Laurie's Blogs.

Laurie:

I tried searching the Yahoo Rehab group for previous discussions for recommended rehab for post op avulsion fractures of the tibial tuberosity in a puppy, but couldn’t find any.

We have a patient that was boarding with us.  He’s a Maltese-X approx 3-4 months old (not actually my patient).  He suddenly came up lame while here.  We are presuming a traumatic incident while he was in the group area playing with the other dogs, but no one actually witnessed the event.  Rads show an avulsion fracture with a small bony fragment from the diaphysis of the tibia, with minimal displacement, but obviously pulled cranially.  Our surgeon associate was to perform the surgical repair today.  I’m not working today so am unsure of the outcome but presume it went well.

I wanted to make recommendations for rehab but couldn't find specifics.  Icing, gentle range of motion, e-stim, joint compressions, laser initially are my thoughts.  I also thought weight bearing exercises with full support so no shifting, but getting use through hips, stifle, hocks.  Tickling, scratching, peanut butter in the groin - to get the proper motion but with initially no weight bearing?  At time of suture removal, start with weight bearing and some weight shifting?  Is that proper timing?  I don’t want to go too quickly, or not enough. 

Thanks for any and all comments and suggestions.

D.U.

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Hi D.,

Sorry for my tardy reply.  I'm so behind since coming home from Hawaii!

So I have seen two of these (both Borzoi's... my breeder - who brings all injuries to me first - I know... not the right way around... but she 'sneaks them in on me').  I found pin-point tenderness on compression over the tibial tuberosity and pain when then trying to put a transverse pressure on the tibial tuberosity as well.  With these findings, I then recommend a radiograph.

So in both accounts (both puppies... with minimal displacement - when she took the to her vet down in Montana - older vet, does a lot of surgeries & has all sorts of higher end diagnostics)... she was advised to do nothing.  Kept them quieter.  They both healed perfectly.

Rehab for this sort of surgery... think of it like a patellar surgery - tibial tubercle transposition.  

No crazy running, but just go with any generic post-op protocol (i.e. my post-op cruciate protocol).

Totally do-able... progress as per what the dog is 'showing you' it can do next... or progress / push a little if there isn't progress!  If the dog is willing to weight bear.  Let him weight bear!  No rough-housing... that's your biggest thing to control / contain!  Beyond that.. slow and steady use.

Cheers!

Laurie

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Laurie:

Thanks so much for your response!  This helps me so I know where to start, and how to proceed.

Take care!

D.