Carpal bone fractures

[Maralynn]

Yesterday Kenzi was diagnosed with a carpal bone fracture. Not positive which exact bone but it's one in the middle. The vet said that he had never seen that one fractured before.

 

She had come up lame in it about six weeks ago and was diagnosed with a hypertension injury then. We did two weeks of leash restrictions and a couple weeks of long line restrictions.

 

Over the weekend I noticed she was favoring the leg and that the joint was extended more than normal. So we did an X-ray yesterday and found the fracture. Makes me wonder if something actually happened when she initially injured it.

 

Anyone else ever deal with something like this? How did you deal with it?

 

The vet put her on 4-6 weeks of crate rest and continued anti inflammatories (Galliprant). I'm planning on a visit with a rehab vet at the end of this period before coming off of crate rest protocol.

 

My poor dog can't catch a break. I've been trying to get chronic back pain issues under control for six months and now this happens.

[Sue R]

[denice]

How old is she? Honestly I would have another vet or radiologist look at xrays. I have rather serious things misdiagnosed. Not saying that is the case but it sure does happen.

I just read an article about a guy who makes braces for dog joints in NE. Might be something to check out if indeed she has an unstable joint

[Maralynn]

Kenzi is 8.5 y/o. I have thought about getting a second opinion.

 

I did email the rehab vet that I've been working with for her back and outlined what happened and the treatment plan as that kind of put a standstill on anything else. That was last night so now I'm waiting to see what I hear back from them before I do anything else.

[rushdoggie]

I'm sorry I haven't experienced this, but I hope you can get a second opinion.

[juliepoudrier]

Some years ago, my Willow fractured a metatarsal when she planted her foot and then spun going after a ball. Treatment involved splinting, I don't remember for how many weeks, but probably at least a month. She healed fine. Not exactly what you're dealing with, but similar.

 

J.

[dogfish6]

One of my border collies fractured a metatarsal bone last summer on a rear foot. I seem to recall it was #3, one in the middle, but could've been #4. She slipped on grass while retrieving a ball. It was a spiral fracture. Of course she thought nothing of continuing on to bring the ball back and then continue for the hiking portion of the afternoon, but her three-legged walk gave her away. Thought as first she'd torn her cruciate ligament.

 

Treatment was splinting and a soft cast to stablize the bone (Internal fixation) after the vet manipulated the bone. She was not allowed any activity but the necessary for bathroom trips. Basically crate rest. This was to have lasted eight weeks. However, x-rays at eight weeks showed the bone had not healed completely - even though she was only five years old and in fantastic physical condition. Likely my fault by not keeping her as completely inactive as she should have been. Total time in the splint and soft cast was 12 weeks. At that time the bone was healed, but the fracture line could still be seen - that's not uncommon in fractures - for both dogs and humans.

 

Since she'd lost some muscle mass anyway - not only in her hind end, but in the foot itself which was shriveled noticeably, and was not flexing the foot properly due to loss of range of motion, I rehabbed her by doing underwater treadmill under veterinary supervision. I hghly recommend this. She was able to quickly put muscle mass back on, but more importantly, regained flexibility and full range of motion, while also building back some ligament and muscle strength in the foot itself. I started out going twice a week for underwater treadmill, then cut back to once per week. By then she was also doing leash walks where I was encouraging her to pull (yikes! never thought I'd want that!). Overall, did the underwater treadmill for six weeks. The vet tech was careful to observe that she was walking, and NOT swimming. Swimming doesn't help at all. The dog needs to actually walk or trot on the treadmill (this concept holds for building rear end muscle mass as well). It was actually super interesting and educational to observe the difference between how a dog uses its body while swimming as opposed to actually using the treadmill.

 

She still has scarring from the pressure sores she got while splinted/casted, but the foot looks completely normal and she resumed full activities (hiking, agility, bossing her the rest of her tribe around, Ball) approximately five months after the break.

 

I did find that she would favor the foot if we went on a really rigorous run (hiking) for about three months after, but would just adjust her activity accordingly for the following few days. She now shows no signs of the injury, but is likely to develop arthritis there as she ages.

 

Hope this helps and good luck to you. The injury is actually not that uncommon.

