Fractured fibula - 2 year old labrador - thoughts?

RE: Fractured fibula - 2 year old labrador - thoughts?

Neil Wheadon — Wed, 11 Apr 2018 20:37:03 GMT

Seems to doing well according to the records

6 weeks up on Monday when it's being X-Rayed again. Unfortunately I'm at a different place next week but will try to get the X-ray

Neil

RE: Fractured fibula - 2 year old labrador - thoughts?

Neil Wheadon — Thu, 29 Mar 2018 22:15:05 GMT

I'm back there in 10 days, I'll ask

Initially for the first 10 days it was going really well

Neil

RE: Fractured fibula - 2 year old labrador - thoughts?

David Mills — Thu, 29 Mar 2018 21:41:26 GMT

What happened with this case?

Had something similar in this week.

RE: Fractured fibula - 2 year old labrador - thoughts?

Anthony Todd — Sat, 03 Mar 2018 16:17:26 GMT

I think Andrew may have found it first too judging by it's relevance.... [which is why it came top!]

Check the others though!

And [ironically] bandaging a head in any species is really ffraught which is probably why the results were published!

RE: Fractured fibula - 2 year old labrador - thoughts?

Michael Woodhouse — Sat, 03 Mar 2018 16:05:02 GMT

31 years old and a human paper with tiny numbers treated.

Your search methodology is poor if that's the first you find!

RE: Fractured fibula - 2 year old labrador - thoughts?

Anthony Todd — Sat, 03 Mar 2018 16:01:43 GMT

[quote user="David Mills"]You have internet. You have lots of time. Pubmed is free. Go knock yourself out. [/quote]

You knew I would and I bet you just looked at the first one and didn't read it...

I did and some others.

More if you want....

CONCLUSIONS:

A total of 702 operations were performed in 577 patients; only five patients received any type of surgical bandaging. There were four SSIs (0.57%; 95% confidence interval [CI] 0.16-1.45). The postoperative infection rate in the 626 clean cases was 0.48% (95% CI 0.10-1.39) and was 2.63% (95% CI 0.07-13.81) in the 38 clean-contaminated cases. The data obtained in this investigation is consistent with the position that bandaging incisional scalp wounds after cranial surgery adds little if any benefit beyond the easier, simpler, and cheaper practice of using antibiotic ointment as a dressing without bandaging.

https://www.ncbi.nlm.nih.gov/pubmed/17566401#

POST SURGERY EXPECTATIONS

Basic Wound Care Instructions/ Post Surgery Expectations

All surgery patients will leave with a pressure bandage on the surgery site whether sutures are used or if the wound heals by second intention.

Pressure Bandage: Antibiotic ointment is applied to the wound and covered with non-stick telfa. A layer of gauze is then placed on the wound and adhered with cover-roll bandage tape.

All pressure bandages should remain on and dry for 48-72 hours after surgery.

http://www.dermsurgcv.com/what-to-expect/post-surgery-expectations/

[PDF]Knee arthroscopy advice sheet

You can remove the outer-crepe bandage and cotton wool yourself at home 24 hours after surgery. If the small dressings are clean and stuck in place leave them intact. However, if they are soiled or peeling off, replace with the clean dressings supplied to you on the ward. Then place tubigrip from your toe to your hip.

www.uhs.nhs.uk/Media/.../Kneearthroscopyadvicesheetpatientinfo.pdf

(3) wound dressings; the use of occlusive dressings to promote moist wound healing is the most significant advance in wound management. Occlusive dressings shorten the time for healing, decrease pain, reduce wound contamination, and improve the cosmetic result.

Adv Dermatol. 1987;2:243-67.

RE: Fractured fibula - 2 year old labrador - thoughts?

David Mills — Sat, 03 Mar 2018 15:16:18 GMT

[quote user="Anthony Todd"]Love to see the "studies"![/quote]

You have internet. You have lots of time. Pubmed is free. Go knock yourself out.

RE: Fractured fibula - 2 year old labrador - thoughts?

Michael Woodhouse — Sat, 03 Mar 2018 13:26:52 GMT

[quote user="Anthony Todd"]Curved bladed garden secuteurs removed all my casts?! Get ones with one narrow curved blade.

https://www.ebay.co.uk/itm/7-Strong-Carbon-Steel-Garden-Shears-Cutters-Secateurs-Plant-Pruning-Trim/361628219983?epid=1428256444&hash=item5432b8ba4f:g:mFwAAOSwgY9XeOA~

or better[/quote]

Not a hope in hell with some thicker casts of synthetic materials.

The cordless Fein oscillating saw is a pleasure to use for cast removal and with an adaptor kit for orthopaedics. We use it for everything including cows.

RE: Fractured fibula - 2 year old labrador - thoughts?

Anthony Todd — Sat, 03 Mar 2018 13:23:31 GMT

[quote user="robloxley"]Maybe modvets operate to avoid the haematomas, seromas, wound interference and swelling and hence get good wound healing?[/quote]

Or perhaps not all of them....

