I know this is an older post but having an FHO "nightmare" here. My former boss did an FHO on a 9 year old addisonian who coded in the FHO procedure. The dog had what I was told was luxation/OA from the owner. Presented to me 2 months post op with minimal toe touching on the leg and 4 inch muscle difference between thighs. I had started UWTM, laser, PROM and message. I could feel the femur right under the skin in line with the ileum. After first session (hopefully not related) the dog had an addisonian crisis and had to skip 2 weeks. Then presents with the knee bending medially and laterally. I wish I took pictures it was pretty gross to watch and I could not leave him like it even for a pic. Test consistent with lateral collateral tears suspected, radiographs show the dorsal displacement of the femur.
I stabilized the stifle with a Balto Brace and the dog could atleast sit and relax and started laser. SX is not an option, recommended custom brace but for now wants the Balto.
My questions:
1. Is slow traction and message recommended for the femur to see if I can get it anatomically better located?
2. Other than bracing any recommendations for the lateral collateral stabilization?
3. Can I even exercise this dog? UWTM? Or land exercises in a brace?
Thanks so much!!!! This site is my life line
Amber
FHO Disaster
Re: FHO Disaster
Hey Amber,
Oh dear! One of those cases that you just want to run away from... but you know that you are the only hope for the dog!
Okay, so, if the Balto brace is working (in that the dog is accepting it and using the leg while it's on) then stick with it for now. (Is it the best brace on the market? No. But for now, that doesn't matter.) Since it's circumferential it'll have lateral stability. If you need more stability, you can add a strip of foam padding or something to the inside on the lateral aspect in order to help with that. (I don't think the Balto's are made from a fabric that velcro sticks to, but if I'm wrong, you could use a strip or two of velcro on the outside of the lateral side of the brace.) The brace will be permanent or until there is enough joint fibrosis to help stabilize.
In regards to the femur. Ugh. I don't know that you can correct for the dorsal displacement at this point in time. Even if you pull it down, you would need enough time in that position in order for the scar tissue / fascia to adapt and glue together in the new position in order to stabilize it as well. The only way you could do that would be to bandage the leg into a NWB position. Which I suppose is an option, but then reduces the chance of using the limb in the long term. So, you might have to let this one go.
In my opinion, I'd start to exercise the limb. Build muscle. Build confidence. Yes, with the brace on land, or UWT with high water. You don't say the size of the dog. But if it's a small dog, you could even try swimming him/her in your UWT if you can get the water high enough (and with someone in the water as well to try to facilitate limb use.)
At this point... 9 year old dog... almost died in surgery... complicating factors... owners indicating that they only want the Balto brace, I take this all as 'work on function'. You're not going to get normal (or even close). Make function your goal and see what improvements you can make. I think this is where you will get the best owner compliance and best use of your time.
Stay positive and upbeat and focus on what the dog can do... (Otherwise, I think this combination of factors would see the owners pulling pins on everything.)
I hope this helps!
Cheers,
Laurie
Oh dear! One of those cases that you just want to run away from... but you know that you are the only hope for the dog!
Okay, so, if the Balto brace is working (in that the dog is accepting it and using the leg while it's on) then stick with it for now. (Is it the best brace on the market? No. But for now, that doesn't matter.) Since it's circumferential it'll have lateral stability. If you need more stability, you can add a strip of foam padding or something to the inside on the lateral aspect in order to help with that. (I don't think the Balto's are made from a fabric that velcro sticks to, but if I'm wrong, you could use a strip or two of velcro on the outside of the lateral side of the brace.) The brace will be permanent or until there is enough joint fibrosis to help stabilize.
In regards to the femur. Ugh. I don't know that you can correct for the dorsal displacement at this point in time. Even if you pull it down, you would need enough time in that position in order for the scar tissue / fascia to adapt and glue together in the new position in order to stabilize it as well. The only way you could do that would be to bandage the leg into a NWB position. Which I suppose is an option, but then reduces the chance of using the limb in the long term. So, you might have to let this one go.
In my opinion, I'd start to exercise the limb. Build muscle. Build confidence. Yes, with the brace on land, or UWT with high water. You don't say the size of the dog. But if it's a small dog, you could even try swimming him/her in your UWT if you can get the water high enough (and with someone in the water as well to try to facilitate limb use.)
At this point... 9 year old dog... almost died in surgery... complicating factors... owners indicating that they only want the Balto brace, I take this all as 'work on function'. You're not going to get normal (or even close). Make function your goal and see what improvements you can make. I think this is where you will get the best owner compliance and best use of your time.
Stay positive and upbeat and focus on what the dog can do... (Otherwise, I think this combination of factors would see the owners pulling pins on everything.)
I hope this helps!
Cheers,
Laurie
LAURIE EDGE-HUGHES