how would you fix this fracture

RE: how would you fix this fracture

Arlo Guthrie — Fri, 11 Mar 2016 11:24:55 GMT

[quote user="Malcolm Ness"]first, my recent quiet period on vet surgeon was, in part, related to the way that some of the "discussions" were moving[/quote]

Must admit, my back has been slightly turned, working on improving VetSurgeon Jobs to the point where it works well for everyone and in turn I start getting paid again (been a while, as I've been investing a lot more into the websites). Huge amount of work going on behind the scenes.

One thing I would like to ask is that if ANYONE feels that someone else is repeatedly derailing discussions, or repeatedly flogging a well-worn mantra, PLEASE email me directly (in confidence) with a link to the thread or threads.

However obvious it may seem to you that their posts are causing, er, frustration, it may well not be as obvious to them (or they think it is justified anyway). They may need a gentle steer in the form of an email or telephone call from me. Or they may need something a bit less gentle. Like I send a couple of VetSurgeon 'heavies' round to their house (wearing branded t-shirts and ear-pieces). Joking.

RE: how would you fix this fracture

Clive Ansell — Fri, 11 Mar 2016 10:05:03 GMT

[quote user="Malcolm Ness"]an interesting and unexpectedly unpleasant time following the sale of our practice to a prominent corporate.[/quote]

That's a shame - please tell us you're joking

RE: how would you fix this fracture

Malcolm Ness — Fri, 11 Mar 2016 07:55:40 GMT

I heard that I was being talked about!

Several points raised here: first, my recent quiet period on vet surgeon was, in part, related to the way that some of the "discussions" were moving but also to my personal circumstances - an interesting and unexpectedly unpleasant time following the sale of our practice to a prominent corporate.

I have seen a number of these isolated fractures of the radius over the years and published on a few cases in JSAP in ?? 1995.

I would manage this conservatively: I would not use a cast because the perceived mechanical aetiology of this fracture probably involves hyper-extension of the elbow against a fixed distal limb - a cast is not likely to effectively control that and might even exacerbate it. I have attempted to plate these (before the paper was written) and reduction of the displaced fragments can be extremely challenging against the intact ulna. A risk of conservatism is that the dog goes on and fractures the ulna - I have only seen that once and that was in a case that had been cast.

Several other issues arose during this thread: fractures heal slowly under plates and very slowly indeed if primary bone union is involved. However, the patient will often weight bear very soon after good plate fixation and continue to do so while the bone heals. Callus healing, as happens in a cast, with an external fixator and in fact, with most platings, is faster in terms of bone healing but can be associated the a long period of discomfort and dysfunction.

Well designed locking plates are powerful orthopaedic implant systems but their use in a two piece fracture like this, even if the ulna were involved, is inappropriate.

Loosening of external fixator pins implies sub-optimal technique. A properly placed ex fix should remain firm and stable throughout the healing period.

Ex fix and casting remain excellent methods of treatment but, like any other method of fracture treatment, they must be used properly on appropriately selected cases.

RE: how would you fix this fracture

Rob Davis — Fri, 04 Mar 2016 18:33:15 GMT

[quote user="Anthony Todd"]

[quote user="Gillian Mostyn"]intermittent diarrhoea[/quote]

The key is in "intermittent", but you are getting near to being a dinovet......

[quote user="Gillian Mostyn"]yes please[/quote]

Oh geez, I'll have to trawl through thousands, but will it change any embedded views?

[/quote]

Tangent, perhaps, for those who can be bothered....

RE: how would you fix this fracture

Anthony Todd — Thu, 03 Mar 2016 17:52:43 GMT

[quote user="Gillian Mostyn"]intermittent diarrhoea[/quote]

The key is in "intermittent", but you are getting near to being a dinovet......

[quote user="Gillian Mostyn"]yes please[/quote]

Oh geez, I'll have to trawl through thousands, but will it change any embedded views?

RE: how would you fix this fracture

Gillian Mostyn — Thu, 03 Mar 2016 17:11:40 GMT

[quote user="Anthony Todd"]My 6 month ME Maine Coon kitten haso had intermittent diarrhoea since 15 weeks old[/quote]

Diarrhoea since 15 weeks old and you query bloods having been done by 6 months old??

