OUR WINNER FOR LAST WEEK'S VOTE WAS, DRUM ROLL PLEASE........LOUIE!! WITH 931 VOTES!!!!!
Belle is a Bernese Mountain Dog and is 2yrs and 6mos old. She weighs 60#. Dr. Kristy of Austin Osage Veterinary Clinic is her referring physician. Back in July of 2008, Belle had a THR. Between then and now, she has had a previous diagnosis of a loose acetabular cup. She now has come in for a Total Hip Replacement revison. Dr. Dew discussed prognosis and recovery. Belle's owners decide to proceed with surgery.
TREATMENT: Dr. Dew observed moderate wear debris associated with loose cup and cup screw. After he implanted a new cup and proceeded to replace the femoral head, a loose femoral component was identified. Following conversations with Dr. Tepic of Switzerland, Dr. Dew elected to explant all components. There appeared to be no crepitus post implant removal and calcar reduction. Dr. Dew discovered also from his conversations that most femoral stem loosening has been associated with low grade osteomyelitis. Cultures were sent to Arkansas State Lab for further examination. Dr. Dew noted adequate femoral neck resection and soft tissue interposition between femur and acetabulum Belle's prognosis is good for healing and resolution of the arthritic pain. Physical therapy will play a critical role in assuring that she has a good return of post-operative function.
Poo is a 7yr old, 10# Poodle sent to us by Dr. Heath Stump of Russellville Animal Clinic. She had been HBC several weeks ago. The left hock had been splinted, but had not stabilized. Dr. Dew discussed primary ligament repair and splint augmentation or stabilization of avulsion fragment. Her owner wished to proceed with surgery.
TREATMENT:
Dr. Dew used a medial approach for Poo's medial collateral ligament reconstruction in her right hock. Radiographs suggested medial collateral disruption, but no fractures were noted. Good stability was achieved by debriding the ligament/joint capsule attachments, and also by drilling a 0.045 hole through medial malleolus and placing multiple SI 2-0 maxon sutures in differing orientations, whereby good stability was achieved. Poo's prognosis is good for normal soft tissue healing. Exercise restrictions and bandage care instructions must be followed to maximize the prognosis for uncomplicated healing.
Diesel is a 1.5yr old 85# Labrador referred to us by Dr. James Hoffman with Westside Veterinary Clinic. He was HBC 4 days previous, and Dr. Hoffman had identified a sagittal fracture of the olecranon that involved the aconeous and articular surface. Dr. Dew discussed internal fixation with lag screws, and gave a good prognosis for return to hunting function. His owner wished to proceed with stabilization.
TREATMENT:
Dr. Dew used a lateral approach with anconeal myotomy for this procedure. He observed good reduction and compression of fragments. He stabilized the fracture with two 2.7mm screws placed in lag fashion. Post-surgically, good reduction and hardware placement was noted. Diesel's prognosis is good for normal osseous healing. Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing. Diesel's leg has been repaired using a combination of wires and/or pins. These implants have been designed to maximize the opportunity for successful bone healing and return to function. HOWEVER, they are initially not as strong as normal bone or tissue! Therefore, exercise restriction is mandatory to prevent catastrophic failure of the fixation hardware.
Dixie is a Labrador who is 6yrs old and weighs 67.9#. She came to us from Dr. Sandra Reynolds with Little Rock Veterinary Clinic. Dixie became acutely lame on the Right Rear 3-4 days previous. Dr. Reynolds identified a right CCL, and upon examination there was + anterior drawer consistent with that diagnosis. The owners have had experience with the TTA (tibial tuberosity advancement) procedure, as Dr. Dew had previously operated on one of their other family members, and had no further questions.
TREATMENT:
Dr. Dew used a medial approach with medial arthrotomy. The Kyon implants used for the Tibial Tuberosity Advancement were a 9x19mm basket, 6 hole plate & fork, and 4 titanium screws. Good hardware placement was observed; tibial plateau was perpendicular to straight patellar ligament. Dixie's prognosis is good for healing, improved function and decreased progression of degenerative joint disease (arthritis). Nursing care, physical therapy, exercise restriction and the use of Glycoflex will play critical roles in an uncomplicated recovery and optimization of long term function. With the TTA procedure, it is not uncommon to see some bruising and edema around the hock (ankle) and on the inside of the leg below the incision. These changes are not painful and will resolve without treatment in 3-10 days.
Haley is a 10 yr and 6mo old, 113# Golden Retriever. She was referred to us by Dr. Scott Hollensworth of Springhill Animal Clinic. Her owner had noted a soft tissue tumor on the caudal aspect of the left mandible. The mass is 2x1.5cm on the buccal side of the 4th premolar. Dr. Dew discussed resection with margins including partial mandibulectomy. Haley's owner wished to proceed with surgery. Presurgical radiographs did not demonstrate any evidence of pulmonary metastasis.
TREATMENT:
Dr. Dew used an oral approach to excise Haley's tumor and perform her left partial mandibulectomy. The removed segment includes the last premolar and 2 molars. There was no evidence of tumor at bone or soft tissue margins. The removed tissue was submitted to Akansas State lab. Haley's prognosis is good for healing; the biopsy results will help define the expected outcome
Coletrane is a Dachschund weighing 12.4# and is 4yrs old. He was referred to us by Dr. Mark Sharp of South County Animal Hospital. Coletrane had had previous rear limb weakness treated conservatively and resolved. However; 48 hours prior to presentation to us, Coletrane became weak bilaterally, and was unable to support weight. He was given tramadol, buprenorphine and robaxin at Dr. Sharp's clinic. Upon examination by Dr. Dew, he had Grade IV paresis in his left hind limb, and Grade V in the right. Dr. Sharp's radiographs were suggestive of T11-12 disc rupture. Dr. Dew discussed the confounding clinical signs that may have been drug influenced. Coletrane's owner decided to proceed with myelogram and hemilaminectomy surgery.
TREATMENT:
Myelogram: Coletrane was given a lumber injection of 4ml iohexol. This allowed Dr. Dew to view the loss of all columns throughout T12, with column attenuation greater on the right side. T11-2 rupture, left sided lesion.
Hemilaminectomy: Dr. Dew used a left dorsolateral approch. There was a large amount of acute and fibrous disc material removed ventral to the spinal cord, decompression extended to level of normal epidural fat. Cord appeared normal. The disrupted disc material from T-11 through T-12 was removed. Coletrane's prognosis is good for healing and guarded for improved neurologic function. A transient worsening of neurologic function can be noted after a myelogram and surgery. This condition will usually resolve to the pre-operative state in 3-10 days. The nervous system is very slow to heal. Improvement can be expected for up to 5 months. Nursing care, physical therapy and exercise restriction all play critical roles in avoiding complications and aiding recovery.
Posts
No comments:
Post a Comment