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Repaired Fracture Questions


Guest GreyKatie
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Guest GreyKatie

We got a new foster tonight, Gabe Cuda ("Cuda"). He broke his leg in January and it was surgically repaired. Ten months later, he is still in pain. He runs around the backyard a little, but on walks he is miserable. He holds the leg up and doesn't walk on it about half the time. When he gets up from laying down, he also holds it up for a minute or two. He's been in the rescue's prison training program since March, and according to his trainer, his leg hasn't improved at all. She had him on some pain meds because he was getting snippy when his leg was hurting him. As far as I'm concerned, he's not adoptable in this condition.

 

I've expressed my concerns to the rescue, and am hoping we can get at least an X-ray done. Is there hope for this guy? The leg still has plenty of muscle tone, so it's definitely not worthless. Can a fracture be fixed after ten months? This guy wasn't even 2 when he was injured, so I'm hoping that works in his favor. He's got a bunch of hardware in his leg, and I know that one screw pushed itself out a few months ago.

 

Any ideas to keep him comfortable until we can get this taken care of? His prison trainer had him on baby aspirin, but I'm not sure if that's the best solution. Help?

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Guest Swifthounds

When was the last time he had x-rays and an orthopedic consult? That would be my first suggestion. Without an informed opinion, you're just guessing at the source of the discomfort.

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Guest GreyKatie

When was the last time he had x-rays and an orthopedic consult? That would be my first suggestion. Without an informed opinion, you're just guessing at the source of the discomfort.

 

It was originally repaired by GPA Daytona's vet, so he had that done in January or so. At some point while he was in the prison program, a screw came out, though I'm not sure whom he saw for that. I don't believe X-rays were taken.

 

I'm trying to get the rescue to let me take him in for at least X-rays. You're right that I'm not sure that this is what's causing his discomfort, and in my perfect world we'd get him into an orthopedist tomorrow. I know there's a lot of hardware in there, a few nasty scars, and a couple of little scabs the size of peppercorns.

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Even a plated fracture should be healed by now, given normal circumstances. He really needs an orthpedic specialist to look at him, and x-rays are a must.

 

My Toni fractured her hock pretty badly to end her racing career. She was in a cast for 2 months and was basically healed 3-4 months later - so a total of 6 months. She has had no problems for some time.

Chris - Mom to: Lilly, Felicity (DeLand), and Andi (Braska Pandora)

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Angels: Libby (Everlast), Dorie (Dog Gone Holly), Dude (TNJ VooDoo), Copper (Kid's Copper), Cash (GSI Payncash), Toni (LPH Cry Baby), Whiskey (KT's Phys Ed), Atom

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Guest Swifthounds

It can be a screw issue (sometimes they "work out" and that's painful), a problem with the healing of the bone, or an issue related to the placement of the plate (the plates are stronger than the bone and can occasionally cause a hairline fracture along the edge, necessitating moving the plate), or something else.

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Guest GreysAndMoreGreys

Could it be possible that there is ligament or tendon damage that was missed during surgery?

The reason I ask is we once had a grey that had a fractured leg, she went to the vet and it was set and wrapped. After several weeks things didn't seem to be getting any better.

Back to the vet again and another wrap but no surgery.

 

After about 6 weeks or so when the wrap came off it still wasn't right. Back to the vet and it was found there was ligament damage.

IIRC they had to do a button hole type thing. Stretch the ligament up and basically wrap it around a screw that was placed at the top of the bone.

 

What was happening was as she was placing her leg down it would hyper-extend and cause pain. So she would pull the leg back up.

Might be something to look into along with checking the hardware to see if it has shifted or needs to be removed.

If there are little scabs around the area of the hardware I would guess stuff is working it's self out and needs to be removed.

 

Oh and yes, a leg can still be repaired after this amount of time :)

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Ohhh.

 

I'd be concerned about a bone infection, but only because my last dog had a TPLO (tibial plateau leveling ostomy?) and month after month after month he wasn't progressing. I went to the vet over and over and was told stuff like "he's a slow healer" and finally the vet basically said my dog was probably a wimp.

 

Nearly a year to the day after the first surgery, he spiked a horrible fever and screamed when I touched his leg. Raced him to my regular vet (his surgery was done by a board certified orthopedic surgeon) who admitted him immediately for IV antibiotics. Blood work revealed a raging infection, and x-rays showed a broken screw.

