Subject: Duke’s summary
A summary of Duke’s injuries and recommendation of therapy:
Right hip: The hip joint is luxated, and was not willing to stay in place when Dr. Xxx reduced it. It also has arthritis secondary to hip dysplasia (as does the left hip), which indicates that there is not likely healthy cartilage to start with. One option is to reduce the hip and hold it in place with an implant (toggle pin), but a prerequisite for this with a successful outcome is healthy cartilage. For this reason I think Duke will do better long term with a femoral head ostectomy (FHO). This entails removing the head of the femur to allow his body to form a pseudojoint. Dogs generally do well with this procedure, but do maintain a limp for life, because that leg is shorter than the other.
Left knee: Duke has avulsion fractures (small bone chips that are pulled off the main bone) which are likely associated with some torn ligaments. Based on palpation Duke has torn his ACL (cranial cruciate ligament injury) and his medial collateral ligament of the knee. This results in instability of the joint with bones moving inappropriately in relation to each other. My recommendation for this injury is to use an implant (tightrope) across the joint to provide stability to the knee in place of the ligaments.
Left tarsus (ankle): Duke has some instability of his tarsus, as well has a fracture of the articular surface of this joint and a luxation of another bone within the joint. In some cases, fractures and dislocations can be fixed directly with surgery, but with Duke’s fracture involving a large portion of the joint surface, he is unlikely to do well with that repair. I recommend arthrodesis (fusing the joint), which will address all the problems in his joint.
We discussed that with any individual surgery there is a risk of
implant failure (which Duke will be at a higher risk for since he cannot favor one limb over another) and infection (which is of greatest concern in his knee with the tightrope, and he carries a slightly higher risk of with his skin wounds). Duke will require a splint on his left foot to protect the arthrodesis to try to avoid implant failure, and the bandage will need to be changed weekly. Duke will also likely need a screw removed from the ankle after recovery, but the remaining implants are designed to stay in for life if there are no problems.
We plan to address Duke’s right hip and his left knee today, and will address the left ankle tomorrow or Wednesday, pending arrival of the implants I would like.