Splinting For Broken Toe

[kudzu]

Well, my goofy boy broke his toe at last potty call last night. Decided to skip e-vet last night & took him to regular vet this morning. Was afraid of what the e-vet might do, like excessive bandaging. Well either I was giving my regular vets too much credit or I have no clue what really needs to be done for a broken toe. Anyway, my poor boy is now sporting a splint that goes half way up his leg & is covered in what seems to be excessively heavy bandaging. If I've got it right this is a clean break of the middle phalanx. It's a weight bearing toe on a front foot.

 

I know it likely needs some immobilization. My question is how much is too much? Am very worried about pressure sores. We got lucky when Venus shattered a toe bone years ago. It was an outside toe on a rear foot. We left it alone, letting it heal on its own. It required weeks of rest with leash walking only but it healed fine. Sol's situation is different. I really don't see how it could heal well if left alone but the size of this bandaging seems out of proportion to the injury.

 

How fast do pressure sores develop? Vet said, "it will take about 6 weeks to fully heal but we need to check it in two weeks." I expressed concern and suggested I bring him in mid-week this week for a recheck to make sure sores weren't developing. He was surprised but said, "we're always happy with sooner. Better that than too late." He asked about Tues or Wed. I said either is fine. He replied, "Well then I think Tues is best." He did say they've got a powder on his toes that is antibacterial & anti inflammatory, plus there is light padding between all the toes. I'm still very worried.

[Hubcitypam]

When Buck broke his toe (middle on a front foot) my vet absolutely refused to splint it. He said splinting toes is a bad thing as it moves pressure on up the leg. Buck just healed on his own.

[kudzu]

Where was Buck's break & what kind was it?

[BauersMom]

Berkeley's break was right at the joint and there was a "floater" piece of bone the vet was concerned about - so we splinted (I have dealt with aabout a dozen dislocated toes so I knew the risks going in). He got a sore in about 4-5 days. We did every other day bandage changes from there.

 

The calmer you can keep them in the splint, the less chance of a sore. That said, it's still an impossible feat with greys. You have to weigh the pros and cons of the splint in the individual case - I would not do it in most cases, but sometimes you can't get around it.

[Hubcitypam]

His was a clean break, no floaters, ragged edges or anything. I don't know about middle phlanges but it would have been just under his knuckle if he were a person...if that makes sense.

[tbhounds]

Doesn't sound excessive too me. In time they may be able to wrap lighter.

[JJNg]

To effectively immobilize a toe on the front leg, you do have to do a splint that goes above the carpus (wrist). And if it's well padded like it needs to be or a greyhound, it will be heavy. When Willow fractured P1 (proximal phalanx) on an inside toe of a front leg, it was a slanted break through the middle of the bone and very unstable. I had it repaired with a screw, and she was in a splint for 6 weeks until it healed.

Because I'm paranoid about pressure sores, I changed the splint twice a week. I definitely wouldn't go 2 weeks in a greyhound, although I'm glad they put padding between all the toes. Here's a photo of Willow's splint. Wiki was also bandaged because he was healing from a a toe amputation (the same one Willow broke!).



The bigger question is whether a toe fracture needs to be splinted at all, and that depends on which toe, which bone, how unstable the fracture is, and how painful the dog is. I'd be more inclined to splint for weight-bearing toes, and for P1 fractures. A compromise might be to keep him splinted for 3-4 weeks for some initial healing and stability, then switch to a padded bandage and continue leash-walking for another 2-3 weeks.

Unfortunately, I've had lots of experience with toe issues with my guys. For more details on my personal experiences, here's a previous post.

[kudzu]

Thanks folks. The break is in P2, I think. Not the one with the claw but the next one up. Bone was out of place. That was obvious just looking at it even without xray. So I'm guessing that would indicate instability. He's definitely painful. Vet said it wasn't a bad bread. Didn't think it needed surgery but did think it needed splinting. The amount of bandaging was rather disturbing to me but sounds like it is appropriate. (Again proving why I'm in accounting & not vet med. )

 

Poor Peg Leg...

 

[greyhead]

Wow, that *is* an impressive bandage! Sending healing thoughts.

[tbhounds]

Just wanted to mention--you may want to purchase a Medipaw boot just to make things easier for you--so much easier than putting baggies on :-)

http://www.medivetproducts.com/

[kudzu]

Thanks, tbhounds. I actually already had one because of a prior hounds adventures in toe injuries. At the time I didn't know what size to get so bought both sizes small for front & medium for rear legs. Turns out medium is a perfect fit for Sol's bandage enhanced leg.

 

You are correct. These Medipaw boots are so very much easier than messing with baggies or plastic wrap. Well worth every penny, especially during mud season.

[tbhounds]

Thanks, tbhounds. I actually already had one because of a prior hounds adventures in toe injuries. At the time I didn't know what size to get so bought both sizes small for front & medium for rear legs. Turns out medium is a perfect fit for Sol's bandage enhanced leg.

You are correct. These Medipaw boots are so very much easier than messing with baggies or plastic wrap. Well worth every penny, especially during mud season.

:-)!

[kudzu]

R_CE -- Well, 3 out of 4 ain't bad. Sol's got rest, compression & elevation covered.

 

Edited March 5, 2013 by kudzu

[BauersMom]

That's hilarious!

