Distal antebrachial fracture in labrador

Re: Distal antebrachial fracture in labrador

John Flynn — Wed, 04 Feb 2015 20:12:20 GMT

[quote user="Will McMullan"]Any particular reason you wouldn't use a T-plate in this case?[/quote]

would a medial plate less risk extensor tendon irritation requiring explantation at a later date compared to a cranial T-plate in a fracture this distal?

Re: Distal antebrachial fracture in labrador

Will McMullan — Wed, 04 Feb 2015 17:14:00 GMT

[quote user="Malcolm Ness"]

Decision making here is relatively straight-forward due to small number of [sensible] options.

Best to manage surgically though [careful] casting is a valid "plan B"

Surgery: two surgical approaches, the first to the medial aspect of the distal radius which should be reduced perfectly then fixed with a 3.5mm plate and screws. I would use a short (probably 5 hole) SOP locking plate but a longer DCP will be adequate. Two screws in the distal fragment and that will necessitate very careful contouring and screw placement especially if a DCP is used. Second caudo-lateral incision over the ulna to apply a second plate - again, I would use a 2.7 SOP locking plate, probably 4 holes, but again a longer 2.7 DCP would suffice.

Prognosis is excellent. There is a similar fracture seen in young racing greyhounds and following SOP fixation as described above, the prognosis for return to previous racing form is excellent so for an overweight pet dog, there should be no problems.

Casting could also produce an adequate outcome in this patient though healing will be relatively slow given the age of the dog. The cast should be applied carefully, and with minimal padding extending to proximal ante brachium. The cast should be applied with toes exposed and such as to allow weight-bearing. Casting is NOT a technically simple, nor a clinically benign option and often turns out to be costly. I am not a big fan of split/bi-valved casts unless they are needed to manage complications so I would look to place a good complete cast on day 1. Always use propriety cast-padding material and never cotton wool. Two layers of cast-padding is the maximum - from what I can see from these rads, there seems to be too much padding here.

[/quote]

Any particular reason you wouldn't use a T-plate in this case? Why do you think it's necessary to plate the ulna when many similar fractures are treated solely with radial plating?

Re: Distal antebrachial fracture in labrador

Beats — Wed, 04 Feb 2015 15:33:54 GMT

xrays taken 2 days ago, has been restricting activity levels up to now, some reduction in carpal flexion, some reduction in weight-bearing at stance but I had to ask which leg to examine when walked into consulting room.

Re: Distal antebrachial fracture in labrador

Anthony Todd — Mon, 02 Feb 2015 23:32:24 GMT

How is the leg and the gait?

Re: Distal antebrachial fracture in labrador

Anthony Todd — Sun, 04 Jan 2015 18:16:25 GMT

[quote user="Eamon McAllister"]It dosen't look a lot different now compared to the previous pictures when the cast was on! P.S. Is that someone's hand on X Ray holding the foot?

[/quote]

I'd love to know the justification for an expensive internal fixation with no discernible advantages over even the temporary cast in terms of alignment or prognosis and disadvantages in terms of an additional anaesthetic and post op complications, totally ignoring the additional cost.

Because of the "localised" nature of the fixation you'd probably need a supportive cast anyway or at least a gutter splint, I would think.

Re: Distal antebrachial fracture in labrador

Eamon McAllister — Sun, 04 Jan 2015 13:46:02 GMT

It dosen't look a lot different now compared to the previous pictures when the cast was on! P.S. Is that someone's hand on X Ray holding the foot?

Re: Distal antebrachial fracture in labrador

Beats — Sat, 03 Jan 2015 13:44:48 GMT

Re: Distal antebrachial fracture in labrador

Beats — Sat, 03 Jan 2015 13:39:08 GMT

Was referred and had a T-plate (not sure if locking implant or not - I'll post post-op radiographs taken here at time of first dressing change below and no doubt somebody will recognize the plate, possibly a proximal-tibial-osteotomy-type one?) put on cranial radius and splinted dressing for 3 weeks and strict confinement - is still on strict confinement and waiting for 8 week post-op radiographs.

I'll try to remember to post the 8 week radiographs when taken, but feel free to remind me :-)

Re: Distal antebrachial fracture in labrador

Tom Ward — Sat, 03 Jan 2015 12:50:38 GMT

So no need to involve the elbow in the cast here?

Re: Distal antebrachial fracture in labrador

Anthony Todd — Sat, 03 Jan 2015 11:45:35 GMT

[quote user="Hannah Wynne Richards"]

I'm another who thought refer or cast.

Wynne

[/quote]

Be good to know what happened and what was done.

In very many threads we are never told the outcome or the journey to it.

I, for one, would like to know, even a PM?

Re: Distal antebrachial fracture in labrador

Hannah Wynne Richards — Mon, 08 Dec 2014 17:15:20 GMT

I'm another who thought refer or cast.

