In Clinic Notes from VSG
Thank you Jessica Lee, for providing Diagnostic Reports
Health Status
Thank you Jessica Lee, for providing Diagnostic Reports
Health Status
Recorded At Weight (Kg) Temperature Heart Rate Respiratory Rate BCS Demeanour
15-08-2011
10:07:14am
6.4
18-08-2011 9:29:15am 6.4 38.0 160 Whine Pink A&R
19-08-2011
10:30:19am
6.4 37.0 180 20 Pink <2 BAR
Presenting Problem(s)
Left forelimb lameness.
History
Dave presented on 15/08/11 for evaluation of left forelimb lameness. The dog had a 2-3 week history of
lameness in the left forelimb that had only responded moderately to nonsteroidal anti-inflammatory
medication. Radiographs of both forelimbs and the spine showed evidence of a step-defect in the left elbow
joint due to presumed premature closure of the distal radial physis. There were no other significant historical
problems reported.
Physical Exam
15-08-2011
» Overall » Bright and alert
Mucous membrane colour and capillary refill time were normal. Thoracic auscultation and abdominal palpation
were normal.
15-08-2011
» Musculoskeletal » Thoracic limb » Bone » Radius
The dog was ambulating with a mild-moderate weight-bearing lameness of the left thoracic limb on gait
analysis. Pain was elicited on flexion and extension of the left elbow joint. No significant elbow effusion could
be detected. No spinal pain could be elicited. No other significant orthopedic or neurological abnormalities
were detected.
Assessment
Left elbow incongruity, premature left distal radial physeal closure.
Plan
Sedation for full-length radiographs of both antebrachia for pre-surgical planning. Probable surgical treatment
with either ulna ostectomy or radial lengthening.
Diagnostics
15-08-2011
Radiographs(Veterinary Radiology)
Specifics
Dave was sedated and radiographs of both antebrachia were taken for measurements. The right radius bone
measured 10.0 cm in length. The left radius was 8.6 cm in length. The left ulna was only 4 mm shorter than
the right. There was no evidence of angulation to the carpus. A large step-defect was evident at the humeroradial
joint.
Outcome
The dog recovered well from sedation.
Therapeutics
16-08-2011
Distraction osteogenesis
Specifics
Dave returned to our hospital on 16/08/11 for surgical treatment of left radial shortening. The dog was placed
under general anesthesia and a two ring circular external skeletal fixation (CESF) device was placed onto the
left radius. Both rings were secured to the radius using two olive stopper K-wires. A mid-diaphyseal osteotomy
was performed on the radius. The osteotomy site was closed using 3/0 Monocryl suture material.
Outcome
The dog recovered well from anesthesia and a bandage was placed around the limb and CESF apparatus.
Medication
Drug Name Quantity Instructions
Codeine Phosphate 15mg tab 100 5 Please give HALF a tablet TWICE daily until finished.
Kefzol 1g inj 1.4 1.4ml SLOW IV Q8 overnight.
Morphine sulphate 5mg 5x1ml 1 1ml SQ 4-6hrly assess as needed.
Clavulox 250mg Tablets 10 Please give HALF a tablet TWICE daily until finished.
Metacam oral suspension 10ml 1 Using the calibrated syringe provided please give a 6.4kg dose orally ONCE
daily.
AM / PM
In-Clinic Notes
25-08-2011 1:41pm
Admitted for Recheck Radiographs and Bandage change.
Sedated with Domitor 0.13mls IV; Butorphic 0.06mls IV
Reversed with Antisedan 0.13mls IM
No further distraction required. Fixator re-bandaged. Plan for weekly bandage changes and re-check rads in
three weeks time.
22-08-2011 12:54pm
Admitted for radiographs and bandage change today. Extra sedative needed. Sedated with Domitor 0.33ml
and Butorphic 0.12ml. Reversed with Antisedan 0.33ml. Distraction was performed with owner this morning.
RJ wants to slow down distraction will only distract one quarter turn each day. This will be pink nail polish to
black, next day black to pink, next day pink to black. Will be back on Thursday for radiographs and bandage
change.
19-08-2011 10:30am
Doing well again today. No problems overnight. Eating and drinking well, toiletting normally. Home today.
18-08-2011 9:28am
Dave is doing well this morning. AEC reported he started to chew at bandage around fixator yesterday
evening so a head collar has been used. He is eating and drinking well, and taking oral medications with food.
Urinating as normal, no faeces produced yet.
16-08-2011 1:28pm
6.4
Left Radial Osteotomy CESF
Premed: Atropine 0.21ml and Morphine 5 mg 0.51ml administered SQ
Induction: Valium 0.32ml and Propofol 2.56ml administered SLOW IV to effect.