Bandages

Bandages help stop bleeding, keep the wound clean, protect the wound from further injury, and prevent the wound from excessive drying. Bandages have 3 layers.

etc

Sort of what I said??

from the latest Merck Manual [on line]

RE: Fractured fibula - 2 year old labrador - thoughts?

Rob Loxley — Sat, 03 Mar 2018 12:38:13 GMT

[quote user="Anthony Todd"]

Most dinovets I knew pressure bandaged everything they could in all animals post op. I did every time. Had significant effect on all the things mentioned above; post op. swelling is an obvious and irrefutible one!

Stopped haematomas, seromas, prevented wound interference and swelling seemed to aid wound healing too.

[/quote]

Maybe modvets operate to avoid the haematomas, seromas, wound interference and swelling and hence get good wound healing?

RE: Fractured fibula - 2 year old labrador - thoughts?

Anthony Todd — Sat, 03 Mar 2018 10:32:26 GMT

[quote user="David Mills"]and most studies into bandaging post op have found little or no (and no significant) effect on post op swelling, comfort or outcome.[/quote]

Love to see the "studies"!

Stopped haematomas, seromas, prevented wound interference and swelling seemed to aid wound healing too.

RE: Fractured fibula - 2 year old labrador - thoughts?

Anthony Todd — Sat, 03 Mar 2018 09:04:41 GMT

Curved bladed garden secuteurs removed all my casts?! Get ones with one narrow curved blade.

https://www.ebay.co.uk/itm/7-Strong-Carbon-Steel-Garden-Shears-Cutters-Secateurs-Plant-Pruning-Trim/361628219983?epid=1428256444&hash=item5432b8ba4f:g:mFwAAOSwgY9XeOA~

or better

RE: Fractured fibula - 2 year old labrador - thoughts?

Evelyn Barbour-Hill — Fri, 02 Mar 2018 14:59:27 GMT

[quote user="James Dunne"]but the splint/cast/stabilising device is more likely to come off if there isn't something against the other axis.[/quote]

But there is something, the bandage and so on that's holding the splint on.

I see your argument, but we'll have to agree to differ.

RE: Fractured fibula - 2 year old labrador - thoughts?

James Dunne — Fri, 02 Mar 2018 12:11:15 GMT

HI Evelyn

The fracture does only need to be stabilised against lateral bending - but the splint/cast/stabilising device is more likely to come off if there isn't something against the other axis. If you mould the splint on the caudal-plantar axis as you describe and bring it up in an incomplete tube around the distal limb, it's another way of doing things without then needing an oscillating saw to remove it afterwards. In theory, stabilising flexion-extension isn't needed, but in reality, the motion in a joint is more complex and flexion-extension motion will result in motion of the fractured segment, so more rigid joint stabilisation might be preferred. It is an inefficient way of achieving the desired effect, but probably the best non-invasive way apart from strict cage rest.

RE: Fractured fibula - 2 year old labrador - thoughts?

Dinu Catilina — Thu, 01 Mar 2018 23:40:15 GMT

[quote user="David Mills"]Where do you get the surgical adoption kit? Very interested in getting me one of these...how much is the bosch too?[/quote]

If you're trying to find a cheap alternative then try e-bay. A chinese autoclavable oscilating saw which is identical with the ones sold by Vetisco and VI, as most likely they buy them in the same place, is about 500 pounds. Got mine 5 years ago and it's still going strong. No need for a shroud, I have my doubts how sterile it stays when you start flushing.

RE: Fractured fibula - 2 year old labrador - thoughts?

Rob Loxley — Thu, 01 Mar 2018 15:11:54 GMT

[quote user="David Mills"]Where do you get the surgical adaption kit? Very interested in getting me one of these...how much is the bosch too?[/quote]

The Bosch 10.8v is discontinued to buy separately so we bought the whole kit from Vetisco, it looks like they're offering a makita saw now: http://www.vetisco.com/joint-surgery/power-tools/makita1-orthopaedic-drill-and-oscillating-multisaw/makita-oscillating-multisaw3

Vet instrumentation do similar http://www.veterinary-instrumentation.co.uk/home.php?cat=241

RE: Fractured fibula - 2 year old labrador - thoughts?

Evelyn Barbour-Hill — Thu, 01 Mar 2018 13:40:01 GMT

[quote user="James Dunne"] I appreciate the comment regarding only one aspect [medial or lateral] needing a splint, but I think that stabilising the joint bi-axially is more secure. [/quote]

I really don't understand that, or else I do understand and I disagree.

This fracture, if it needed stabilisation, only needed stabilisation against lateral bending.

A splint that stabilised against lateral bending would obviously stabilise against medial bending as well.

A simple flat splint applied to the caudal, extensor, plantar, side would achieve that stabilisation.