[quote user="Anthony Todd"]This was one and I'll find better ones if you like[/quote]

yes please

RE: how would you fix this fracture

Anthony Todd — Thu, 03 Mar 2016 16:08:01 GMT

[quote user="Lucy Fleming"]I can't recall any cases of diarrhoea discussed on here where bloods were done on day 1[/quote]

My 6 month ME Maine Coon kitten haso had intermittent diarrhoea since 15 weeks old. He arrived on a raw diet and had constant liquid faeces. Bloods no concerns

This was one and I'll find better ones if you like. [I mean bloods before diet trial]

RE: how would you fix this fracture

Gillian Mostyn — Thu, 03 Mar 2016 13:25:04 GMT

Yeah...40 years old and I've just been called modern. You've made my day!

RE: how would you fix this fracture

Lucy Fleming — Thu, 03 Mar 2016 12:50:02 GMT

[quote user="Gillian Mostyn"]Really? I was under the impression that everyone does what I do at the first consultation for D++ - bloods, faecal culture, ultrasound scan and, occasionally, MRI. Oh dear....am I doing something wrong? [/quote]

oh you modvets...

RE: how would you fix this fracture

Gillian Mostyn — Thu, 03 Mar 2016 12:40:43 GMT

[quote user="Lucy Fleming"]I can't recall any cases of diarrhoea discussed on here where bloods were done on day 1[/quote]

Really? I was under the impression that everyone does what I do at the first consultation for D++ - bloods, faecal culture, ultrasound scan and, occasionally, MRI. Oh dear....am I doing something wrong?

RE: how would you fix this fracture

Lucy Fleming — Thu, 03 Mar 2016 12:25:23 GMT

[quote user="Anthony Todd"]again and again we have diarrhoeas which become complex multiorgan problems because the bloods etc are done on day one[/quote]

I can't recall any cases of diarrhoea discussed on here where bloods were done on day 1

RE: how would you fix this fracture

Anthony Todd — Thu, 03 Mar 2016 11:55:07 GMT

[quote user="Robin Grimmer"]3 days of chicken and boiled water[/quote]

No, and as usual what I said, and probably again and again, because, again and again we have diarrhoeas which become complex multiorgan problems because the bloods etc are done on day one [and with D+ you'll get blood changes which are totally inconsequential in most cases] but not after a simple diet trial which will sort 90% or more of simple D+s.

AFTER a failed single protein diet trial THEN do all your tests but not before.

Ironically, [quote user="Robin Grimmer"]often quite complex and interesting cases[/quote] turn out to be as above....

RE: how would you fix this fracture

Martin Atkinson — Wed, 02 Mar 2016 08:53:51 GMT

[quote user="cathal rafferty"]If you're referring to mike guillard's advice, i don't think he was necessarily suggesting a cast would be his first choice;[/quote]Mike's actual words were: 'Definitely cast, it will be fine'. I trust him because he would be the first to tell me I was wrong as I would him. We have mutual respect but being good friends also won't pull any punches criticising each other. I don't think there is any doubt it will heal whichever way we deal with it its just which is most practical and convenient for all concerned. There's no point me undertaking orthopaedic surgery if I'm no longer confident in my dotage and it 'aint bad enough to refer.

RE: how would you fix this fracture

cathal rafferty — Tue, 01 Mar 2016 21:05:02 GMT

If you're referring to mike guillard's advice, i don't think he was necessarily suggesting a cast would be his first choice; more like " now it's in a cast, you may as well leave it and see what happens" . Or at least that's how i read it.

on a more general note, there will always be a market for "the old ways are best" type veterinary. I take the view that if people are only interested in the cheaper option maybe they're better off going somewhere else anyway

a few months ago i had a cruciate which went to a mixed practice elsewhere because the surgery would be about 250 euro there ( who knows what they were doing for that kind of money). Yesterday i had another client in how couldn't speak badly enough about that practice after having a cruciate done there years ago. We are all judged by our results

people will vote with their feet, usually when they get a new pet and decide to try someone else. If an older technique genuinely is inferior, the practitioner will get found out sooner or later.

RE: how would you fix this fracture

Anthony Todd — Tue, 01 Mar 2016 20:27:54 GMT

[quote user="David Mills"]cast [/quote]

I did smile to myself when the only apparent expert comment in the thread recommended a cast, unfortunately on page 3 or 4 and not earlier.

RE: how would you fix this fracture

Gerry Henry — Tue, 01 Mar 2016 19:55:57 GMT

At the risk of sounding like a money grubbing principal but ... if the client isn't skint or a charity case why the obsession among some of this parish to save money. Read - save money - as reduce practice income; presumably the same money savers want the full salary at the end of the month, their pension contributions, RCVS fees paid for, ditto CPD. It all has to be paid for children, just remember that.

RE: how would you fix this fracture

Robin Grimmer — Tue, 01 Mar 2016 18:11:52 GMT

I agree. It's not just re casts. He constantly belittles any form of diagnostic tests, and all gi problems can be solved by 3 days of chicken and boiled water, and so on. And because of the turbo posting, it just derails the thread of often quite complex and interesting cases.

