News & Events


News and Events

Case Study: Approach to Premature Closure of the Distal Radial Physis

Overview

Gayle Jaeger, DVM, MSpVM, DACVS, an orthopedic and soft tissue surgeon at VRC, has been treating a Golden Retriever puppy named Lito after his distal radial physis closed prematurely.  As a result, his right radius was shorter than the adjacent growing ulna with subluxation of the elbow joint. If left untreated, this would progressively create lameness and complete dysfunction of the limb.

History & Diagnostics

Lito initially presented to Dr. Jaeger in early December 2016 at 5.5 months of age, with a progressive three-week history of right front limb lameness unresponsive to rest and anti-inflammatories. Radiographs at that time revealed evidence indicating premature closure of his distal radial physis with secondary elbow subluxation.

Initial Radiographs


Above are lateral radiograph projections of the front limbs. The left is the normal side and the right is the affected side. Notice the open left distal radial physis on the left compared to the closed distal radial physis 
on the right. Also note the shorter length of the right radius compared to the ulna as well as the resultant radiohumeral (elbow) incongruity.

 

Procedures

Partial Ulnar Ostectomy

A partial ulnar ostectomy was elected in an attempt to curb the secondary effects this incongruity would create on the elbow and carpal joints. By performing this procedure, we realized that over time his right antebrachium and overall limb length would be shorter than his left side. Our first priority was to save his elbow joint from discomfort and irreversible damage as the ulna continued to push up against the humerus.

 

Above are post-operative lateral radiographs of the right antebrachium before and after the partial ulnar ostectomy. There is immediate mild improvement of the step between the height of the radius and ulna simply by releasing tension in the longer ulna. This improved further with weight bearing on the limb.

Second Partial Ulnar Ostectomy

Unfortunately due to his young age, Lito’s ulna healed prematurely requiring a second partial ulnar ostectomy to remove more of the ulna while he continued to grow.


Note above how the step between the radius and ulna improved with weight bearing, making his elbow more comfortable and preventing deformity.

Once his growth plates started closing and we knew how long his normal leg would be as an adult, we could measure the true length deficit of his right side and start planning to lengthen his limb. The affected right radius was ultimately almost 4 cm shorter in length than the normal left side.


Above depicts the left fully-grown normal limb versus the shorter right limb. Note the persistent changes of his right elbow compared to his left.

Radial Osteotomy & Stryker Triax External Skeletal Fixator Application

We contacted Stryker for assistance in providing a special external skeletal fixator called the Triax.  This device would allow us to slowly lengthen his leg over time. The external connecting bar of the Triax frame has the ability to lengthen bone by turning a distraction bolt; separating two bone segments in small increments. Lito again went into surgery and we repeated the partial ulnar ostectomy, created a radial osteotomy, and applied the external fixator.

 


Post-operative radiographs of the radial osteotomy and application of the Stryker Triax External Skeletal Fixator.

Slowly, we distracted and lengthened the limb by having the owners turn the distraction bolt on the fixator in small increments every day.

Outcome

After a month of distraction, we can see the amount of bone length that was achieved (figure below). There is also a cone of new bone at each end of the osteotomy. When performing these distraction procedures, there is a fine balance in timing. If performed too slowly, the bone may heal before distraction is complete. If performed too quickly there is not enough time to allow the soft tissues (tendons, muscles and ligaments) to stretch with the bone, which may impede full extension of the carpus.  During his distraction, Lito has also been involved in a rigorous formal physical rehabilitation program.


Lateral radiograph after one month of distraction. Note the length of the distraction gap and the new bone forming from each fragment end.

Once Lito’s distraction program was completed and the desired radial length was achieved, the bone was permitted to consolidate. When complete healing occurred, his fixator was removed. He continues physical rehabilitation to improve his joint range of motion, build muscle mass and improve overall limb use.


Above: Lito’s radius has almost completely healed.

 

Rodenticides Warning

Rodenticides that use Bromethalin as the active ingredient are extremely dangerous and can be deadly for cats and dogs. Bromethalin is used in many rodent poisons and the challenge is, there is currently no known anecdote. Be sure to take a look at our warning flyer to learn the symptoms of Bromethalin poisoning, what to do if your pet exhibits these signs, and tips for prevention.

Click Here to view and download our flyer.

Memorial Day: Discount for Military, Police, and Assistance Dogs

On Memorial Day, we stop to remember the brave men and women who have given their lives while serving and defending our country. However, men and women aren’t the only ones who protect and serve. Across the country and around the world there are hundreds of thousands of military, police, and assistance dogs that help keep us safe every day. Whether they’re serving in Afghanistan or Iraq as military working dogs helping to detect explosives and perform guard duty, assisting the police in tracking down narcotics, or improving the lives of persons with disabilities right here in the United States, service dogs of all kinds deserve to have their work acknowledged, which is why at your VRC specialty veterinarian in Philadelphia, all military, police, and assistance dogs receive a 20% discount!