In practice a gutter splint placed there would be easier to do and more comfortable, and would itself be stabilised against slipping off the calcaneus and thus no longer lying on the extensor surface.

I honestly cannot see any necessity to apply a whole cast or to attempt to stabilise against flexion-extension forces.

James, unless I have visualised it wrongly, from your description you would apply in effect a gutter splint to each of the lateral and medial sides, supplying maximum stabilisation against flexion-extension, just where it isn't needed. I'm sure such a structure would also counteract lateral-medial bending forces, but it seems an odd and rather clumsy and inefficient way to achieve the desired effect.

RE: Fractured fibula - 2 year old labrador - thoughts?

Neil Wheadon — Thu, 01 Mar 2018 12:33:52 GMT

[quote user="James Dunne"] I do not place the cast and then cut it to divide it. I place the material in a linear fashion along the limb either side and mould it to the limb. you then have a split cast without the need for cast saw / robust scissors etc.[/quote]

If you can get this exactly right that would work, but wouldn't you get a slight overlap that has the potential to cause abrasions. In effect you'd still need to trim it.

Casts are all about the damage they cause to a dog rather than the stabilising effect they effect in my opinion

Neil

RE: Fractured fibula - 2 year old labrador - thoughts?

David Mills — Thu, 01 Mar 2018 12:23:13 GMT

[quote user="robloxley"]

[quote user="Evelyn Barbour-Hill"]oscillating "multi-tools" (£19.99 at Aldi)have sometimes been pressed into use [/quote]

We have one of the Bosch ones with the stainless surgical adaption kit - great for the odd osteotomy, luxating patella and femoral head excision too!

[/quote]

Where do you get the surgical adoption kit? Very interested in getting me one of these...how much is the bosch too?

RE: Fractured fibula - 2 year old labrador - thoughts?

James Dunne — Wed, 28 Feb 2018 19:46:10 GMT

Been away for a few days - sorry for not replying. I do not place the cast and then cut it to divide it. I place the material in a linear fashion along the limb either side and mould it to the limb. you then have a split cast without the need for cast saw / robust scissors etc. Obviously you have to be fairly quick during application, especially with the newer fibreglass materials, or they harden before you've finished. I appreciate the comment regarding only one aspect [medial or lateral] needing a splint, but I think that stabilising the joint bi-axially is more secure.

RE: Fractured fibula - 2 year old labrador - thoughts?

Rob Loxley — Wed, 28 Feb 2018 19:46:01 GMT

[quote user="Evelyn Barbour-Hill"]oscillating "multi-tools" (£19.99 at Aldi)have sometimes been pressed into use [/quote]

We have one of the Bosch ones with the stainless surgical adaption kit - great for the odd osteotomy, luxating patella and femoral head excision too!

RE: Fractured fibula - 2 year old labrador - thoughts?

Evelyn Barbour-Hill — Wed, 28 Feb 2018 13:20:31 GMT

[quote user="Neil Wheadon"]well the travelling orthopod who did the crucial did have one, but with one anaesthetic machine I had to anaesthetise after the crucial and she had to go. At £7000, she wasn't keen to leave it, so scissors it was and I just about managed [/quote]

Angle grinders (B&Q's finest) and oscillating "multi-tools" (£19.99 at Aldi)have sometimes been pressed into use

Dare I say on this forum.... (insert trepidation emoticon).... if you had used the material to make a gutter splint you would not have needed to cut anything

RE: Fractured fibula - 2 year old labrador - thoughts?

Neil Wheadon — Wed, 28 Feb 2018 09:22:56 GMT

[quote user="robloxley"]

[quote user="Neil Wheadon"]Casted this way today, tough work with a pair of scissors to split it.[/quote]

Indeed, much easier with an oscillating saw!

[/quote]

well the travelling orthopod who did the crucial did have one, but with one anaesthetic machine I had to anaesthetise after the crucial and she had to go. At £7000, she wasn't keen to leave it, so scissors it was and I just about managed

Neil (necessity is the mother of invention)

RE: Fractured fibula - 2 year old labrador - thoughts?

Rob Loxley — Tue, 27 Feb 2018 23:57:10 GMT

[quote user="Neil Wheadon"]Casted this way today, tough work with a pair of scissors to split it.[/quote]

Indeed, much easier with an oscillating saw!

RE: Fractured fibula - 2 year old labrador - thoughts?

Neil Wheadon — Tue, 27 Feb 2018 22:14:46 GMT

[quote user="James Dunne"]

Hi Evelyn

A contoured cast split in the cranial-caudal direction would prevent lateral-medial bending of the hock. Maybe my wording wasn't clear!

Kind regards

James

[/quote]

Casted this way today, tough work with a pair of scissors to split it. We did have some embryotomy wire but no wire cutters. I made sure the distal fibula and calcaneous were included in the cast, ended up as an oblique cranial - caudal split

It looked really good when we discharged and the owner was pleased, hopefully the next 4 weeks will go well

So thanks to everyone who contributed

Neil