Leg injuries are tricky business
If you had the choice, would you opt for a broken bone or a torn tendon or ligament?
Neither, I hear you say.
At least a bone can usually be fixed and will heal to normal strength, whereas a ligament like a cruciate or shoulder tendon tear can take months longer and will need careful management to get near normal function and strength again.
With warmer weather and everyone out and about, the past weeks have been orthopaedic central at the hospitals.
Broken bones have been the main problem, but several cruciate ligament ruptures and an Achilles tendon break have added to the poor furry ones’ leg problems.
Yes, our patients do have Achilles tendons. Their hock on the back leg is the equivalent of our ankle and their Achilles tendon goes from the point of the hock back upwards to their knee.
A common cause of a ruptured Achilles in people is from playing squash. In cats and dogs, no-one really knows the cause, but it is usually after running around at high speed chasing something – dog versus cat, cat versus anything.
Marg, named by a Simpsons fan, is a cute and unusually little miniature poodle with an awesome nature, and had suddenly developed an unusual walk in one hind leg last week after playing tag with one of her friends.
It didn’t seem to slow her down much when she came to see us, as she wagged her tail in a blur and investigated every corner of the room. A full examination quickly found the problem – a ruptured Achilles tendon.
Her hock was touching the ground just as our ankle does, which isn’t normal in my patients. If you stand on your toes, then that is how four-legged creatures walk.
Their ankle or hock is right up off the ground and the long bones of your foot are at a 45-degree angle in their legs. So, if you pulled your Achilles tendon right up, that is how their legs are normally – sort of a suspension apparatus.
When the tendon ruptures, their ankle or hock has nothing to hold it up off the ground, their hock drops and they lose any propulsive force in the foot.
Two problems: How to get the tendon back together and how to keep the tension off it to give it the best chance of healing, which can take eight to 12 weeks.
With Marg sound asleep in a warm surgery and her leg all nicely shaved and cleaned, we carefully dissected out the two ends of her tendon, which had contracted up her leg.
To take the tension off the tendon, we placed a fixing orthopaedic screw in the back of her ankle to keep her hock extended.
Then we were able to place several special stitches with strong material between the two tendon ends and bring the tendon together. That all went well, but it is really the easy part.
Yes, a cast is next, just like in people, to keep the leg fixed in a bent angle so the tendon has no tension on it.
I don’t like casts at all on any animal because of the problems they can cause, but it was necessary here. Casts need to be closely managed for rubbing, pressure sores and being too tight.
They also need to be kept dry, while the patient needs to be confined, so they don’t rub and have less of a chance of falling off or being pulled off by a friend.
So far, everything is going to plan. We will have to wait for a couple of months yet to see how strong the tendon will have repaired and that screw will need to come out as well when we gradually let the hock down.
Cruciate ligaments are a little trickier. Ruptured ACLS, as they are called in people, are the most common orthopaedic injury in the hind leg of dogs and we see about two or three a month, especially over summer.
The ligament can’t, unfortunately, be joined back together. Commonly, the tear is sudden and your friend refuses to stand on the leg as they come up the river bank.
There are several surgical techniques, but our newer ones are giving great results and hopefully reduce the incidence of arthritis later in life.
Recovery is usually four to five months after a gradual increase in exercise levels and a month of strict rest.
A different scenario is all those broken bones this month, which have been great for getting out the drills and, with the use of plates and screws, our little friends are usually walking within days and the bones are almost healed after eight weeks or less.
So, be careful playing squash and have a nice warm week from all of us here at your local hardware store – I mean vet hospital.