Here at DVH Dr. Geoff Dewire and Dr. David Paull perform a wide range of orthopedic procedures. Unlike routine soft tissue surgery, orthopedics requires special experience, expertise and equipment. Some orthopedic injuries are traumatic, such as a broken bone. However many are due to congenital abnormalities, joint instability or degenerative joint disease (arthritis). Below are some of the most common examples of orthopedic injuries and the surgeries performed to correct them.
Canine Cranial Cruciate Ligament (CCL) Disease
This is by far the most frequent orthopedic injury in dogs. The cranial cruciate ligament is very similar anatomically to the anterior cruciate ligament (ACL) in people. The ligament lives inside the knee joint, and provides stability between the femur and tibia. When this ligament is completely torn, the knee becomes unstable. Initially this injury causes pain and inflammation, and over time it leads to significant arthritis.
Luxating Patella Correction
This is a very common condition, especially in small breed dogs. This occurs when the patella (knee cap) pops in and out of place while your dog is walking. There are many different grades of luxating patella, based on how much time it spends out of place. Lots of small dogs live their entire life with this condition, with only minimal symptoms. Surgery is an option when a dog has persistent pain or lameness, or they develop an associated CCL injury. Every one of these cases is unique, and may require up to three techniques during surgery to allow the knee cap to stay in place. After the postoperative period, most of these patients do very well long term.
Femoral Head and Neck Excision (FHO)
The hip in cats and dogs is very similar to that of a person. It is a ball and socket joint. The ball of the femur held in place by the neck of the femur, which attaches to the rest of the bone. The “socket”, or acetabulum of the pelvis is what holds the ball of the femur in place.
There are many abnormalities; some congenital, some acquired, which lead to an unhealthy painful joint. For example, young male cats are prone to injuring the growth plate of their femoral head. Many dogs can develop dysplasia (abnormal formation) which leads to instability of the hip joint and arthritis. Some patients can traumatically dislocate their hip, which can often be difficult to reduce. All of these are painful, and some cannot be reversed medically or surgically. These are the cases in which case an FHO may be a good choice.
During this procedure, the head and neck of the femur are removed. By doing this, the source of pain (inflammation associated with the joint) is removed. The body will then heal around the joint, creating a psuedo-joint. While a little wobbly at first, your cat or dog will acclimate and learn to use their new joint pain free.
Any injury can be painful, but a broken bone can be accompanied by significant trauma. Depending on the patient, some of these injuries are caused by a tremendous force (ie car accident), however others can occur with just jumping off of the bed. It is important to understand the basics about how to manage and correct these injuries.
In order for bone to heal, it needs to be stable and be in proximity to the other bony fragments. Traditional ways to achieve this are external casts and splints. Unfortunately, some types of fractures cannot be stabilized in this manner alone. Examples would be a comminuted fracture (one with many fragments), a significantly displaced fracture (where the bony fragments aren’t near each other), an open fracture (part of the bone is outside the body), or a fracture where there are several forces (bending, rotation, shear etc) that cannot be controlled with a cast or splint. For these patients, surgery and internal fixation are the best way to allow the bone to heal.
“Internal Fixation” simply means that an implant is placed within the body, and acts as an rigid splint to keep the bone stable. There are many different techniques to achieve this, the most common being a metal plate being attached to the bone via a number of screws. Depending on the nature of the injury and which bone is affected, there are many variations on what type of implant is used and where it should be placed.