Meet Will! Our first exoprosthetic limb patient.

By Brent Higgins and Elena Saltis

 

Will is a ten year old Collie dog who was presented to Vetspecs in September 2012 for management of an open comminuted metatarsal II fracture and tarsometatarsal luxation of the left pelvic limb after getting his foot caught in a gate whilst working. At presentation, we were concerned that he had a vascular injury as the toes were cold and discoloured. Ischaemic injuries to the distal pelvic limb can occur when vessels, such as the perforating metatarsal artery, are traumatised.  Tissue viability can be difficult to predict when there is a significant amount of traumatic swelling and so, after discussion with the owners, we proceeded with stabilisation in an effort to enhance tissue viability. After epidural analgesia, a type II tarsometatarsal external skeletal fixator (ESF) was applied with a type 1a ESF applied to metatarsal II creating a rigid mechanical construct.

Open wound management and laser therapy were utilised until it was clear that permanent ischaemic injury was continuing to ensue. This was a really disappointing result for the whole team who had fallen in love with Will. After discussion with the owner, Will was taken on by one of the nursing team at Vetspecs and planning for exoprosthetic artificial limb replacement was initiated. Whilst proximal limb amputation was an option, this has marked biomechanical disadvantages to the quadriped and involves removal of healthy components of a limb. We now have the technology to allow these patients to continue to use four limbs despite the loss of a foot.

The foot was amputated at the most distal possible location, which in this case was at the level of the tarsometatarsal joint. The amputation was performed in such a way that ‘stump toleration’ to a subsequent exoprosthetic was optimised; this meant ensuring the suture line  was on the surface with the least load-bearing responsibility. Physiotherapy to the stump included laser, deep tissue mobilisation, stretching/flexibility/ROM of the remaining proximal limb, contralateral limb, and spine, and desensitisation of the stump.

Elena Saltis, Physiotherapist and Canine Rehabilitationist, and Dr Brent Higgins, Registered Specialist in Small Animal Surgery, have undergone overseas training in canine orthotic and prosthetic treatments. As a result, Vetspecs is now offering  and  performing exoprosthetic limb replacement for amputee patients.  They are the only practitioners in New Zealand that are trained and skilled in prosthetic limbs using the world leader in this technology, US company Orthopets.  Elena and Brent underwent their training in Australia and, since then, Elena has travelled to the Orthopet facility in Colorado to undergo further instruction. Elena constructed Will’s individualised fibreglass impression mould and documented all the necessary measurements, along with videos and pictures of Will.  This was sent to the factory in the USA for construction of a temporary custom-made prosthetic.  After three months of use,, Will’s initial prosthetic will be sent back to the USA for analysis and the permanent prosthetic limb will be made.

Current physiotherapy with Will has included:  caveletti poles, balance discs, peanut ball, manual limb placement while walking, pelvic limb strengthening, stretching/flexibility, gait training, weight shifting, as well as manual therapy and laser.

Will is currently loving his new limb and is running around the farm and playing with other dogs.  His biomechanics have been terrific during this adaptation phase.  He has not shown any discomfort with his limb and is back to working - his true love.

For more infomration on the wonderful team at OrthoPets please see their website www.orthopets.com