 

More surgery to drain the joint, remove the plate and screws, and about three months on two antibiotics and he was OK, finally!


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Susan,  Hamish,  Mister Bigglesworth and Nikita Stanislav. Missing Ming, George, and Buck

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Guest GreyKatie

So after Cuda tried to bite us for having gently touched his leg, the rescue agreed it was time for X-rays. The vet was able to see the films from the original break, the original repair, 5 months later (he was seen for lameness), and today, 13 months later. At least one of the screws has moved and is causing him pain. He has lost muscle mass in his bad leg. He will need surgery to remove what's bothering him (right now, he has 6 screws and a plate). In the meantime, he's on Novox to manage the pain and inflammation.

 

I'm not sure what to expect. I imagine he'll be in more pain immediately following surgery. At what point should he start to feel better? What sort of repercussions will there be from removing the hardware? Will this make his leg less stable or strong in the future? We love our fosters, and of course we'll baby him like we do with all of them, but I have no experience with post-op dogs (besides spays), and I want to make sure this gets the best possible shot of working for him.

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Guest Greyt_dog_lover

My boy Bart had 2 rods and 8 pins to hold together his shattered hock. 1 year post-hardware removal (he was having similar issues with the pins moving) he was clocked at GPA WI reunion at 43mph! He did have hydro therapy as well as physical therapy during recovery. So as long as you have a very good orthopedic surgeon, your hound should have no issues. The key being a very good orthopedic doc.

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So after Cuda tried to bite us for having gently touched his leg, the rescue agreed it was time for X-rays. The vet was able to see the films from the original break, the original repair, 5 months later (he was seen for lameness), and today, 13 months later. At least one of the screws has moved and is causing him pain. He has lost muscle mass in his bad leg. He will need surgery to remove what's bothering him (right now, he has 6 screws and a plate). In the meantime, he's on Novox to manage the pain and inflammation.

 

I'm not sure what to expect. I imagine he'll be in more pain immediately following surgery. At what point should he start to feel better? What sort of repercussions will there be from removing the hardware? Will this make his leg less stable or strong in the future? We love our fosters, and of course we'll baby him like we do with all of them, but I have no experience with post-op dogs (besides spays), and I want to make sure this gets the best possible shot of working for him.

 

This happened to my girl. She got so she wouldn't walk on it at all. After a couple vets and a few phone calls, we took her to a vet in West Virginia. She had been repaired wrong. He removed the screw that had worked out and caused a fracture in the calcified area around the original break. Was wrapped for a few days and once the pain was gone, she was good to go.She runs, jumps and is our crazy little girl. So there is a happy ending. She had no plate. Just 2 screws. He was not happy with the repair that had been done on her. He made her better, thank god!!

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Guest GreyKatie

My boy Bart had 2 rods and 8 pins to hold together his shattered hock. 1 year post-hardware removal (he was having similar issues with the pins moving) he was clocked at GPA WI reunion at 43mph! He did have hydro therapy as well as physical therapy during recovery. So as long as you have a very good orthopedic surgeon, your hound should have no issues. The key being a very good orthopedic doc.

 

That gives me so much hope! The vet only wants to remove the one screw at the moment. It's possible she'll change her mind once she opens him up. I really hope that this allows him to run and be relatively pain-free.

 

What kind of physical therapy/exercises did you do? I am certain the rescue will not cover that, as they can barely afford this surgery bill as it is (a dog was attacked two months ago, resulting in an $8K vet bill...now we're broke). But I would like to do whatever I can on my own to help him heal better.

 

What was the initial recovery like? Did he walk on the leg, or did he stay off it for a while? I assume stairs will be out of the question. This guy is super high energy, really rowdy...it'll be tough to keep him quiet for very long!

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Guest Swifthounds

You can probably do the rehab/PT yourself. It's really a matter of getting everything healed and then working up slowly to rebuild the atrophied muscle.

 

I haven't done it with a greyhound, but with an IG who had a fracture so clean it looked as if it had been cut with a bone saw (the fracture hurt, but once it was plated there was not really any pain - and believe me with and IG you know). Then there was a hairline fracture even with the top edge of the plate (and a few weeks in a cast) and then the decision to reposition the plate. Three separate rounds of splints and casts and now she has a good usable leg. Her ortho surgeon is the best and actually did the plate removal and repositioning at cost because we had been through so much with her.

