Lateral humeral condyle fracture - post-op splint?

RE: Lateral humeral condyle fracture - post-op splint?

Hannah Wynne Richards — Fri, 03 Jul 2015 16:10:46 GMT

Great!

Wynne

RE: Lateral humeral condyle fracture - post-op splint?

Sarah Mark — Fri, 03 Jul 2015 15:22:05 GMT

Just to update - the radiographs from Canada showed an excellent repair with a lag screw and 2x im pins, but they were very tight-lipped about the spica splint. The surgeon did email me last night to say it was only a precaution as the pup was flying overseas, and didn't plan to leave it on for 6 weeks - an error in the post-op instructions it seems.

Anyway, I've taken the splint off and re-radiographed, all looks fine and the pup is doing well so far! Thanks for everyone's help :)

Re: Lateral humeral condyle fracture - post-op splint?

Gerry Henry — Wed, 01 Jul 2015 14:20:19 GMT

I wouldn't assume that some sort of internal fix has been performed, this might not be the case; I'd X ray right now, there's still time to lag if necessary.

Re: Lateral humeral condyle fracture - post-op splint?

John Flynn — Tue, 30 Jun 2015 19:43:17 GMT

The age of the pup?

Unless I had proper notes that made sense and preferably post-op rads, I'd take decent xrays NOW rather than in couple of days time as I'd like to know what was going on inside (probably all good, but if not then the longer you leave it the harder it gets to sort...)

I'd be concerned what you might find as sending a pup with a broken leg, operated on or not, on a long flight from Canada to UK sounds bit weird to me.

I've never applied a Spica splint to lateral condylar fracture and struggle to imagine the situation where I thought this appropriate - perhaps with a T or Y fracture where a tenotomy of triceps tendon had been performed in an adult dog I could understand better? Also in a pup (<9 months old?) I can't see the need for external coaptation for 6 weeks if there has been even a vague attempt at internal fixation - perhaps a week or 2, but even that would likely be detrimental to articular cartilage and soft tissues?

[quote user="Sarah Mark"]if the original practice don't reply[/quote]

Try phoning them during their opening hours.

Re: Lateral humeral condyle fracture - post-op splint?

Sarah Mark — Tue, 30 Jun 2015 18:58:40 GMT

Thanks everyone, I also hadn't come across a SPICA before - it does look well done but I am a bit worried about leaving it on. I'll keep trying to get some more info from the Canadians, like you Tim I did wonder why they had splinted it, is there more to it than meets the eye? Especially splinting for 6 weeks? The owners are nice folk who want what's best for the pup and as much as you can ever tell with these things, are hopefully likely to be understanding if things get tricky!

Like I say, he's in on Thursday (1 week post-op) so if the original practice don't reply I'll just soldier on!

Re: Lateral humeral condyle fracture - post-op splint?

Evelyn Barbour-Hill — Tue, 30 Jun 2015 18:21:27 GMT

[quote user="Tim Charlesworth"] the dressing you describe is a SPICA splint. They are effective in immobilising the elbow by maintaining it in extension[/quote]

I've learnt something new again!.

Re: Lateral humeral condyle fracture - post-op splint?

Tim Charlesworth — Tue, 30 Jun 2015 17:54:46 GMT

**I AM NOT AN ORTHOPOD***

Was waiting for one to jump in but in case they don't - the dressing you describe is a SPICA splint. They are effective in immobilising the elbow by maintaining it in extension but as you rightly say this is not something that you usually want to do in a humeral condylar fracture where early mobility is usually encouraged.

I would be a little concerned that there is something going on that you don't know about (eg is there some immobility in the joint, were the collateral ligaments or even triceps insertion accidentally trashed during the surgery etc)? I would do your best to get hold of the clinical notes and surgery report from Canada but if you can't get hold of them then discuss your concerns ("this is not usually done for this type of surgery so we are not sure if there were intraoperative complications but ideally we would like to take the cast off..." etc) with the owner.

Best of luck,

Tim

Re: Lateral humeral condyle fracture - post-op splint?

Evelyn Barbour-Hill — Tue, 30 Jun 2015 17:12:37 GMT

I would imagine that the splint is on in an effort to prevent things from going wrong rather than to correct a repair that's already gone wrong.

I doubt if it will work.

Personally I can't see how you can effectively splint an elbow anyway.. I'd guess this thing is just acting as a handicap to reduce use of the leg.

But I haven't talked to the Canadian vet, so I don't know.

Tricky situation. But the case is yours now.

Personally I think i'd go along with the Canadian plan, even if I had no faith in it, as long as it was not doing harm.

Not very helpful. Sorry.

Re: Lateral humeral condyle fracture - post-op splint?

Hannah Wynne Richards — Tue, 30 Jun 2015 10:17:22 GMT

Total agreement with Gillian. When cases go wrong it's always considered by owners to be the fault of the last veterinary surgeon to treat.

Wynne

Re: Lateral humeral condyle fracture - post-op splint?

Gillian Mostyn — Tue, 30 Jun 2015 09:48:44 GMT

In this situation, with the owners permission, I would radiograph the dog and from now on just treat the dog as you feel best. Trying to continue with another vet's treatment choices is going to be difficult, but if there are complications or failures you will be the one held responsible!

(Sorry, just a gpvet so can't give advice on fracture management, but I'm sure others will....)