CONTRIBUTION TO MANKIND

Service dogs have been helping mankind since the days of the ancient Assyrians, Babylonians, Greeks, and Persians. Service dogs help visually impaired individuals cross busy streets, as well as performing search and rescue operations, acting as sentries, and helping to detect bombs and drugs. Right now, there are approximately 2,700 active-duty dogs serving in the military, according to the U.S. Department of Defense. Military working dogs (MWDs) help with everything from explosive and narcotics detection to scouting and patrol duty, and are deployed all over the world.

According to the United States Police Canine Association (USPCA), there are between 10,000 and 15,000 working police dogs in the United States, serving 90% of police departments in communities of 100,000 or more. That means more than 60% of all police officers in America are employed in departments where they may work alongside canine companions. While we often think of police dogs as primarily assigned to sniffing out drugs, they serve a wide variety of roles on the police force, including aiding in search and rescue efforts.

Finally, the University of Arizona has estimated that there are nearly 400,000 assistance dogs partnered with individuals with disabilities throughout the United States. While we may be most familiar with “seeing eye dogs” that assist those with visual impairments, these dogs aid a variety of individuals with disabilities including hearing impairments, PTSD and other mental illnesses, mobility impairments, diabetes, autism, and more. Assistance dogs are often more than just a help to individuals living with disabilities; they are also a much-needed friend and source of comfort.

DISCOUNT

All of these dogs who serve us in so many ways are an inspiration to us here at VRC, and we’re proud to offer a 20% discount for all training, active duty, or veteran service dogs, including those serving with the police, in the military, or as assistance dogs. If your best friend falls into one of these categories and needs specialty or emergency medical care for any reason, please let us know when you make your appointment.

CONTACT US

To learn more or schedule an appointment today, just contact VRC, a specialty veterinarian hospital in the Philadelphia area.

Frequently Asked Questions: Internal Medicine

Internal Medicine at VRC

 

Why does my pet need to see an internal medicine specialist?

Most patients that present for evaluation to internal medicine have complicated ailments that may be difficult to diagnose or treat. Our goal is to help discuss with you your diagnostic options, do everything that we can to get an answer to what is going on, and treat your pet in a way that will provide the best outcome possible.  The initial consultation will simply be to discuss your pet’s condition and all options regarding how to proceed.

How is my pet going to do during/after treatment?

Many patients that have complicated diseases/disorders can respond to treatment in different ways. This means that we often need to initiate treatment, monitor your pet’s responses, and adjust treatment based on what we see.

Does my pet have to receive diagnostic testing?

We encourage diagnostic testing as it can play an important role in allowing us to make proper medical recommendations and treatment adjustments for your pet. A definitive diagnosis gives us the best likelihood of a successful treatment. If you decide not to pursue diagnostic testing, we can try to treat your pet’s most likely condition(s) without a definitive diagnosis. It is important to understand that if we are treating your pet without a definitive diagnosis it is impossible to predict how they will respond.

Can my veterinarian do the follow up treatments?

Absolutely, we always work closely with your veterinarian. Many clients travel from a long distance and it is difficult for them to continue to make trips back for recheck blood work, weight evaluations, x-rays, etc. If you are going to follow-up with your veterinarian, we ask that you request diagnostic updates to be faxed to us so that we can continue to monitor them. We will then fax our medical recommendations, based on the information provided, to your veterinarian and (s)he will get in touch with you to discuss any changes to the treatment plan.

Can I get the prescription medications from my veterinarian?

We would be happy to fax any necessary paperwork to your veterinarian to fill a prescription as long as the medication is in stock and a valid Veterinarian-Client-Patient relationship exists. This means that your pet has seen a particular primary veterinarian for visits and check-ups on a regular basis (typically within one year).

Can I get my pet’s prescription medications from a human pharmacy?

As long as the recommended medication or a suitable substitute is available as a human prescription, we would be happy to fax a prescription to a local or online pharmacy of your choice. Given that the cost of human medications fluctuates with time and across pharmacies, we recommend that you do some price shopping.  The same is true for online prescription purchases.

Do I need to fast my pet for the appointment?

Generally your pet does not need to be fasted prior to the appointment. If your pet will need to be fasted for specific tests or anesthesia, we will discuss fasting recommendations during the first appointment. If your veterinarian thinks that your pet will need anesthesia the day of the appointment or has recommended fasting, please contact us to discuss options.