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Thursday, August 25, 2011

Freak Accidents Unfortunately Happen

This afternoon one of our clients brought their dog in for a simple nail trim.  He is a 13 year-old German shepherd mix (probably with husky) and not in the best of health.  He also is a bit of a biter.  One of my assistants brought him to the back to have the nail trim done, and a new doctor we just hired was holding the dog.  As they were doing this the dog's hind legs suddenly slipped on the smooth tile flooring and he went sprawling with his hind legs splaying in a "frog-leg" position. 

When they tried to get him up they found that he couldn't stand and was painful.  They brought the owner back and got me to look at him.  I noticed that he was very painful in his left hip and couldn't put that leg down.  I was also having difficulty trying to extend the hip backwards.  We put him in a kennel to rest for about 30 minutes and then got him out for another exam; we found the same problem.  The next step was x-rays.  We told the client that we needed to sedate him and do this, and wouldn't charge her for it.  Once we put up the films we noted quickly that the left hip had dislocated.  Ouch!  For many reasons.

This is a very old dog who wasn't in the best of health.  When we ran routine blood tests in May we noted increases in his liver values.  He also had severe muscle wasting in his hind legs and hips, though he was walking pretty normally.  In fact, I think the lack of good muscle mass was the reason for the dislocation.  Many people don't realize it but good muscle tone and development is just as important for hip support and strength as tendons and ligaments.  I've seen many dogs slip or lay like he did, but I've never seen a hip dislocation.  It was also strange because normally when a hip dislocates the femur moves craniodorsal ("up" and "forward").  This hip slipped ventrally ("down"), opposite the normal direction.  I think that the muscle atrophy allowed the hip to move abnormally; a normal amount of muscle likely would have prevented the injury.

Unfortunately we found other problems on the x-rays.  The 3rd through 7th lumbar vertebrae had bone bridging that was fusing the vertebrae together (called spondylosis, and not an uncommon finding in older dogs).  We also saw stones in both kidneys.  These findings were incidental but weren't good to see.

So let's recap. We had a geriatric dog with underlying liver problems, atrophied muscles, spondylosis and kidney stones slip on the floor and dislocate his hip.  Not a good situation by any analysis.  While he was sedated and relaxed I tried to put the hip back in socket, but no luck.  It's hard enough to replace a dislocated hip, but this hip was out in a way that I was never trained to fix. 

This was a completely freak accident that I have never heard of before.  Unfortunately it happened at our facility, so we feel responsible even though we didn't do anything wrong, and there is some potential liability since it happened under our care.  We sent the dog home with analgesics and didn't charge for anything we did.  We're also sending him to an orthopedic surgeon tomorrow to have the case reviewed.  I'm hoping that the surgeon may know some tricks to non-surgically put the hip back in joint because this dog is a pretty poor surgical candidate.  We're also going to cover the costs of any treatment, even if it comes to surgery.  We're not technically to blame, but we don't want the owner to feel that way and also do feel bad about the situation.

No, it's not easy being a vet.