Alice is a 7 year old spayed female Shepherd mix. She was hit by a car on May 16, 1999. She had fracture of the distal left tibia (at the ankle joint) which broke through the joint surface. The entire inside of the ankle joint was an abraded open wound. The medial collateral ligaments were braided away, creating gross instability of the joint. She also had a left hip dislocation. Below are the radiographs (X-rays) of the fracture and dislocation. The arrows indicate the fracture line and dislocated femoral head:
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Figure 1: Ankle Fracture
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Figure 2: Hip Dislocation
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The hip was reduced via open surgery on May 18, 1999. The joint capsule was torn from the femoral neck, so I was able to suture the joint capsule attached to the acetabulum (hip socket) with heavy nylon suture through a drill hole in the femur bone. I added a second heavy nylon suture through the drill hole in the femur and anchored it to a screw placed next to the acetabulum. The following radiographs show the hip 4 months after the surgery. The hip joint is very quiet, no signs of arthritis are seen, and there is full, normal range of motion.
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Figures 3 & 4: Hip Four Months After
Surgery
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The ankle’s open wound was cleaned and bandaged a few times over the next 9 days, waiting for the wound to develop a healthy bed of granulation tissue. On May 27, 1999, the 3 pieces of fractured ankle were reconstructed with 3 "lag" screws to anchor the fracture fragments in place. This also realigned the joint cartilage surfaces, but there was some damage to the joint cartilage. A new medial collateral ligament was created with the use of heavy nylon sutures wrapped around screws. However, there was not yet enough skin to close the wound completely, so it was allowed to heal "by second intention". The surgery was protected with a splint. The following radiographs show the ankle reconstruction 4 months after surgery. The joint moves smoothly with full range of motion, is very stable, and the wound has since closed over with skin. Alice uses the left rear leg normally most of the time, but occasionally "skips" when she runs.
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Figures 5 & 6: Ankle Four Months After Surgery
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