Wrapping up the second week of Ortho meant wrapping up a week of TPLOs. And if we weren’t seeing new cases of cranial cruciate ligament tears, we were rechecking old ones. Unilater, bilateral, those that failed (rare) and those that didn’t. In fact, out of our 15 TPLOs, we only had three appointments that were not somehow related to the cranial cruciate ligament.
For whatever reason, Lady Luck of Cases was on my side because I scored two of the three none CCL-related appointments. The first case was a recheck appointment for a middle-aged DSH neutered cat with a mandibular and maxillary fractures. Six weeks ago he had been hit by a ca and presented for further evaluation of the fractures. Although we can’t say for sure, because comparative radiographs were not taken, we suspect that his fractures of the mandible and maxilla are healing. The referring veterinary hospital had placed a cerclage wire around the mandibles to facilitate alignment and reduce instability. The cat had been great at home, with a normal appetite and ambulating well. His owner showed me pictures from the day he staggered home, barely conscious with a face indistinguishable because of blood and matted fur.
He had severe facial swelling. His antibiotic and analgesic protocol had been completed and we examined both fractured maxillary canines. He is scheduled to have these teeth (104 and 204) extracted since the pulp cavity is exposed. In a couple weeks, he’ll have the cerclage wire gone for good. One lucky cat. Who will hopefully, be spending a little less time by the busy highway.
The second appointment was a recently rescued eleven month old puppy with two hind legs as straight as boards. There was severe muscle atrophy of the pelvic limbs and much of the musculature that remained felt fibrous. He had extremely limited range of motion in his tarsus, stifle and hips. His stifles were hyperextended and flexion was minimal (less than 10 degrees). His elbows also had limited range of motion, and elicited pain upon full extension.
Right off the bat the Clinician asked what was causing the rigid extension, to which I answered the quadriceps muscle. True answer, but not entirely true. Something had to have precipitated this contraction of the muscle, and then ultimately the continue state lead to secondary changes. We started speculating as to what the inciting cause of the quadriceps contracture could be, which we knew we’d never really get an answer for. Our clinician had never seen Quadriceps contracture bilaterally before, and especially never this severe. We brainstormed causes of quadriceps contracture (chronic) and our list included congenital malformation , developmental abnormalities, and acquired neuropathies. We conducted a neurological examination, which we primarily evaluated conscious proprioception (CP) and reflexes. His CPs were all normal with no evidence of neurological disease. Quadriceps contracture, or “Stiff stifle disease,” can also be secondary to femoral fractures and improper surgical repair. It could be that he fractured his legs as a puppy and his fractures were not addressed adequately. Neospora caninum is also a potential cause of the myositis, very rarely ever leading to such extreme contracture without also showing systemic signs.
At this point, he had too much fibrous replacement of muscle that surgical grafting of muscle would be of no benefit. The damage had been done, in otherwords. Early treatment is the way to really effectively address the contracture. We then turned our attention to our most immediate concern, the elbows. As expected, the CT of the elbows showed mild to moderate osteoarthritis. Not too far into the future he will likely need elbow arthroscopy with removal of oseophytes or joint mice.
Unfortunately, his prognosis is poor. But right now he is still comfortable overall and wins sweetest puppy of the year so far in 2015.
For what was supposed to be a TPLO centered entry, this took an unexpected turn. And considering the massive amount of writing that needs to be accomplished in the senior paper department of my life, I probably better save the TPLO talks for another time. Plus, it’s a beautiful sunny morning outside, I slept more than five hours and the day is still young! Time to get productive!