Calcaneal fracture in a pup

RE: Calcaneal fracture in a pup

Mark Hedberg — Mon, 09 Nov 2015 13:54:11 GMT

[quote user="David Mills"]

Thanks Malcolm, detailed and helpful as always. Pup underwent successful surgery this week which by the sounds of things went well.

[quote user="Anthony Dennison"]Ah Grenada, lovely place. Are you just based there or are you island hopping? Aruba is amazing.[/quote]

Alas, was just doing a short stint of neutering at a shelter, now back in breezy Britain. Ridiculously warm, only offset by the cheaper-than-water local rum and the plethora of American vet students.

[/quote]

Your sacrifices in the cause of Animal Welfare are duly noted. ;)

RE: Calcaneal fracture in a pup

David Mills — Mon, 09 Nov 2015 13:28:39 GMT

Thanks Malcolm, detailed and helpful as always. Pup underwent successful surgery this week which by the sounds of things went well.

[quote user="Anthony Dennison"]Ah Grenada, lovely place. Are you just based there or are you island hopping? Aruba is amazing.[/quote]

Alas, was just doing a short stint of neutering at a shelter, now back in breezy Britain. Ridiculously warm, only offset by the cheaper-than-water local rum and the plethora of American vet students.

RE: Calcaneal fracture in a pup

Anthony Dennison — Thu, 05 Nov 2015 11:47:45 GMT

[quote user="David Mills"]Very limited here with repair but there is a university with a vet school and gadgets on the island.[/quote]

Ah Grenada, lovely place. Are you just based there or are you island hopping? Aruba is amazing.

RE: Calcaneal fracture in a pup

Malcolm Ness — Wed, 04 Nov 2015 09:28:40 GMT

I have come to this late and somewhat impaired by my limited view of the images on a phone.

Best treatment as follows:

This appears to be an avulsion injury with the epiphysis in one piece and no other fractures to the remainder of the calcaneus. Any fragmentation of the epiphysis or concomitant fractures to the body of the calcaneus (I can't see any) will make this very much more difficult to manage.

The Achilles tendon is the key structure here - there are three components; the sup digital flexor tendon (which carries on past the point of the hock to insert distally) and the two parts of the Gastrocnemius tendon which insert on the point of the hock - i.e. the on the avulsed fragment. As has been suggested, the tendon itself is unlikely to be damaged in a pup of this age, but it is important to appreciate that an unattached tendon is useless functionally so firm re-attachment of that avulsed epiphysis is key.

A caudal approach and reflect the superficial digital flexor tendon from the rest of the Achilles. Identify the avulsed epiphysis; reduce it perfectly and fix with 2 very thin Kirschner or arthrodesis wires. Place a single, figure 8 tension wire (0.8 or 1mm). Replace the Sup dig flexor tendon and then otherwise routine closure.

I might use a light dressing for a day or two, but no more. Avoid any casts/splints/supports in a puppy of this age as there is a very high risk of severe complication. It is likely that the pins will loosen following healing and might need removed later.

Prognosis for a full functional outcome is excellent.

Plan B: The fragment is not widely displaced and given the small size of the dog, it will probably heal in its present location offering a reasonable chance of a decent functional outcome so if plan A is not available, for whatever reason, I would manage this conservatively - no casts, splints or dressings, just limited activity and medical pain control with the expectation of seeing some tentative toe-touching over a few days followed by a very gradual return to weight-bearing and near full function over a couple of months. Continuing lameness associated with distraction/displacement of the avulsed fragment might occur and that would be bad news as it will disable the extensor mechanism of the hock which will be significantly disabling.

RE: Calcaneal fracture in a pup

David Mills — Tue, 03 Nov 2015 16:56:24 GMT

[quote user="James Dunne"]

Hi David

It would probably repair well with a wire tension band over a K-wire as already mentioned. The Achilles is unlikely to have failed in a dog of this age. It may help to keep the hock somewhat extended to prevent excessive tension on the repair. The implants may require removal after a few weeks due to loosening or skin irritation from the wire and pin ends. it should heal in 3-4 weeks given the presence of open physes. Hope that is of some help

James

[/quote]

Thank you. I did one way back when and haven't seen one since, reassuring to here approach is still the same. Have since returned to the UK so sadly won't be getting my hands on it but dog was due repair today (I think) at the island uni.

Re other comments, digital x-ray, photos from screen taken on phone. Originals beautiful. Think I'm just about adult and ugly enough to make a reasoned risk/benefit analysis for exposure of my own bones, but thanks for the concern(s).

RE: Calcaneal fracture in a pup

James Dunne — Tue, 03 Nov 2015 14:33:20 GMT

Hi David

James

RE: Calcaneal fracture in a pup

Anthony Todd — Sun, 01 Nov 2015 20:25:17 GMT

[quote user="Stephen Courtney"]But I'm more than a bit taken aback at the extraneous bits of human being visible, and overall poor contrast suggests you have high scatter anyway.....[/quote]

Or just expiring developer??

Just out of interest, the radiographer when I was at Uni showed me a sort of red plastic sheet with which you could view a continuous Xray. He said he's been doing it for years and only had "a bit or arthritis in his hands"....

I know irradiating the gonads is not a good idea but, actually, how much irradiation is harmful to bones?

Valentino and Marc would be interested too, as they've probably had more Xrays than hot dinners

RE: Calcaneal fracture in a pup

Stephen Courtney — Sun, 01 Nov 2015 14:08:53 GMT

I would say it needs surgery, likely a tension band.

But I'm more than a bit taken aback at the extraneous bits of human being visible, and overall poor contrast suggests you have high scatter anyway.....

The problem with hand restraint for radiographs is once you start, it's always easy to justify the next 'quick picture' and the next thing you know you end up like Marie Curie or the forgotten lady who was as much part of decoding the double helix as Watson and Crick.