Case of the week - orthopaedics

RE: Case of the week - orthopaedics

Gillian Mostyn — Fri, 01 Nov 2019 08:10:15 GMT

[quote user="Anthony Dennison"]I could do basic orthopaedics if I have to[/quote]

And that's all I was getting at. Deferring to someone more keen/experienced is fair enough. It is a shame so many vets won't go near it ever, to the detriment of some of their cases who get amputations instead of basic ortho.

RE: Case of the week - orthopaedics

Anthony Dennison — Tue, 29 Oct 2019 09:32:53 GMT

[quote user="Gillian Mostyn"]Don't we all do things every day that hold little interest for us? It is part of being a GP vet! Basic ortho used to be just another part of the job.[/quote]

I could do basic orthopaedics if I have to, but we currently have 2 or 3 vets fighting over the ortho cases as it is so why would I do it when there are people that have a real desire to? I can work up ortho cases, know the appropriate treatment and can then inform the vets about it. I can do DIY at home, same thing.

RE: Case of the week - orthopaedics

Michael Woodhouse — Fri, 25 Oct 2019 21:13:36 GMT

[quote user="Gillian Mostyn"]Basic ortho used to be just another part of the job.[/quote]

Still is here

RE: Case of the week - orthopaedics

Gillian Mostyn — Fri, 25 Oct 2019 20:41:28 GMT

[quote user="Anthony Dennison"]I've got no interest in orthopaedics. [/quote]

Don't we all do things every day that hold little interest for us? It is part of being a GP vet! Basic ortho used to be just another part of the job.

RE: Case of the week - orthopaedics

Evelyn Barbour-Hill — Fri, 25 Oct 2019 19:30:43 GMT

[quote user="Anthony Dennison"]

[quote user="Gillian Mostyn"]It is a shame that younger vets are so reluctant to take on even basic orthopoedics - they are often easier than you think - certainly much easier than a fat bitch spay![/quote]

I've got no interest in orthopaedics. Would much rather do the fat bitch spay! I could give it a go but I much prefer the parts around the surgery - imaging, diagnosis, peri and post operative pain management.

Medicine is much more challenging than surgery

[/quote]

De gustibus non est disputandum.

RE: Case of the week - orthopaedics

Anthony Dennison — Fri, 25 Oct 2019 18:06:00 GMT

Medicine is much more challenging than surgery

RE: Case of the week - orthopaedics

vetbl.locum — Fri, 25 Oct 2019 16:46:05 GMT

[quote user="Anthony Dennison"]

[quote user="vetbl.locum"]

Yes very bad IMO

Rgds

[/quote]

Why?

[/quote]

Sorry very busy afternoon

Will expand why later

Rgds

RE: Case of the week - orthopaedics

Evelyn Barbour-Hill — Fri, 25 Oct 2019 15:06:45 GMT

[quote user="Gillian Mostyn"]

I think Anthony's post could be read that amputation would be the recommendation which, presumably, shouldn't necessarily be the case based solely on the radiograph. The bones can be fixed and the cat will always be better on 4 functional limbs than 3. If for no other reason than it still has a spare!!!

However, amputation is always available if the fracture, clients, finances or aftercare (or lack of) would indicate it is a better option than fixation.

It is a shame that younger vets are so reluctant to take on even basic orthopoedics

[/quote]

Agree.

(What's happened to the agree button?)

RE: Case of the week - orthopaedics

Gillian Mostyn — Fri, 25 Oct 2019 15:04:14 GMT

However, amputation is always available if the fracture, clients, finances or aftercare (or lack of) would indicate it is a better option than fixation.

It is a shame that younger vets are so reluctant to take on even basic orthopoedics - they are often easier than you think - certainly much easier than a fat bitch spay!

RE: Case of the week - orthopaedics

Lindsey Edwards — Fri, 25 Oct 2019 14:39:43 GMT

Treatment target surely has to be to make the cat comfortable and mobile in the long term? We are not treating the x-ray but the patient!

Major ortho reconstruction is dependent on homecare input and finances (with potential for catastrophy); amputation is less costly and recovery time of a few days. All options should be put to owner/caregiver/guardian/fee payer and a treatment plan agreed mutually. I have no problem amputating in a cat with limited finances and/or minimal/unreliable aftercare, or with extensive repair (with or without referral) if aftercare is assured.

RE: Case of the week - orthopaedics

Anthony Dennison — Fri, 25 Oct 2019 13:57:10 GMT

[quote user="Dinu Catilina"]

[quote user="Kate Richardson"]Disagree. Not bad. [/quote]

Disagree. Bad

[/quote]

Just to clarify my post that has started this monosyllabic argument that those disagreeing with me aren't elaborating on their reasoning on their opinion...

It wouldn't be my first choice in every situation. However to the people suggesting external fixators - how often have you seen a complete success with these with no complications in a cat? In my (albeit limited) experience cats don't tolerate them very well at all.

