Candidates for week of 4/26 - 4/30 for Patient of the Week

Grace won our last week's vote with 8 votes :)

Congrats, Grace!

Here are the candidates for this week's Patient of the Week:

PATIENT SUMMARY:

Tucker is a Labrador Retriever weighing 98# and is 8yrs old. Dr. Greg Hartman with Hartman Animal Clinic was his referring veterinarian. He had chronic right forelimb weight bearing lameness, and the signs were only partially palliated with NSAID's. Radiographs from Dr. Hartman did not demonstrate lesions of any significance in Tucker’s elbow or shoulder. Upon Dr. Dew’s examination, he was weight bearing lame on the right forelimb, and there was moderate atrophy of suprascapular muscles. Tucker had pain on palpation of his biceps tendon. His elbow and carpus palpate normally. Dr. Dew discussed the taking of radiographs to rule out changes in the proximal humerus consistent with a tumor, and then if indicated he would perform a biceps tenotomy. Tucker’s owner wished to proceed with the above treatment plan.
TREATMENT:
A radiograph of the right shoulder demonstrated only a small osteophyte at the caudal aspect of the humeral head. Dr. Dew used a craniolateral approach for Tucker’s biceps tenotomy. The osteophytes lined the biceps groove, but Dr. Dew was able to perform a complete biceps release. Tucker’s prognosis is good for reduction of lameness.

PATIENT SUMMARY:
Clyde is a Labrador/Chow mix. He is 10yrs old and weighs 80#. He was referred to us by Dr. Linda Ford of Noah’s Ark Veterinary Services. Clyde had an acute onset of left rear lameness 2 weeks previous. He had previously had a right TPLO. Upon examination by Dr. Dew, there was positive anterior drawer and medial buttress consistent with CCL rupture. He discussed the TTA (tibial tuberosity advancement) procedure, recovery and prognosis with Clyde’s owner, and he decided to proceed with a left TTA.
TREATMENT:
Dr. Dew used a medial approach with medial arthrotomy for Clyde’s TTA procedure. He used Kyon implants as follows: 12X22mm basket, 6 hole plate & fork, and 4 titanium screws. His 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.

PATIENT SUMMARY:
Peco is a Bassett mix. He is 4yrs old and weighs 46#. He was referred to us by Dr. Scott Hollensworth of Springhill Animal Clinic. Peco was HBC the day previous, and radiographs from the AEC demonstrate bilateral ischial fractures, a right SI luxation (moderate displacement) a left ilial body fracture and disruption of the left tarsus-medial collateral ligament. There is moderate to severe devitalization of the dermis most prominent in the right flank and ventral abdomen. Deep pain and voluntary motor movement are present in both rear limbs and tail. Dr. Dew discussed stabilization of SI, ilial body fracture and tarsus, also discuss possible need for dermal closure or treatment at a later date. His owner decided to proceed with ilial body stabilization, and hock stabilization. The SI luxation will be allowed to heal without surgical stabilization.
TREATMENT:
Dr. Dew used a lateral approach to the ilial body and a medial approach to the hock. Dr. Dew observed good reduction, hardware placement left ilial body, and good approximation of medial collateral ligament and chip fragment. Dr. Dew was suspect of a possible abdominal hernia, but this was unidentifiable by radiographs. The hardware used to stabilize Peco’s ilial body was 6 hole, 8mm plate with 6 - 3.5mm screws. The hock was stabilized with 2-0 maxon SI sutures. Peco’s prognosis is good for normal osseous healing. Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing. The soft tissue injury may result in loss of the dermis and could require surgical intervention in order to close the developed wounds.

PATIENT SUMMARY:

Mona is a 23#, 5yr old Corgi. She was referred to us by Dr. Carl Fulton of Faulkner County Veterinary Clinic. Mona was possibly HBC the previous week, and Dr. Fulton had identified a left coxofemoral luxation. The radiographs demonstrate craniodorsal luxation, and the acetabular depth appears adequate for an open reduction. Dr. Dew discussed open reduction/trochanteric transposition with Mona’s owner with a 90-95% prognosis for maintenance of reduction and uncomplicated return to ambulatory function.

TREATMENT:
Dr. Dew used a trochanteric osteotomy approach for Mona’s surgery. She was stabilized using divergent 0.062mm wires and 20 guage tension band wire. Mona’s prognosis is good for normal osseous healing. Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing.

PATIENT SUMMARY:
Anonymous is an 11# 10yr old Siamese mix referred to us by Dr. Ken Smith at Parkway Animal Hospital. She had been attacked by a dog, and had acute non-weight bearing lameness on the left stifle. Dr. Smith identified multiple ligamentous disruption. Dr. Dew discussed the use of suture stabilization and augmentation with ESF (external stabilization fixator), with a fair prognosis for return to normal indoor cat function. Her owner wished to proceed with surgical stabilization.
TREATMENT:
Dr. Dew used a medial approach for this surgery. Sutures were placed to appose collateral remnants, and tunnels were drilled for 0-biosyn CCL sutures. He placed a transarticular 5/64 pin to maintain femoral/tibial alignment. The ESF bar was a 1” acrylic, and it was attached to 4 - 5/64 enhanced thread pins to complete stabilization. This prognosis is fair for ligamentous healing and return to ambulatory function. Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing.

PATIENT SUMMARY:
Abbigale is a 1yr and 6mo old Min Pin, and she weighs 13.3#. She was referred to us by Dr. Carol Entricken with Benton Veterinary Hospital. Abbigale has had intermittent rear limb lameness, and Dr. Entricken identified bilateral MPL. Upon examination by Dr. Dew, she did have grade III MPL. Dr. Dew discussed MPL correction, recovery and prognosis. Her owner wished to proceed with bilateral MPL correction by TTT (tibial tuberosity transposition).
TREATMENT:
Dr. Dew used a medial approach for Abbigale’s TTT surgeries. He used 0.045 divergent pins to stabilized her patellas. Abbigale’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:
Tag is a 66# 2yr and 6mo old Golden Retriever. He was sent to us by Dr. Cathy Kaga of Town & Country Animal Hospital. He had been out in the yard when he had acute onset left rear lameness 1 month ago, and rest and NSAID's have resulted in minimal improvement. Dr. Kaga has identified a calcaneal tendon injury. Upon examination by Dr. Dew, Tag was non-weight bearing lame, and he was able to flex the hock with stifle locked in extension. There was palpable thickening of proximal and distal calcaneal tendon at mid body. Dr. Dew discussed a calcaneal tendon rupture, and repair of hock arthrodesis, as Tag is to be an obedience competitor. His owner decided to proceed with tendon repair with a 70% prognosis for return to athletic function.
TREATMENT:
Dr. Dew used a lateral approach to the stifle and hock. He harvested fascial strip with lateral 1/3 of straight patellar ligament as attachment. With this, he created a soft tissue tunnel for fascial strip, and opened the tendon sheath to debride the tendon ends. He then re-apposed the tendon with 2-0 maxon. Dr. Dew was able to use fascial strip to buttress/augment tendon for 2cm on either side of rupture, lavaged, and then closed tendon sheath incorporating fascial strip. For stabilization, he placed 6 pins (4 enhanced thread, 2 smooth) and a composite Type II ESF with 1" acrylic bars. He also implanted 1ml of BioScaffold into the tendon sheath.  Tag’s prognosis is fair for uncomplicated healing and return to athletic function.  Exercise restrictions must be followed to maximize the prognosis for uncomplicated healing.