Wynne

Re: Distal antebrachial fracture in labrador

Anthony Todd — Mon, 08 Dec 2014 16:54:17 GMT

[quote user="Michael Woodhouse"]I don't like casts. I'm frightened to leave them alone so I'd want a look underneath at least once.[/quote]

In simple #s with minimal displacement and.or good alignment they work fine. and, provided you leave something out the end, you can check the circulation and viability without removing the cast as well as letting them weight bear gently and walking only....

Sounds like casting #s is a dying art.

Re: Distal antebrachial fracture in labrador

Anthony Todd — Sun, 07 Dec 2014 23:15:39 GMT

[quote user="Malcolm Ness"]cast extends around the extended digits [/quote]

Another reason not to enclose the foot is that you cannot ensure that the cast is not compromising the circulation which, IMHO, is vital.

Re: Distal antebrachial fracture in labrador

Michael Woodhouse — Sat, 06 Dec 2014 21:10:28 GMT

[quote user="Beats"]A referral has been sorted for Monday, but it's good to know that there were at least some options there if this hadn't been possible and Malcolm gave some really practical advice on both surgical options and casting technique.[/quote]

Is this not something most of us would do in house with a plate? Technically not that difficult and the kit is a reasonable outlay but doesn't eat anything.

We would always offer referral to a specialist for such surgery, but I wouldn't push for it.

I don't like casts. I'm frightened to leave them alone so I'd want a look underneath at least once. I've tried it as a cheap option and the bill adds up. Now I'd push for surgery in house or send away if they are insured or have lots of money.

(I do mainly large animal work and not much small animal surgery any more, but ortho falls to me - possibly because it involves power tools.)

Re: Distal antebrachial fracture in labrador

Anthony Todd — Sat, 06 Dec 2014 20:33:46 GMT

[quote user="Beats"]Re the cast:[/quote]

I would have cast that with impunity but not included the foot joint [sorry purists, but you know what I mean]

Never, ever, include the foot in a cast!!

[horror stories on demand]

I would expect the results to be good.

Must never ever go off the lead with a cast on...

Re: Distal antebrachial fracture in labrador

Beats — Sat, 06 Dec 2014 13:43:26 GMT

Thanks for all the advice - especially for such a detailed reply from Malcolm!

A referral has been sorted for Monday, but it's good to know that there were at least some options there if this hadn't been possible and Malcolm gave some really practical advice on both surgical options and casting technique.

Re the cast: Malcolm is correct, it was too loose (due to excessive padding). Late on a Friday night I decided that it was adequate as temporary stabilisation to reduce further damage pending a decision on referral. I placed this to an inch above the elbow - do I understand correctly that just below the elbow (as well as allowing weight-bearing with toes exposed) would have been better had casting been attempted as the definitive treatment option?

Re: Distal antebrachial fracture in labrador

Malcolm Ness — Sat, 06 Dec 2014 13:07:52 GMT

Good reduction and excellent alignment are essentials with any cast. What has been achieved here is more than good enough in that regard. However, the cast extends around the extended digits so this dog will not weight-bear with this cast and in addition, the apparent thickness of padding will allow a considerable amount of movement within the cast. Compare with an overlarge shoe compensated for by four pairs of thick socks while the ideal is a pair of thin socks under properly fitting shoes.

Re: Distal antebrachial fracture in labrador

David Shepherd — Sat, 06 Dec 2014 11:02:37 GMT

Interesting (as a non-orthopod) that the current casting appears to have achieved a fair degree of reduction and re-alignment of the fracture

David

Re: Distal antebrachial fracture in labrador

Malcolm Ness — Sat, 06 Dec 2014 09:42:17 GMT

Decision making here is relatively straight-forward due to small number of [sensible] options.

Best to manage surgically though [careful] casting is a valid "plan B"

Re: Distal antebrachial fracture in labrador

Beats — Sat, 06 Dec 2014 09:20:54 GMT

[quote user="Braden Collins"]What was the mechanism of injury?[/quote]

clipped by a car when chasing it - car doing maybe 5-10mph around a corner.

[quote user="Braden Collins"]What is the soft tissue like?[/quote]

Skin is excellent (prior to cast application anyway...); small, minor non-full thickness excoriation medially only.

[quote user="Braden Collins"]What are the owners and dog like?[/quote]

I'm not too sure at this timepoint - intial impressions would be sensible owners and lively bouncy labrador weighing in a little heavier than ideal.

[quote user="Braden Collins"]Personally I would refer a case like this if they had the budget [/quote]

Agreed. Quote for referral options and whether this is within owners budget remains to be seen. Trying to consider the best options in advance if referral doesn't happen.

Re: Distal antebrachial fracture in labrador

Braden Collins — Sat, 06 Dec 2014 01:22:43 GMT

What was the mechanism of injury? What is the soft tissue like? What are the owners and dog like? I think if budget is restricted, sensible dog and sensible owners who would rstrict the dog, I reckon this would have a good chance of healling with a cast (bring on the debate).

Personally I would refer a case like this if they had the budget as I think a surgical treatment wouldd be beyond my skill level.