Patient of the Week candidates for 4/19 - 4/23

Your winner for last week's voting was Max with 21 votes.

Way to go, Max!

PATIENT SUMMARY:

UK is a Pembroke Welsh Corgi. He weighs 35# and is 9 yrs old. His referring veterinarian was Dr. Mark Davis of Davis Animal Hospital. UK has had a history of bilateral rear limb lameness, but most recently the left rear had been the most affected. Dr. Davis's radiographs demonstrated degenerative changes in the left hip and the right stifle. Upon On examination by Dr. Dew, there was bilateral medial buttress and cranial drawer present; no overt pain was noted with hyperextension of the left hip. He discussed bilateral CCL rupture, EFS (external fascial strip) and TTA (tibial tuberosity advancement) augmentation procedures. Dr. Dew also discussed THR (total hip replacement), BioScaffold procedure and FHO for the left hip. UK’s owners elected to proceed with bilateral TTA and left coxofemoral (hip) BioScaffold implantation.

TREATMENT:
Dr. Dew used a medial approach with medial arthrotomy. Implants from Kyon used on each side in UK’s TTA procedures were as follows: 6x16mm baskets, 3 hole plate & fork, titanium screws. A cancellous graft was also placed to promote healing and bone growth. For the BioScaffold implantation, Dr. Dew used 0.5cc and injected this into the Left hip area. UK’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. Due to having both knees corrected in a single surgery, "UK" may require some assistance rising and walking for the first 1-10 days. Optimal improvement for the hip joint should be noted 30-60 days from the implantation.

PATIENT SUMMARY:
Bryner is a Siamese Mix weighing 27# and is 5 yrs old. Dr. Howard Foggo with Benton Veterinary Hospital was his referring veterinarian. Bryner had been attacked by a dog and had acute onset of left rear lameness afterward. Dr. Foggo's radiographs demonstrate a luxation of the left stifle, consistent with multiple ligamentous disruption. Dr. Dew discussed suture stabilization and the supplemental use of ESF (external stabilization Fixator), fair prognosis for return to function over 16-24 weeks, if pain free function is not obtained arthrodesis could be considered. The owners wished to proceed with surgical stabilization.
TREATMENT:
Dr. Dew used a medial approach for Bryner’s surgery. Both the bilateral collateral and cranial/caudal CCLs were ruptured, and Dr. Dew used 0-PDS sutures to approximate the ligaments as well as using 4 pin type I composite fixator, 0.062 pins and 1" acrylic column. As the damage was not as extensive as Dr. Dew had originally estimated; Bryner’s prognosis is good for uncomplicated healing and will return to weight bearing activity.  Aftercare instructions must be followed to insure the best possible outcome.

PATIENT SUMMARY:
Charley is a 72#, 6yr and 8mo old Labrador Retriever. He was referred to us by Dr. William Hezel of Hickory Hill Animal Hospital. Charley had an acute onset left rear lameness, and Dr. Hezel has identified a left CCL injury. Upon exam by Dr. Dew, anterior drawer was consistent with CCL rupture. Dr. Dew discussed CCL disease, TTA (tibial tuberosity advancement) and EFS (external fascial strip) augmentations, recovery and prognosis. Charley’s owner decided to proceed with EFS procedure and took advantage of the transport service to Russellville.
TREATMENT:
Dr. Dew used a lateral approach with lateral arthrotomy. He observed that the meniscus was intact. He explored, debrided, lavaged, imbricated joint EFS, using a medial buttress suture #1-PDS. Charley’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.

PATIENT SUMMARY:
Guinness is a 75#, 5yr and 9mo old Labrador Retriever. Dr. Amy Hawley of North Hills Animal Clinic was her referring veterinarian. Guinness had an acute onset of left rear lameness, and at the time our appointment, she was then intermittently lame on the left rear. Dr. Hawley had identified a left CCL injury. Upon examination by Dr. Dew, there was positive anterior drawer, which is consistent with CCL rupture. He discussed CCL disease, TTA (tibial tuberosity advancement) and EFS (external fascial strip) augmentations, recovery and prognosis. Guinness’s owner wished to proceed with a left EFS procedure.
TREATMENT:
Dr. Dew used a lateral approach with lateral arthrotomy. He observed that the meniscus was intact. He explored, debrided, lavaged, imbricated joint EFS, using a medial buttress suture #1-PDS. Guinness’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.

PATIENT SUMMARY:
Grace is a Golden Retriever. She is 4yrs and 10mos old, and weighs 72.2#. She was referred to us by Dr. Bob Hale of Briarwood Animal Hospital. Previously, Grace had seen us for right TTA, right LPL correction, and Grace continues to have intermittent LPL on the right. Dr. Dew discussed trochleoplasty procedures. Her owner decided to proceed with right trochleoplasty today.
TREATMENT:
Dr. Dew used a medial approach with medial arthrotomy for Grace’s revision. The patella was easily reduced, and unable to be luxated post surgery. There was also a 1.5cm in diameter mass sub –Q on her right mid-thigh. This was removed and submitted to the AR State Lab. Grace’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.

PATIENT SUMMARY:
Blue is a 44.7#, 5mo old Blue Tick Hound referred to us by Dr. Clifton Peck of Double Tree Veterinary Clinic. Blue had been rolled over by a heat & air truck. Dr. Peck's radiographs demonstrate bilateral SI luxations, a left comminuted acetabular fracture and a left capital physeal fracture. Upon exam by Dr. Dew, there was deep pain present in both rear limbs, and voluntary motor movement to his tail. Chest radiograph was normal. Dr. Dew discussed the articular nature of fractures, and that arthritic changes will progress, but "Blue" has a good prognosis for bone healing and return to ambulatory function with stabilization of SI, acetabular and capital physeal fractures. Blue’s grandparents gave permission for surgical intervention.
TREATMENT:
Dr. Dew used a Right dorsal SI approach for the SI Luxation, Fracture acetabulum-comminute, left, capital physeal fracture left. The ventromedial wall of the acetabulum was fractured and unable to be reduced, but dorsal 1/2 of rim is able to be stabilized. Dr. Dew observed good joint surface alignment, and good hardware placement. Dr. Dew stabilized SI luxations with 4.5mm screws/washers and dorsal 3/16 enhanced thread pin. The right ilial wing growth plate was stabilized with divergent 0.062 wires (2), and the acetabular fracture was stabilized with 5mm 4 hole acetabular plate, 3-2.7mm screws, 0.062 enhanced thread pin. The capital physis was stabilized with 2-5/64 enhanced thread pins and 1-7/64 smooth pin, and the greater trochanter stabilized with 5/64 divergent pins and a 20g tension band. Despite all of his injuries, Blue remained a trooper throughout. Blue’s prognosis is good for normal osseous healing. Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing. Due to the severity of the fracture, "Blue" may require some assistance rising and walking for the next 1-14 days. Arthritis will certainly develop in response to the fractures, it is hoped that it will remain at a sub-clinical level.