Femoral Head Fracture

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Greenepony

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Poor Olive- we've been treating her for anxiety for a month and a half but we went for a check up yesterday because she started spitting up after drinking so they had an Xray done. Normal gut, lungs, etc but there's a very obvious fracture!

Looking back it makes sense, we have a lot of stairs in our house, and the main floor is wood so she was constantly putting torque and pressure and so in pain- of course she was panting and anxious! This is the same dog who didn't flinch when they were poking at her broken tooth last winter, so she didn't react when the vet started manipulating her leg (she was already panting, not a fan of the vet's office.) We feel awful that we missed the symptoms and chalked it up to anxiety.

So she's finishing up the last week of her prozac script and now on an analgesic for the pain. Definitely saw more results from the latter which makes me think she's not as anxious as we thought. But the clinic ortho is on vacation for a week so we won't know a long term treatment plan until then. Until then she gets carried up the stairs and less mobility. The GP thought she may be a candidate for FHO but couldn't say for sure. VOSM is not even 15 minutes away so we may go for a second opinion too. Thankfully insurance covers everything but PT so the cost isn't a concern for us (we made sure we picked one with a good ortho policy after my cousin's dog needed bilateral CCL surgery.)

For those who have gone through FHO or other reconstructive surgeries- what did you find the recovery like? Mobility afterwards?
 
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VOSM is the Mayo Clinic for canine orthopedics. People actually fly their hunting and performance dogs, some by private jet, to the clinic for Dr. Sherman Canapp to perform surgery. He is a pioneer in platelet-rich plasma and stem cell therapy -- he speaks all over the world on his techniques. His clinic is simply the best. Before we went, I read some of his veterinary medical journal articles and other non-technical pieces by and about him.

Layla's experience there was fantastic. She had bilateral elbow surgery to repair osteoarthritis and extend her time as a therapy dog. She stayed overnight and had round-the-clock nursing care. I was welcome to call whenever and as often as I wanted -- they were so kind at 1 am when I just wanted t check one more time -- the report was thorough and comforting.

She's eight weeks into her rehab now and is moving so well -- pain-free! We do daily range-of-motion and walks -- we have progressed from literally no walking except outside to potty and staying in an x-pen to her taking off last week to run a deer out of the yard with no ill effects. Her first 8 weeks of rehab consisted of cold laser, range-of-motion checks and massage. THe docs do 4, 8 and 12 week checks. Yesterday she began underwater treadmill therapy (oh yeah, that went over well :rolleyes2:), which she'll be doing weekly along with cold laser. Her "graduation" is 1 September, when Dr. Canapp will do a final thorough evaluation. If he feels she needs more platelet-rich plasma, we'll do that. Should she need stem cell treatment in the future, she might be enrolled in a study, which will keep the cost down.

My friend who has had Service Collies had stem cell treatment at VOSM on two of her dogs, and one of Layla's Walter Reed pals, a German Shepherd, also had surgery and stem cell treatment by Dr. Canapp. All did very well, with extended working lives that would not have been possible otherwise. It's great that you have insurance, for this kind of cutting edge treatment isn't inexpensive -- but it is so worth it. I have my happy, active girl back, and I'm overjoyed that we'll be able to serve at Walter Reed for years to come.

Celebrate? You bet -- we're headed for Niagara Falls the week after her final VOSM visit!
 
Thanks for both of your responses! (I'll call if I have any questions). We're going to call a vet friend who just finished his internship in surgery to make sure we're not over reacting not going with our normal clinic surgeon. Definitely looking at them for rehab.

Have fun in Niagara! My brother moved up there and we can't convince him to move back he loves the area so much.
 
I am sorry you are going through this.

I really recommend seeing an ortho vet, it's worth the effort. They just have a lot more knowledge about the latest research in their field - general vets have to keep up with a lot of broad information so may not know as much in this field. Tully had a hip replacement (THR), which we think was the result of an un-treated fracture that didn't heal properly, which I figure means if it had been caught and treated in time she wouldn't have had the ossification develop. So there is a chance that you won't need an FHO or THR at this stage if you can manage the fracture.

You may want to join the Yahoo groups "Orthodogs" https://groups.yahoo.com/neo/groups/orthodogs/conversations/messages and CanineHD https://groups.yahoo.com/neo/groups/CanineHD/info. They aren't very active groups (the CanineHD in particular) but they have a wealth of information.

With Tully's hip replacement, it never got back to normal. She gets pain if she runs (she'll still try to chase bunnies) and in winter she gets stiffness and is slow. She was the smallest dog they'd ever done, and looking back now I wish I'd waited for them to do a couple more small dogs before her. The prosthesis itself is fine, and her leg muscles are now even again, so she's using it and doing fine in that regard. I get the feeling they may not have gotten the angle right though. I had hoped for more, but I would still have done a THR over a FHO. There are people on the forum who have been through FHOs, probably more so than THR.

I also recommend getting onto pentosan polysulfate injections asap (aka Cartrophen or Xydex) as this will help build the joint and reduce the chance of arthritis developing.
 
We went to VOSM today (Chris, Dr. Dycus is doing her surgery). It turns out a FHO is the only option.

It looks like she has been living with a partial FHO since before we adopted her (so 4+ years). It could be from Legg-Calve-Perthes or it could be an injury but now there's just a ball of tissue and bone in the joint and it couldn't support an implant. She does have changes in her hip but that shouldn't be a problem since there won't be any bone to rub against, but he did recommend supplements. She also has limited range of motion at the joint and some muscle atrophy- the fluffy pants are a downside for noticing that sort of thing, even with hands on.

Olive goes in for the surgery tomorrow and starts three months of physical therapy next week (she has to do aqua therapy too... she hates being wet). Dr. Dycus did say that since she has been living with this for so long, she likely can return to the same level of activity- just with a better range of motion.
 
I am so sorry that Olive needs surgery, but you're getting it done at the best place in, probably, the world. I'll keep Olive in my prayers -- keep me posted on her progress.
(I was there today, too, for Layla's swim, at 1230!)
 
So sorry to hear this is all going on. Keeping Olive in my thoughts and prayers! Please give us an update on how everything went. I am keeping my fingers crossed! :fl
 
Wow, everything's moving ahead so quickly. Poor Olive having this for so long, such a stoic little girl.

Hope everything went well with the surgery, and you're pulling through okay as well.
 
We picked Olive up at noon today- she looks so sad with her shaved chicken leg :(

I wish I had taken a picture of her finished xray. But here is what it looked like before (not the greatest, she was not fond of laying on her back). But where the mass is, is now nothing. She's already putting some weight on it, but when she is in a hurry (like getting to the car when leaving the vet) she starts bunny hopping. Unfortunately, she really likes laying on her right side but starts crying when she does that right now. Currently she is moping with her inner tube of shame, since she doesn't wear the e-collar well.

She seems to have charmed the vet techs, several commented on how sweet she was (she convinced them she needed to be hand fed, although she had a healthy appetite when we picked her up, I think she just wanted attention.) And I have nothing but good things to say about VOSM. Dr. Dycus gave us a full explanation of the problem and procedure, certainly didn't dumb it down. We were welcomed to call the recovery ward as much as we wanted to see how she was doing.

We start PROM on Monday and PT on Wednesday.
 
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