2-Year-Old Dwarf Pit Bull Terrier Mix Destroys Leg Splint Bandage
A Dog With a Broken Leg is No Fun!
Purdue had no problem running around on three legs. After all, one broken leg can be help up under the belly while the other three legs bob you up and down and you still get to lick the veterinarian’s hand and beg for treats!
Purdue was a male, neutered mix of something very short and crooked-legged and a lusty boisterous American Pit Bull Terrier; basically, he was a mutt with heart of a Pit.
Jumping off of the bed led to a leg held up, some whining, and a reluctance to finish his dinner. So he ended up in Doc Truli’s examination room.
Broken Hind Leg So Obvious, So Why the Radiographs?
The left hind leg jutted out at an odd angle. A light finger touch to the skin revealed moving bones, a grinding, grating feeling. A person could not possibly hear the bone fragments crunching against one another, yet Doc Truli gathered the distinct impression she could hear the bone pieces scraping against one another.
Purdue’s mom wondered, “If we know the leg is broken, why do we have to X-ray the break?”
“Good question,” said Doc Truli, “If we splint, cast, or otherwise stabilize this leg, without setting the bones as near normal relation to each other, then nerves will throb, bones will float, and healing will not occur.”
“Oh,” said Purdue’s mom.
How to Help Broken Bones Heal the Best
- No movement
- Less oxygen tension
- Close proximity of the pieces
- Stabilize internally with surgical stainless steel or titanium pins or plates
- Bandage or Cast
- Decrease movement and activity
- Line the bone pieces up well
Purdue Suffered a Comminuted, Mildly Displaced Tibial Fracture with a Possible Sequestrum
Let VirtuaVet show-and-tell.
The first picture shows the fracture almost in the middle of the leg. Purdue really did a number on it! The black line through the bone outline the center piece separate from the top and bottom of the bone. A connection might exist that does not show on the radiographs (x-rays), but most likely, that bone piece is on its own.
A healing blood clot immediately forms at the site of a broken bone, and the body makes healing connective tissue to provide nutrients and a framework for healing. Even with the miracle of healing in the body, a piece of bone on its own, like seen in these x-rays, can become a bony sequestrum.
A bony sequestrum is a piece of bone that fails to establish a healthy blood supply or rejoin its bone neighbors. The piece of bone dies. The dead piece becomes necrotic – the fancy word for something in the body rotting. Obviously, a dead piece of bone just sitting in the leg triggers a violent rejection reaction in most animals and people.
Once the sequestrum dies, rots, the body rejects the sequestrum. The body treats that piece like a thorn or splinter. Sterile pockets of pus can form. Ever-growing fluid pockets can eat away at the surrounding healthy bone, the leg can rebreak, or worse, become a spreading dead zone.
Preventing a Bony Sequestrum
The best prevention once the bone breaks, is surgery to align pieces right away, perhaps wires, screws, metal plates — anything to bring the bone pieces in close alignment so the healing can be quick and efficient.
What If the Broken Bone is Older? Say, a few days or a week or more?
The current scientific thinking holds a different view of an older fracture site. Years ago, a surgeon would open up the fracture site, clean out the connective tissue, scar tissue, blood clots and body detritus (as it was believed to be), and align the pieces and sew everything together. We now know the blood clot and the healing process are invaluable.
Sometimes a surgeon can use lag screws or other pressure techniques to tighten the bones together without cleaning out the area. Some newer techniques involve inserting a bone stabilizing metal plate from the ends of the injury, instead of the middle in order to avoid damaging the healing process. Even external fixator devices, which are metal rods with screws going into the bone pieces from enough planes of force to prevent movement and rotation – are advantageous for some fractures old and new.
All this medicine and surgery and science sounds great. But it comes with US$2,000-$3,500 price tags. In reality, if a dog is lucky enough to be taken to the animal hospital for veterinary services, a splint or cast is the likely treatment.
Purdue received a Robert Jones splint bandage.
