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Thursday, July 16, 2015

A Really Bad Break

Recently I saw a small dog who had been unable to walk for a few days.  When I talked to the client it came out that her husband had backed his truck into their dog.  Why they didn't come right in, I'll never understand.  However, that wouldn't have changed the outcome of the case.

The dog was a surprisingly well behaved Chihuahua who couldn't stand up on his hind legs.  His left hind leg was out to the side at an odd angle, and worst of all he didn't seem to have any sensation or movement in his legs.  Normally this kind of deficit indicates a spinal injury, and when there is no deep pain sensation there isn't much that we can do.  

In order to assess the extent of the injuries and see if there was anything we might be able to do, we took some x-rays of the dog.  Here is your radiology lesson for the day!  See if you can figure out the problems this dog has.  Go on, I'll give you some time.

My veterinary readers have probably started picking up on the multiple problems.  But for the laypeople looking at this let me give you a hand.  First, let's start with the side view.

Look at the vertebrae in the green oval.  Notice that there is virtually no space between them, and if you look at the intervertebral space in front of them (to the left), you'll see what it should look like.  The whole back (caudal) half of the lumbar spinal column is significantly compressed.  This likely indicates that the discs between the vertebrae have slipped out of place and are pushing against the spinal cord.  

Then look at the yellow circle.  This is a sharp projection of the pelvis that simply shouldn't be there.  This is an indication of a fracture and dislocation of part of the pelvis.  We'll see this injury better in the next view.

Look at the right hand side of the image.  The yellow line goes from the upper edge of the pelvis to the hip joint itself.  The green circle is the "head" of the femur, which is the ball part of the joint.  That right side (actually the dog's left side) is normal.  Compare that to the opposite side (the left side of the image, which is the right side of the dog).  Notice that the yellow line is at a much different angle and doesn't cross of the the femoral head.  If you look at the structure just "above" (towards the top of the image) of the femur on that side, you'll see a striking difference.  The pelvis is fractured in that area and significantly displaced.  Observant readers will also notice a fracture in the middle of the pubic area of the pelvis.

Let's summarize.  First of all the dog has significant spinal compression and herniated discs, leading to pressure on the spinal cord and complete paralysis.  Even with immediate surgery this dog has less than a 10% chance of recovery and ever walking again.  Additionally there is a bad pelvic fracture that would require surgery to correct.  Either of these injuries is bad by itself, but together they paint a very bleak picture.  This dog needs at least $6000 in surgery and probably an additional couple of thousand dollars in post-operative care, all with no guarantee whatsoever of being normal.

In the end the owners elected euthanasia, and frankly I can't blame them.  They simply didn't have the money to do the treatment this dog needed, and even if they had it the dog was unlikely to walk again.  Really they made the best decision, tragic though it was.