Maintained: iso/N2O/O2
Brachial Plexus Block: Marcain 2.5ml
Pre op AB's: Kefzol 22mg/kg 1.4ml SLOW IV
Post op Analgesia: Morphine 5mg 0.8mg/kg 1ml SQ 4-6hlry assess as needed.
Post op AB's: Kefzol 22mg/kg SLOW IV Q8 overnight.
Oral medications: TBA
Hospital notes: Post op Left Radial Osteotomy - Morphine and Kefzol as charted overnight. PLEASE KEEP
BANDAGE DRY. SLING TO WALK. HAS HAD A BRACHIAL PLEXUS BLOCK. (2)
15-08-2011 1:06pm
Rad measurements;
Right radius CC - 10.0 cm
Left radius CC - 8.67 cm
Right radius lateral - 10.0 cm
Left radius lateral - 8.6 cm
15-08-2011 9:06am
Admitted for sedation and rads.
Domitor- 0.13mls/ Butorphic 0.06mls
Antisedan- 0.13mls
18-08-2011 1:47pm
15-08-2011 4:44pm
Dave was discharged the same day as the procedure. Based on the dog's clinical signs and radiographs, I
have discussed and recommended surgical treatment with radial osteotomy and distraction osteogenesis. The
owners have agreed to proceed with surgery and the dog will return for surgery on 16/08/11. I will keep you
informed on this dog's progress.
Thank you for your referral and please don't hesitate to contact me if you have any questions or concerns.
Sincerely
Dr. Richard Jerram, BVSc, Diplomate ACVS
Registered Specialist, Small Animal Surgery
19-08-2011 10:58am
Dave has recovered well from surgery and will be discharged on 19/08/11 following instructions on performing
the distraction process on the CESF device. The dog will return to our hospital on Monday, 22/08/11 for
bandage changing and radiographic reassessment. I will keep you informed on this dog's progress.
Thank you for your referral and please don't hesitate to contact me if you have any questions or concerns.
Sincerely
Dr. Richard Jerram, BVSc, Diplomate ACVS
Registered Specialist, Small Animal Surgery
25-08-2011 6:06pm
Dave returned to our hospital on 22/08/11 and 25/08/11. The dog was sedated and radiographs confirmed
excellent distraction of the radial osteotomy site was evidence of new bone formation within the osteotomy
gap. On 25/08/11, it was evident that normal congruity of the elbow joint had been restored. The dog has
been discharged with instructions for no further distraction and maintenance of the CESF apparatus until
adequate bone consolidation has occurred.
The dog should return to our hospital weekly for bandage changing and further radiographs will be taken in
three weeks time. I will keep you informed on this dog's progress.
Thank you for your referral and please don't hesitate to contact me if you have any questions or concerns.
Sincerely
Dr. Richard Jerram, BVSc, Diplomate ACVS
Registered Specialist, Small Animal Surgery
Discharge Summary
Dave has had surgery to lengthen the radius bone of his left front leg. The shortened bone was causing
incongruity and potential arthritis in the elbow. A circular external skeletal fixation device has been placed on
the radius bone. The radius bone has been cut. The fixation device includes 2 distractor devices to enable the
bone to be lengthened gradually as it heals. Further x-rays will need to be taken during the healing process to
ensure that the distraction is proceeding appropriately.
Please follow these instructions to ensure that Dave has a complete recovery from this surgery.
1. NO RUNNING, JUMPING, OR STAIRS FOR SIX WEEKS. Your dog should be confined to a small room or
kennel during this time. Take your dog on a lead for urination and defecation.
2. The bandage has been placed to reduce swelling around the bone. This bandage needs to be changed
regularly. This should be done at our hospital to enable assessment of the limb.
3. Sutures need to be removed 10-14 days following the surgery. Please call if there is any swelling,
discharge, or redness around the suture line.
4. Give the medications as prescribed.
5. The distractor devices need to be turned ½ turn twice daily beginning on 19/08/11. X-rays should be taken
on 22/08/11 to evaluate the bone length.
6. Once distraction has stopped the fixation device must remain in place for a minimum of 4 weeks. Further Xrays
will need to be taken to determine whether complete bone healing has occurred.
7. Please don't hesitate to call if you have any questions or concerns.
Dr. Richard Jerram, BVSc, Dipl ACVS.
Registered specialist, Small animal surgery.Jessica Lee
Veterinary Surgical Consultants.
97 Carrington rd
Mt Albert
Ph: 845 5455
