Clinical Cases

7

A BIT OF A PICKLE

In early 2016 an approximately 8 week old, female, tabby domestic short hair, stray kitten presented at Rolleston Vet Services for a check-up and to evaluate a limp.

On presentation I performed a thorough clinical exam and determined that “Poor-Wee-Pickle” was malnourished and underweight, suffering from generalised ringworm and had a swollen left front leg with what appeared to be instability in the humerus and suspected radial nerve damage.

“Pickle” was admitted to the hospital for further diagnostics. Radiographs under sedation confirmed a simple, non-comminuted, mildly displaced, oblique fracture of her left distal humerus. At this point there was still a degree of concern as to whether or not there was radial nerve function as “Pickle” was non-weight bearing and holding her carpus in a flexed position. Examination of the lateral dermatomes however confirmed that skin sensation was still present, which was a good indication that nerve function was intact. “Pickle” was given an opioid and an anti-inflammatory injection and went home with me to monitor closely in crate confinement.

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Radiograph of left front humeral fracture

Over the course of the weekend, with pain and inflammation well managed “Pickle” began to use her broken leg, confirming that the radial nerve was not damaged. In this time “Pickle” and I also formed a strong bond and she found her forever home. Dr Nick Page then reviewed “Pickle’s” radiographs and came up with a plan for surgical repair of the fracture. The necessary equipment was ordered and surgery was scheduled for that week.

Weighing in at just over 1kg, “Pickle” was one of Rolleston Vet Services smallest orthopaedic patient’s. Her surgery was difficult and time consuming as care had to be taken during the procedure to protect her radial nerve which lay directly over the fracture site. Nick had to use a bit of Kiwi ingenuity to devise a way to isolate and guard the tiny, fragile nerve whilst still allowing himself full access to the fractured bone. It was also complicated by the fact that her surgery happened more than a week after the fracture occurred.

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  Dr. Nick Page beginning surgery

20160127_100644 Anesthetic monitoring machine showing Pickle’s vital signs during surgery

Puppies and kittens tend to heal far quicker than adult animals and in the time between “Pickle’s” injury occurring and surgery being performed her body had already begun to mend, forming a callous at the fracture site. This callous needed to be removed by a process called debridement before her bone could be properly realigned and stabilised using an external fixator device consisting of a tied in intra-medullary pin and two cerclage wires. “Pickle” was under full general anaesthetic for the duration of the surgery and she was also given a peri-operative brachial plexus nerve block in an attempt to make the procedure and recovery as pain free as possible.

20160127_104755Fracture exposed during surgery

At Rolleston Vet we are very fortunate to have a C-arm fluoroscope and so an intra-operative image of “Pickle’s” leg with her fancy new hardware could be taken to confirm that bone alignment was correct before suturing the soft tissue closed and concluding the surgery.

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Image from the Fluroscopy machine during surgery once the IM pin has been placed to align the fracture site

Post-operative radiographs were taken on the afternoon of surgery, confirming that her leg was well aligned and stable. It is quite difficult to position an animal with an external-fixator device for straight radiographs and so our view was mildly oblique. We were happy however that the bone looked good. “Pickle” went home that evening on oral NSAIDs to manage her pain and strict instructions to be kept quiet and confined in a crate. I now have a better understanding of just how difficult this is. Confining a boisterous young kitten and trying to convince her to stay quiet and relaxed is no easy task!

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Post-op radiograph shows the use of an IM pin, circlarge wire and external-fixator

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Pickle waking up from surgery with her External-fixator covered in pink bandaging material

Due to some post-operative swelling there was some transient radial nerve paralysis but this passed with time and “Pickle” began to weight-bear, play and swing from the bars of her crate like a naughty monkey.
Three weeks later “Pickle” was back in hospital. By this time she had had her first kitten vaccination and her ringworm was fully resolved. Repeat radiographs were performed under sedation and these showed that “Pickles” leg was healing beautifully. There was visible and palpable callous formation and her leg was pain free and stable. The decision was made to keep her confined for an additional week and then remove her hardware. At this time she was allowed out of her crate for short periods of time and taken for supervised, on-harness walks in the garden to allow her to vent some of her pent-up energy.

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Callous forming around fracture site

A week later her external-fixator was removed under her second full general anaesthetic. At this time “Pickle” weighed in at a whopping 1.6kg and was still smaller and lighter than the surgical drill used to perform the procedure.

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External-fixator being removed

After 5 weeks of crate confinement, “Pickle” was given her final kitten vaccination and was finally able to escape her crate and be a normal, happy kitten and she is loving her freedom. She thoroughly enjoys playing in the bushes in the garden and given the opportunity she will play in any water she can find, including diving head first into the bath or a sink full of dishes and soapy water.

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A happy Pickle playing with full function in her fixed leg

By Dr Allison Bird, BVSc (Pret)