[kudzu]

Had the first bandage change today. All looks very good. No sign of any sores starting. Toe/foot is still a little swollen but much less so than Saturday. Toe looks nice & straight, not with the tip cocked off at an angle like it did Saturday before they set it. He's now sporting purple wrapping. Next change is Friday. He's getting around surprisingly well but it's clearly an effort keeping that peg leg held up, out in front of him. Goofy boy is back on his bed, snoozing away, looking none the worse for wear. It's going to feel like a long 6 weeks but I'm definitely optimistic that all will be well.

[Trihounds]

Bumper had a full cast, like yours. Padding between the toes, etc. I had the wrap changed every 5-6 days or so and I'm glad I did because one of the changes (different vet) wrapped it differently and not as well done - a pressure sore developed. From then on, only the 1 vet tech I trusted did it and no more issues.

 

Bumper broke the outside toe on his left foot. A radial type fracture that didn't displace but he ended up developing arthritis in the joint and limps even to this day because of it. I had wanted to do a toe amp originally but the vet said we should try the splint route first. Just make sure the changes are done right and often enough and you should be ok. About 2 weeks into the recovery, we demanded a shorter wrap so the boy could at least walk a little better. Good luck.

 

 

[Guest cwholsin]

Leg of shame!! Our boy Nash just busted up his toe on Sunday and we had it amputated today. He managed to split the middle 'long' bone in half diagonally. Rather than make him deal with a splint for 2 months and then deal with the possibility of it still hurting him, we opted just to cut it off. His was the back left outside toe, so non-weight bearing.

[cello]

Specky broke her toe last year chasing a squirrel in the potty yard. We amputated the next day, but here is the wrap she had for that first night. Her post-amp wrap was actually smaller!

 

I highly agree with getting a medi-boot. It will make turn outs so much easier.

 

[kudzu]

And every last one is a front left foot.

[BauersMom]

And every last one is a front left foot.

My gosh, you're right!

 

For the record, none of my dogs did any damage to their left front.

[Guest cwholsin]

My dude did in his back left, but I didn't post a pic. His post amp bandage is really small.

[kudzu]

Well, we are a month into the healing process. We've kept twice weekly bandage changes because of my worries about sores. About 10 days in he did have a small spot rubbed raw at one bandage change. It was the same change where they discovered he had broken his splint. I had no idea that had happened. That spot was scabbed & healing nicely when a new spot showed up a bit red & bare at the next visit. Both of those were OK the next visit both a new spot was looking iffy at a later follow up. Basically that's how it's been going. So far none have expanded & rebandaging seemed to solve the problem.

 

The boy is a total goof though. He is really ready to play. Has been bouncing around the house at points & tossing stuffed toys. So one day, out of the corner of my eye, I catch him play bowing. He reaches out & it looks like he's grabbing for a toy but actually he chomps down hard on his splint! Then the doof attempts to pull his leg up like he's going to toss it in the air. Needless to say he didn't get far & I was forced to be the fun police. I'd say he's feeling pretty good.

 

Xrays were taken at his last visit, the 4 week mark. All was healing nicely but vet wants the splint to stay on. Ah, well. It wasn't a surprise. So we've a couple weeks left. Hoping all progresses as it has.

Edited April 3, 2013 by kudzu

[JJNg]

Sounds like things are going well. And your experience supports my personal preference for doing twice weekly bandage changes in greyhounds.

 

Love the story about him trying to play with his splinted leg - too funny!

 

One note about x-rays... It's not unusual for toe fractures to look like they're not completely healed on x-rays. Some orthopedists don't even repeat x-rays on toe fractures for this reason. As long as the toe feels stable, isn't painful, and the dog isn't lame, it's usually fine. Sometimes the bone never fully heals, but the fibrous union is enough for full function.

 

Also, after being splinted for so long, you may have some stiffness and decreased range of motion in the joints immobilized by the splint, especially the carpus (wrist). It may take time for this to resolve, and physical therapy and passive range of motion exercises help. I actually did some careful range of motion exercises with Willow when the splint was off during her bandage changes, but her toe fracture was stablized with a screw, so I didn't have to worry too much about disturbing the fracture site.

[kudzu]

So at one point I had to reschedule an appt for a couple days later. Sure enough there was a small ulcer on the outside of one toe. We debated leaving the splint off at that point but he's such a dork I was afraid he'd do something crazy before I could stop him even if crated or in an xpen. So they carefully rewrapped him. Ulcer healed without issue. Friday the splint came off. We've got two weeks of leash walking now.

 

Sol doesn't seem to realize he's unsplinted. He's not using that leg. We are doing range of motion exercises. Am trying to leash walk him very slowly because he is more likely to put his foot down then. He is more likely to put it down when going up the ramp. Think this really may be a combo of habit, stiffness & perhaps some discomfort. Wasn't worried for the first couple days but am not feeling to happy about things today. Will continue the exercises & give it another day or two. Will talk to the vet in tomorrow or Tues if things aren't improving some. Think I just need to be more patient.

[JJNg]

Was he walking on the leg with the splint on? I often do a soft, padded bandage without the splint for a few days to a week after removing the splint. I think it allows a more gradual transition and provides some support while they're getting used to not having the splint anymore.

 

You're probably right that it's due to habit, stiffness, and maybe mild discomfort. Walking slowly and putting a hand on his shoulders and applying a little gentle pressure downward can encourage him to use the leg. Praise when he puts weight on the leg. Some dogs are more stubborn about it and take longer than others to start using the leg normally.