A charity case with a risk of clients never coming back and not following post op care instructions or coming back for post op checks? Why isn't amputation a viable option?

RE: Case of the week - orthopaedics

Kate Richardson — Fri, 25 Oct 2019 13:42:57 GMT

[quote user="Dinu Catilina"]

[quote user="Kate Richardson"]Disagree. Not bad. [/quote]

Disagree. Bad

[/quote]

Why back at you?

Amputation wouldn't be the wrong thing to consider. I wouldn't give it as the only option and I'm fairly sure Anthony Dennison wouldn't either, but it is an option. Why is this so bad?

RE: Case of the week - orthopaedics

Dinu Catilina — Fri, 25 Oct 2019 13:14:29 GMT

[quote user="Kate Richardson"]Disagree. Not bad. [/quote]

Disagree. Bad

RE: Case of the week - orthopaedics

Anthony Dennison — Fri, 25 Oct 2019 12:27:33 GMT

[quote user="vetbl.locum"]

Yes very bad IMO

Rgds

[/quote]

Why?

RE: Case of the week - orthopaedics

Kate Richardson — Fri, 25 Oct 2019 11:25:15 GMT

[quote user="vetbl.locum"]

[quote user="Anthony Dennison"]

How has the cat managed post-operatively? I've no interest in orthopaedics, so my first thought was to just amputate the limb. Immediate recovery, no restricted exercise, no risk of implant failure... is that bad?

[/quote]

Yes very bad IMO

Rgds

[/quote]

Disagree. Not bad.

RE: Case of the week - orthopaedics

vetbl.locum — Fri, 25 Oct 2019 09:59:29 GMT

[quote user="Anthony Dennison"]

[/quote]

Yes very bad IMO

Rgds

RE: Case of the week - orthopaedics

Anthony Dennison — Fri, 25 Oct 2019 09:51:03 GMT

RE: Case of the week - orthopaedics

David Mills — Tue, 22 Oct 2019 17:02:33 GMT

There was mild facial trauma and a small instability in the mandibular symphysis so was consistent with fall from height.

The mediolateral view showed no surprises.

Re diagnosis, I think these cannot always easily be defined. The ligaments were amazingly still intact, and the main lesion was a lateral malleolar fracture - I find these difficult to differentiate from fibular luxation. This was better appreciated during surgery.

Whilst the suggestions for surgical fixation are sound, I like to simplify things as much as possible, and so two a wires were placed across the fracture and it stabilised nicely. Apologies for the crap positioning, it was late in the day and everyone wanted to get home so the cat was half awake!

RE: Case of the week - orthopaedics

Dinu Catilina — Mon, 21 Oct 2019 21:06:03 GMT

I had a few cases where money were an issue where I just replaced the collaterals with prolene 3M through bone tunnels. Cage rest for 8 weeks, no ESF, no dressing, half splints for some. They develop a degree of ankylosis and a functional limb.

RE: Case of the week - orthopaedics

Iain Richards — Mon, 21 Oct 2019 20:54:25 GMT

What height? Did it really fall? If signiincat height it should have facial injuries shouldn't it?

RE: Case of the week - orthopaedics

Beats — Mon, 21 Oct 2019 20:40:47 GMT

transarticular ex-fix for 3-6 weeks. cage rest for 6 weeks. will do great ;-)

RE: Case of the week - orthopaedics

James Dunne — Mon, 21 Oct 2019 06:54:43 GMT

Looks like talocrural luxation with distal fibula fractured. I would take the orthogonal radiographic view to avoid getting burnt by something unexpected [I am not happy that the talus is entirely intact on the view presented] and it might change my mind whether I go for repair or primary arthrodesis. Charity case, some charities fund more than others, so assuming funds are okay = Reduce the joint, suture or replace with prosthetics for torn collaterals, suture the joint capsule [most likely torn dorsally/cranially]. Place a medial ESF since cats tolerate it better than bandages, remove after 4 weeks. Arthrodesis for salvage if this fails.

RE: Case of the week - orthopaedics

Glen McIntosh — Mon, 21 Oct 2019 04:04:33 GMT

I’m no ortho - I usually refer this sort of thing to our ortho specialist - but I’ll have a swing.

Tibio-tarsal luxation and distal fibula fracture.

Analgesia, GA, closed reduction of the luxation, RJ bandage and 6 weeks cage rest.

In the event that doesn’t work then off to the surgeons for arthrodesis?

RE: Case of the week - orthopaedics

David Mills — Mon, 21 Oct 2019 00:31:50 GMT

[quote user="janine redman"]

And can I have some additional radiographic views please

[/quote]

Not required in this case, this is diagnostic.

Finances are that they are a donation-based charity client.

RE: Case of the week - orthopaedics

janine redman — Sun, 20 Oct 2019 23:59:18 GMT

And can I have some additional radiographic views please