fourleg.com

Hello All,
Sure could use some advice for a patient our clinic has been seeing for several months. We have a 1.5 yr old St, Bernard that was seen at another facility for a fractured Femur. The repair went south during healing and the pin that was placed, had "backed" out of the Femur and actually ended up falling out of the patient ???? Owners came to us with the dog 100% non weight bearing, extreme atrophy, painful and with an infected joint. We treated the infection, repaired the non healing fracture with a plate and started rehab. The previous complications of pin movement within the fracture site caused some neurological deficits, but the patient had been slowly regaining function back. We had incorporated laser, massage, wobble board work, Under water treadmill, assisted walk with toe up device, tens, basically we threw everything we had at him. The neurological deficit complicated return of muscle mass/function . The dog was staying with us for a week at a time then going home for a week with homework exercises to do. Unfortunately his last trip home he may have overdone it, he came back to us 100% non weight bearing and now has a luxating Patella. Our Vets believe it may have to do with the lack of muscle mass/ support for the area. Owners are considering amputation as they have spent so much and just are so leery to try another surgery. They are wondering about a brace. My question is has anyone ever had a case anything like this where a brace has helped give a patient enough support to use the limb to regain muscle mass and treat the patella issue like you would a conservative, non surgical luxation. Can a brace stabilize the patella enough or is amputation really the only way?? It hurts to even type this word (amputate) as I feel I have failed this patient and my heart aches for these owners too. Any help would be greatly appreciated.

Oh... what a terrible case!

These kinds of cases are so hard to deal with because you know that it's a long up hill battle. You don't know the outcome. It's all a crap shoot. And then some new garbage gets thrown your way!

I hate the sound of amputation as well... but if we logically factor in all things, it's an option that needs to be an option.

Okay... now to your questions.
No, there is no patellar stability brace for dogs. Not one that would work. I remember sitting in on a quick consult that an orthotist had with a little dog while at a conference. The dog had a medial patellar luxation. The orthotist was so good about listening to the owner, and then when it was his turn to talk, he patiently explained how the forces that would be needed to hold a patella in place to counteract the muscle pull and biomechanics that would be pulling the patella out of alignment would have to be so great and so precise that it would actually be impossible to do. Our human legs and lack of standing angle gives us a wee advantage in that department.

So what to do? You either continue on the muscle building path, with lots of laser thrown in to help with nerve regeneration... and hope for the best. OR, they amputate and you teach the dog how to function that way.

Sometimes the 'win' is not always about getting an animal back to 'normal', but instead getting an animal back to 'function'.

Best of luck!

Laurie

Thanks laurie. I guess I knew the answer just wanted to hear it from someone that has more experience than me and not emotionally involved in the case I have so much respect for your opinion. In respect to working with strengthening the muscles in the rear limb and dealing with the luxation, would you recommend more stationary work like 3 leg stands, front feet on platform and weight shifts, resistance band in stands etc so I am not asking to much movement for the stifle and luxating the patella ?
Laura

Hey Laura,

So for strengthening, I'd start with static. Work up to small movement dynamic (i.e. mini squats). Then full range strengthening.
Check out video training 125, 126 & 186!

Best of luck!

Laurie