[quote user="Michael Woodhouse"]

In the same situation if I thought I could fix it myself I'd work something out. No reason that you learning how to do this is not good CPD and if the practice is quiet - good use of locum time. The direct cost to the practice is maybe £50 for the plate, screws and consumables. The rest is for time and facilities and to allow some profit at the end of the day.

It's a circular argument - each procedure should carry its share of fixed costs, but if you are going to put the dog down otherwise, if someone is going to learn something then I'd crack on.

[Says the man who removed 3 legs last week - all outside my skill set!]

[/quote]

TBH I probably would as well. But then i own my practice and would probably use the opportunity to let my staff get more experience in orthopaedics. However I at one point risked getting a reputation for this when I heard that the PDSA local to me were telling clients to come here as we were cheap and did standing orders etc. As a result my stance has had to harden, especially after a couple of notable bad debts. Plus there is always the "it was cheap for him, why have I had to pay so much argument."

Re: cost of plating a fracture

Michael Woodhouse — Sun, 19 May 2013 14:35:21 GMT

It's a circular argument - each procedure should carry its share of fixed costs, but if you are going to put the dog down otherwise, if someone is going to learn something then I'd crack on.

[Says the man who removed 3 legs last week - all outside my skill set!]

Re: cost of plating a fracture

John Flynn — Sun, 19 May 2013 14:14:05 GMT

[quote user="Mark Rowland"]In the right situation immobilisation can be just as good and was for many years before we got so good at orthopaedics.[/quote]

And in toy-breed, adult dogs with radial/ulna fractures there was an irritatingly high failure rate.

Re: cost of plating a fracture

Mark Rowland — Sun, 19 May 2013 13:54:27 GMT

[quote user="CatherineThomas"]

[quote user="Mark Rowland"]

In my first job we would place a cast then saw it in half longitudinally so we could replace it and support it with vetrap. We had to sedate the cats but a small dog would be ok to redress conscious. Couple of hundred would more than suffice cases like this. Not the best option I know but if the money wasnt there, its still cheaper than amputation.

[/quote]

but what happens if the casting doesn't work? Then we're back in the same situaition if not worse but having spent at least a couple of hundred on cast/bandage material, x-rays to assess healing and our time to do these things. By which time everyone is even fonder of the dog and even more reluctant to euthanase.

I know there's a chance that my boss won't agree to it. But he has agreed to something similar for another case before. So I'm hopeful that we can arrange something, particularly now I have found someone who wants to take the dog on.

[/quote]

Everything has a risk Catherine. If the plating did'nt work the bill would be even more. If it got MRSA the bill would be even more. Its all about informed consent in these cases. I hope the dog does OK whatever. In the right situation immobilisation can be just as good and was for many years before we got so good at orthopaedics.

Re: cost of plating a fracture

John Flynn — Sun, 19 May 2013 13:40:32 GMT

It really just depends on your boss's outlook.

If the locum is going to be there anyway and it's that quiet that there is time to do the procedure (or the locum is a keen bean and happy to do off-the-clock with you assisting also for no charge), then I'd happily do for equivalent of £350-£500 - the procedure itself would still be easily more profitable than euthanasia at that.

I personally hate amputating a broken leg or euthanasing a pet with loving, but financially-restricted, owners. It is a business ultimately and I wouldn't put off paid work to do this at cost price only, but the actual procedure will not take long (incl. short prep time etc.) so the effort is usually more in planning a surgery and getting the suitable equipment ready and cleaning and packaging and sorting it properly afterwards. I offer a discounted procedure if owners have made a decision to euthanase / amputate based on costs alone. Time-permitting, I will offer surgical repair (on selected cases like this with a good outcome with surgery and poor outcome with external coaptation) for the cost of the amputation with a free-of-charge amputation if things go wrong.

If you want to scrub in and help the locum, ask for this to be part of your CPD training. Your boss will probably give you an afternoon off occasionally to go and listen to someone drivel on about a topic that hasn't even changed since you did your lectures a few years ago and even pay for the privilege, so why not spend that time more helpfully on case-based learning that would benefit a patient at the same time. If you private message me I'll happily look at the xrays and help you plan the surgery with implant sizes etc - to me a case like that which will otherwise be euthanased is a perfect case to learn basic bone plating on and an amateur job done for couple of hundred pounds is going to be a lot more useful to the owners and the dog than a gold-plated £2000 one. The dog's trust emergency fund may be able to help also if in UK.

Re: cost of plating a fracture

CatherineThomas — Sun, 19 May 2013 13:25:46 GMT

[quote user="Mark Rowland"]

[/quote]

Re: cost of plating a fracture

Gillian Mostyn — Sun, 19 May 2013 12:44:49 GMT

[quote user="Mark Hedberg"]One compromise would be to work out the cost of your materials and donate your time; the time is the expensive bit. [/quote]

erm........unless you mean for her to take a pay cut this month, I think you'll find it is CVS that will be doing the donating!!!

I'm afraid if I was your boss I wouldn't be too enthusiastic - the marketing stuff may well backfire. It is all well and good being generous with strays or unusual/desperate situations, but average folk who can't/won't find the money to pay for adequate treatment for their pet will see it as an easy get-out clause - if the pet gets hurt, you can just rehome it...... Especially for a pedigree animal that the owner has paid a substantial amount to own in the first place...

But then I'm a cynical practice owner.

There isn't an easy solution in these cases and I do sympathise with your situation.....but the actual cost of the surgery is unlikely to be the biggest hurdle you face, IMHO.

Re: cost of plating a fracture

Mark Rowland — Sun, 19 May 2013 12:22:56 GMT

Re: cost of plating a fracture

Mark Holmes — Sun, 19 May 2013 11:55:13 GMT

[quote user="Mark Rowland"]

Well without seeing any radiographs, if there is no money at all, why not analgese and put the leg in a pot.

[/quote] Is casting really cheaper? By the time you have redressed and the associated after care?

Re: cost of plating a fracture

CatherineThomas — Sun, 19 May 2013 11:21:49 GMT

It's on analgesia at the moment obviously, and has a splint on. The orthopaedic surgeon I spoke to didn't think that splinting/casting was likely to be effective. What do you mean by "in a pot"?

Re: cost of plating a fracture

Mark Rowland — Sun, 19 May 2013 11:15:08 GMT

Well without seeing any radiographs, if there is no money at all, why not analgese and put the leg in a pot.