Bilateral Forelimb Fractures

[lehughes]

Good afternoon Laurie,

I am hoping that you could help me out. I have a new patient (surgeon's dog) coming in next week with Bilateral Forelimb Fractures in a 12 weeks old puppy that was surgically repaired (not quite sure when). Do you know of any good articles that I could look at for reference? Have you experienced this? The rehab center that I work at only has a laser so unfortunately that would be out of the question.

Any help would be greatly appreciated!

Thank you,

E

[lehughes]

Hi E,

Poor puppy!!!

So, I don’t think there are articles in the way of what you are looking for. There are articles about surgical procedures:
https://pubmed.ncbi.nlm.nih.gov/2968491 ... from_pos=1
https://pubmed.ncbi.nlm.nih.gov/3114063 ... from_pos=3
(This one talks about PRP in conjunction with surgery) https://pubmed.ncbi.nlm.nih.gov/3083228 ... al+therapy

But beyond that, I think you just look at function. How can you help the pup to function. Watch for growth abnormalities (i.e. premature closure of growth plates).
I’ve seen an ‘imperfect pinning’ of Radio-ulnar fractures’ that leave the dog with a slight supination of the forelimb, thus creating the necessity for the dog to ‘flick / flip’ the carpus as it walks.
I’ve seen slow to heal fractures (laser and ‘take home’ PEMF loops would be my recommendation for this).

Here’s a link to the chapter on Fracture Management that I wrote for a text book. https://www.fourleg.com/media/Fracture% ... 0info2.pdf

All in all, you’ll just have to adapt your strategies based on the dog (or puppy) in front of you.
Can it walk?
Are there gait abnormalities?
Where is there atrophy?
What compensations can you find?
ROM?
Soft Tissue Tension?
What functional limitations does the dog have?
Has posture been compromised in some way?

And then you work from there to correct these things based on what you find.

There’s not much you can really ‘plan for’, other than to look for typical problems.

Best of luck!

Laurie

PS No need to limit laser if you think it is useful. The only studies that show it is detrimental to growth plates used Waaaaay high, non-therapeutic doses. If it’s a non-union, and or the little one needs extra pain relief, then I would feel comfortable using it!

[pjmueller1@gmail.com]

You need a bit more information, which hopefully you will get when you see the puppy. Were the fractures radius and ulna both limbs? Salter Harris fractures or not? If not growth plate hopefully plated not pinned. At this age should heal in 4 to 6 weeks so how far along is the pup? Were splints placed post-op? Hopefully not but if so you may have joint restrictions to deal with.

Laser is great for bone healing I would for sure use it. Then as Laurie says see what you are starting from

Pam Mueller PhD DVM CCRT