 

Screws working their way out is pretty common and quite painful. They can work their way all the way out and erupt through the skin on occasion. Once things are in place, no matter how much needs to be moved, there should be far less discomfort than now.

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Guest Greyt_dog_lover

The hydro therapy was swimming of course, you may check to see if there are any human hydro therapy places around that would like to get some good pr. Talk to the manager and see if they would possibly donate time to your hound. Explain the situation, a lot of places will work with non-profits.

 

As far as the physical therapy, we did massage therapy (tough to explain but basically massaging the leg to ensure good blood flow to reduce atrophy of the muscle) as well a regiment of walking increasing distances each day (usually we start at 1/2 block then by a month or so they are walking 1.5 miles with our other hounds). Also we would do what I called the reverse wheel barrow. Basically you pick up the hound's front legs like you are going to dance, then walk them backward and forward. This forces them to put weight on the leg. Of course this is something that you have to work with your vet as to when you can start doing the different methods of rehab. I would not begin to suggest when each part of the therapy you would start.

 

As for stairs, no issues there. I have tri-pods in and out of my house and I have 9 open-faced wood stairs to get into my back yard. Also, I am the second tier rehab home for broken leg hounds in my group (the first tier home has them when they are in casts and for a few weeks post-cast, then the cat-workable hounds come to my house) so I do get many hounds that frequently don't want to use their broken leg and they ALL do the stairs. You just have to be there for the first week or so to make sure they take them at a slow pace. They usually want to jump up the stairs in two bounds and thats not good. They also get half way down then want to jump the rest of the way down. You just have to be there holding the collar to control the speed at which they go up and down the stairs. Usually after a week or so they get the idea and will self-regulate a safe speed.

Edited by Greyt_dog_lover
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I went through this with a foster. It was clear a screw was backing out on x-ray and the ortho was suspicious there was also a bone infection going on, which was confirmed via biopsy after hte surgery (he took the sample when he was in there). They removed all of his hardware, plate and all screws. Honestly, if your foster's leg is healed completely, I'm not sure why they wouldn't just remove everything to avoid having to go in and remove more hardware again later. Once teh bone is healed, there's no need for it.

 

Total recovery time for us was a few months. The first month was critical, he had to be kept completely calm, always on lead or in an x-pen or crate, no running and especially no jumping/leaping that would put pressure on that back leg. We went in for weekly or sometimes 2x/week bandage changes. He started to develop sores from the splint so we had to switch to a soft bandage earlier than planned, which the vet was okay with only because I was so diligent about keeping him calm. The bandage was on for a total of 3 weeks I think, there may have been an additional 4th week where we kept a light bandage on for support and to keep him away from teh sores so they could completely heal. Month 2 was spent gradually working him up to more normal activity levels, which went smoothly. I still kept him pretty calm inside and there was no off lead time. He was adopted at the end of the second month and I saw him recently, months later and he is doing great, absolutely no issues and has total use of that leg.

 

Our vet did put bone grafts into the holes left from the screws to assist in the healing process. I don't know that that's standard practice so you might want to ask about it. I believe they used synthetic material for my foster, but I can't remember for sure.

 

Oh, he was on pain meds during the first few weeks of his recovery - Tramadol and an NSAID (Deramaxx in our case). He was also put on a strong dose of Clavamox to treat the bone infection - I believe that lasted 3 weeks. We were then able to wean him off the Tramadol and Deramaxx.

 

I hope this helps.

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Jen, CPDT-KA with Zuri, lab in a greyhound suit, Violet, formerly known as Faith, Skye, the permanent puppy, Cisco, resident cat, and my baby girl Neyla, forever in my heart

"The great thing about science is that you're free to disagree with it, but you'll be wrong."

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My dog was confined to an x-pen for months with his initial (bone cutting) surgery, but when he had his surgery to remove the plates, the orders were along the lines of no jumping off furniture and leash walking only, but that was mostly because he has about 27 staples in his leg closing the incision.

 

He was more sick from infection that the broken screw, and once the infection started to get better, he was a new man!

 

He made a full recovery, although he did have arthritis when he got old.


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Susan,  Hamish,  Mister Bigglesworth and Nikita Stanislav. Missing Ming, George, and Buck

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