RE: how would you fix this fracture

David Mills — Tue, 01 Mar 2016 17:56:11 GMT

I've no problem with him personally at all. What I have a problem with is someone turbo-posting the same anecdotes over and over on every orthopaedic thread. I have no problem with a less-is-more approach, where appropriate.

E.g. from this one...

[quote user="Anthony Todd"]one cast with no possibility of post-op complications.[/quote]

[quote user="Anthony Todd"]cast [/quote]

[quote user="Anthony Todd"]a cast.[/quote]

[quote user="Anthony Todd"]pre-cast [/quote]

[quote user="Anthony Todd"]Casts[/quote]

[quote user="Anthony Todd"]a simple cast[/quote]

You can look at how little Malcolm has posted since that other thread. He used to be on here most of the time before that. Mighty suspicious if you ask me - if I was him, a specialist, I certainly wouldn't waste my time arguing with such dogmatic nonsense.

RE: how would you fix this fracture

Bob Russell — Tue, 01 Mar 2016 14:56:15 GMT

I would consider a number of options but I sure as heck would not tell you miserable lot which it was!

A combination of Ovarid, prednisolone and homoeopathy would be a good starting point!

RE: how would you fix this fracture

Eamon McAllister — Mon, 29 Feb 2016 16:50:40 GMT

[quote user="David Mills"]

Anthony has form for this sort of rubbish. This was the thread that denied the forum of an expert and helpful contributor. Ignoring him is best I think.

https://www.vetsurgeon.org/uk/small_animal/f/161/t/20999.aspx?pi1596=1#126864

[/quote] Malcolm Ness has been on here lots of times since then so I don't think that you can blame Anthony for his absence. What have you got agin him anyway - he really seems to irritate you with his philosophy of keeping it simple, less is more etc... Just because one might have all the gear sitting on the shelves it doesn't mean that it has to be used all the time. I would consider casting this or maybe even applying a splint.

RE: how would you fix this fracture

Martin Atkinson — Mon, 29 Feb 2016 15:48:33 GMT

Final (for now) decision. I passed it by a real orthopaedic surgeon (sorry Malcolm you haven't replied yet) - my good friend Mike Guilliard who says leave it in the cast, mind he probably knows what a useless orthopaedic surgeon I am so is playing safe. Anyway, I can now blame him if it goes tits up!

RE: how would you fix this fracture

Rob Loxley — Sun, 28 Feb 2016 19:40:24 GMT

[quote user="Michael Woodhouse"]

Vetisco have a number of loan kits that cost £100 including delivery and return. They invoice you for what is used. It's there as an option.

That said - £1500 will get you a complete 2.7/3.5 kit that will cover anything doggy that doesn't go in a handbag.

[/quote]

Interesting to know, we last rented from animalcare (I think) when we did a plated tarsal arthrodesis. As for buying we'd need a smaller kit than 2.7 I think to deal with some of our smaller patients.

RE: how would you fix this fracture

Michael Woodhouse — Sun, 28 Feb 2016 18:48:56 GMT

[quote user="robloxley"]Not everyone has lots of different systems to choose from: we don't have a decent plating kit and selection of plates (and don't see the caseload to justify the investment) but do have a decent ESF kit so that influences what we'd choose.[/quote]

Vetisco have a number of loan kits that cost £100 including delivery and return. They invoice you for what is used. It's there as an option.

That said - £1500 will get you a complete 2.7/3.5 kit that will cover anything doggy that doesn't go in a handbag. They don't eat anything. I assume you have a drill if you are doing ex-fix anyway.

I claim no great ortho experience but I would always sterilise the ex fix kit if I was planning a plate as 'plan B'.

RE: how would you fix this fracture

Martin Atkinson — Sun, 28 Feb 2016 18:39:48 GMT

Well certainly food for thought, as always opinion is divided: surgeons go for surgery, clinicians go for conservative treatment. Dog is coming in tomorrow for a check-up, if the cast is comfortable I think I will leave it. I will give the owner an option, as I've been on an orthopaedic conference of a referral for MIPO, the dog is a nutter though so i wonder how well they will keep it under control after surgery.

RE: how would you fix this fracture

grumpyoldman — Sun, 28 Feb 2016 15:31:50 GMT

Good points , I find pin loosening, pin tracts and client compliance problem, so tend to go for an interlocking plate in places where we would have used an ESF 5-10 years ago , but everyone has their own ways of dealing with these problems.