 

Beth

[Maralynn]

Well, we're 5 weeks in and I don't like the look of her foot yet. Heading back to the vet this week. They suggested laser therapy (huh?!? I mean, I get that it's great for some things but the joint itself is still way over extended) or a splint over the phone. I'm going to be asking for another X-ray to see if the bone is healing or not. And then proceed from there.

[Maralynn]

Figured that I would update this again to say that Kenzi had carpal arthrodesis surgery today - basically surgery to fuse all the bones in the wrist.

 

Five minutes with an ortho vet and he said what I was highly suspicious of - damage to ligaments, etc that was never going to heal and was only going to get worse over time. He suggested the surgery to fuse and said there was an excellent chance that she could return to pretty much full activity. Which is basically what I had gathered in more than a little bit of online research. So I left her for surgery (they called late this afternoon and told me that everything went fine) and hopefully will pick her up tomorrow.

 

I'm kinda kicking myself for not insisting on this earlier but I guess in the back of my mind I was second guessing my gut feeling as the regular vet had never even considered that type of diagnosis. And the big kicker was on looking at the x-rays, the vet today couldn't see what the regular vet deemed a fracture at all (something else I didn't quite see but figured that I would go with the more educated opinion)

 

So now we've been dealing with this since the end of April and have another 8-12 weeks of highly restricted activity. Sigh.

[Sue R]

At least your Kenzi is now on the path to recovery. Very best wishes!

[GentleLake]

Glad you were able to finally get the right treatment for her. Hope her recovery is uneventful.

[Maralynn]

One week post op and she's doing really well. She was sent home with sufficient pain medication and trazadone so her attitude has been really good and she's being pretty mellow (for her) and compliant with crate rest. She had a one week recheck and bandage change yesterday with the vet who did surgery and everything looked good. And she was super happy to get out and go for a ride and see people

 

Now we're on the waiting game while the bone heals. We'll get bandage changes at the local vet every 2-3 weeks and then follow up X-rays in about 8.

 

Part of what has really sucked through all of this is how miserable she's been with the restricted activity. So when they were going over surgery with me I was so relieved to hear that long term trazadone was part of the protocol. It makes such a difference when she's more relaxed and not miserable.

[GentleLake]

[juliepoudrier]

Hoping for a speedy recovery!

 

J.

[Lawgirl]

Long enforced rest is very difficult. If she really loved the car ride, can you make a little car ride a treat for her? My boy loves driving down to the laundromat and back, even if he only walks to the car and back.

[Maralynn]

Almost 9 weeks post op now. We had a recheck with he surgeon today and X-rays showed that the bone is 85-90% healed. He was happy with it all and said she was right in track healing wise.

 

I got the okay to start gradually increasing walking and step climbing (I live in a 2 story house) to her daily routine and am also going to get a rehab visit scheduled. Her unused foot looks amazingly horrible as it's (naturally) lost all the muscle mass from being in a cast. I've never really thought about the muscles in a dog's foot before now. I've definitely got some work cut out getting her back into shape

[Sue R]

[Maralynn]

Because I always find it useful when others update threads -

 

Kenzi had a second carpal arthrodesis surgery last week on her other front leg. She had significant hyperextension and had become hesitant to put weight on it. I could have waited a bit longer but she was obviously pretty uncomfortable even on pain medication. And I really want her healed before the snow flies. I was told that it was uncommon for a dog to need two like that but obviously stuff happens. One vet mentioned that genetics quite likely played a factor. She’s always been an active dog but nothing reckless enough to account for an acute injury.

 

So back to another 8 weeks of mostly crate rest. But really hoping that she’ll be happier and much more mobile and comfortable on the other side of all this. 

 

There are some new forays into treating this type of injury without arthrodesis (VOSM in MD has been working on it). But at her age (10 in Dec) my goal was something straight forward that would allow her to be happy and comfortable being a dog around the farm. Her leg that was done last year is highly functional for that and pain free.  I’m hoping to (finally) get her therapy dog cert when this is all over to give her a retirement job that she’ll love.

 

For anyone wondering on cost for something like this - in my area, each surgery was about $3,700 initially plus a bit of follow care.

[GentleLake]

Ugh. Sorry you and Kenzi are having to go through this again.

Hope her recovery is uneventful. I think you'll both enjoy therapy work as a lower key retirement activity for her.