Re: need help with a complicated bulldog case

June 8, 2010

I posted this on friday, and haven't gotten any response. I will be out of town

the rest of the week, but am desperate for help with this little girl. Does

anyone have any good suggestions? Thank you!!

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> I have a difficult case and I am lookin g for some additional ideas to help

this dog. Gabby is an 8 month old English bulldog. At 9 weeks (December 2009)

she fractured the lateral condyl of the left humerus. Due to the radiology

report being read as a medial condylar fracture an approach was made medially.

A screw was placed which did fix the fracture well, but was placed from the

medial epicondyle. The patient did develop a MRSA infection post operatively.

The pin and screw had to be removed due to the infection and ongoing, lameness

in February (9 wks post op.). On April 14th she refractured the lateral humeral

condyle. Surgery was performed again with a good repair from a lateral

approach. April 23rd we started rehab. She had significant muscle atrophy, she

was bearing weight but still offloading, and also had flexor contraction to

carpus. Rehab included laser, ultrasound of the left triceps and elbow region,

range of motion exercises, 3 legged stands, flexor stretches, adequan, and

treadmill at shoulder height. We continued her on deramaxx and tramadol. I

noticed a popping in test of the mcl. We only performed 3 treatments when we

decided to have a CT performed to evaluate the elbow further. There were no

complications with the screw or pin and the fracture was well apposed. However,

there was marked degenerative change and remodeling with all of the bones of the

right elbow being affected. We reinstituted rehab with the same plan as before,

but added cavallettis to try and get her to bend and lift the elbow instead of

swinging it. She still has good ROM but when she walks she swings the leg in a

lateral arc, still has flexor contraction causing her to knuckle at the carpus,

and bears only about 50% in the limb. This is a very young dog that has never

been able to be a puppy. My goal is to get this dog as comfortable as possible

and improve her gait. Does anyone have any other suggestions that we haven't

tried? I have considered putting a weight on the affected leg, and using

therabands while in the tread. Thank you ahead of time for any assistance.

Amy Waggoner RVT, CCRA

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