Hailey is a 7 year old German Shepherd Dog, who first came to our hospital for a second opinion on how to treat an injury to her right front paw caused by jumping out of a doorway.
At that time she wasn’t using her leg at all and there was a swelling just behind her carpus (wrist joint) That joint was overextending and collapsed if she tried to put weight on it.
Figure 2 – Hailey’s over-extension on x-ray
X-rays had been taken by her original vet who confirmed there were no fractures but the joint space was abnormal which led the veterinarian to suspect Hailey had torn the ligaments that run up the back of the carpus.
Figure 1- Normal Carpus
It was decided to put Hailey in a cast to support the joint and hope the ligaments would heal. Hailey initially did well but her leg became ulcerated by cast rubs (pressure sores) and she came to Riverside Small Animal Hospital to see if anything else could be done.
Upon examination two conclusions were reached; the tendons were not healing, and would not heal by that method as the leg was too ulcerated and infected to remain in a cast. Hailey’s owners were faced with a difficult decision between two treatment options; either surgical fusion of the joint or limb amputation.
The surgical fusion option is called Carpal Arthrodesis. To do this the surgeon removes all the cartilage surrounding all the little bones of the carpal joint. The space is then packed with bone graft (bone tissue taken from same patient and used elsewhere) and fixed in place with a metal plate and screws. This means the joint stops being a joint that can bend and becomes more like an extension of the long bone of the front leg.
Hailey’s owners were presented with the pros and cons of each procedure to consider which option fit best for Hailey’s lifestyle, age and the financial commitment required.
The primary advantage of arthrodesis was that after a long recovery she would have a very functional leg. The primary disadvantages of arthrodesis were the need to delay until the ulcerations were healed, and it is an advanced surgical technique done only by specialist hospitals. It is also a very expensive procedure.
Amputation was the other treatment option available and its primary advantages were the surgery could be performed locally and at significantly lower cost. The disadvantages were, it is more difficult for dogs to adapt to front leg amputation, and Hailey’s opposite front leg was beginning to show signs of carpal over extension and was, therefore, considered at risk of failure. Of course once a limb has been amputated there are no other options for that limb.
After careful consideration of the all the advantages and disadvantages Hailey’s owners elected for carpal arthrodesis to be performed at the University of Saskatchewan’s Western College of Veterinary Medicine.
Hailey’s owner could stay with family rather than having hotel costs for the 9 day stay.
In preparation for surgery the infection and ulcerations on Hailey’s leg needed to be healed. Her pre-surgical treatment consisted of antibiotics for the infection and pain medication to keep her comfortable. Hailey was able to walk but with each step the joint bones moved causing significant pain and no wraps or splints could be used in order to allow the ulcers to heal.
Hailey went to Saskatoon for surgery on October 27th, 2011 Her pre-surgical assessment included a blood profile and urine test to make sure she was fit for anesthetic, and radiographs (x-rays) of the leg to assess the full extent of the injury at that date.
The surgery was performed and went smoothly. The bone graft was collected from Hailey’s shoulder and Hailey’s carpus was fused with cross pins and a metal plate.
Hailey required weekly dressing changes for 6 weeks post surgery, during which time we had to deal with her occasionally chewing the dressing and some minor bandage rubs. Immediately after Surgery she had very restricted exercise for 12 weeks and monthly x-rays to check on the progress of healing.
She had painkillers as needed throughout the process.
Now 8 months after the initial injury she is using the leg well and has the green light to exercise normally!! Hailey’s owner would be more than happy to share her experiences/advice having been through this with other pet owners who may be considering this procedure, please contact our hospital for contact information.