Robert Jones Splint Bandage
A Robert Jones is a bandage made of many, many layers of cotton to a thickness sometimes of a foot (usually comes on a roll), then stretch gauze to tighten the cotton to a snugness so firm that the surface thuds like a hollow log when flicked with a finger.
Plastic, fiberglass, or other materials can be incorporated into the bandage to provide firmness and further stability.
An outer water repellent layer, like the Vetwrap product sold in the US finishers the job. By the way, incorrectly applied Robert Jones splints will cripple or necessitate amputating the leg.
The extra tape on the bottom provides extra layers for wear and tear on the floor contact surface.
Healing a Leg Fracture
Non-Unions are Bad
An adult dog can expect to rest and stay off of the leg for about 6-8 weeks. If the fracture has not healed by 8 weeks, it may be considered a non-union. A non-union will not support the functions of the leg and can lead either to surgery or euthanasia or a lifetime of pain or variable degrees of crippling dysfunction, depending upon the personality and tolerance levels of the dog.
Purdue’s Slow Healing
Because the splint cannot prevent movement like a surgeon’s metal bone plate, some movement across the fracture line occurs, allowing extra oxygen and disturbing micro-healing processes. Lots of microscopic restarts take place. Some go awry and a cartilage or scar tissue connection could result instead of solid bone. Obviously, proper rest and home care dictate the outcome.
Purdue Ruins Several Splints
A veterinarian’s nightmare is a bandage that gets wet, unravels, gets chewed, slips down, or otherwise loosens or moves. Purdue destroyed three splints through puddle-jumping, peeing on his own splinted leg and once, he chewed and drooled a hole through the splint. Each time he needed a new splint, he needed sedation to stay calm and still to replace the bandage. The time and costs and frustration mounted. It almost seemed like the money could have been put toward surgery instead of multiple costly technical bandage replacements.
The Destroyed Robert Jones Spint
Doc Truli hospitalized Purdue in order to control his environment, exercise, and rambunctious ways. Obviously, the home environment allowed too much freedom to make doggy mistakes!
“I checked Purdue at 8 am. At 10 am, I was confronted with the sight you see in the following picture,” says Doc Truli.
You should know that Purdue’s family was fed up with the bandages They went against medical advice and forbid regular rebandaging. Their intent was to save money by stretching the life of the Robert Jones splint as much as possible before changing the bandage. Furthermore, as we later learned, the bandage repeatedly became soaked with urine on Purdue’s morning walks. The family used a blow-dryer to dry the layers (they read about that on the internet), and they thought it unnecessary to notify the medical team of the repeated wetting on the bandage.
When Doc saw the condition of Purdue’s leg underneath the bandage, she understood his super-fast chewing expedition to remove the offending material.
The Damage Caused by a Wet Leg Bandage
Purdue was lucky. His foot pads did not fall off. His skin did not slough off exposing bone. His bloodstream escaped septic spread of infection.
Hind Limb Edema in a Dog
Purdue suffered swelling of the leg, called edema. The build-up of edema fluid brings protein to the interstitium between the layers of the skin and connective tissue. Bacteria love to feed on this protein. A small sore can become a massive infection, even a septicemia (blood infection) within hours.
The skin starts to ulcerate, or open up. The red spots show here the fur rubbed off and the skin turned spongy and ripe for infection. After bandage removal, the leg was soaked in warm, mild antiseptic solution. Even though the bone fracture could use splint stabilization, the skin needed to feel some fresh air and light in order to dry up and heal.
Purdue was lucky! Some dogs loose skin, foot pads, all their fur, and even suffer bone exposure and need some degree of amputation to close the defect. Others harbor deep infection down to the bones of the fracture site and the bone marrow, which provides blood cells to the body. These dogs need expensive serial blood cultures and long, strong courses of antibiotics to survive.
Purdue’s skin healed in days. His fracture healed enough to hold together without a splint. The potential sequestrum does not bother him. In a perfect world, we would radiograph that bony piece again to identify if healing is complete. Purdue’s family says, “No, thank you.”
For now, Doc Truli certainly hopes so.