Case Report, Bindi Sue L

8/11/2019 Case Report, Bindi Sue L.

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Case Report

Signalment: Bindi Sue, 2yr, 9mo old, spayed female, Labrador Retriever, weighing 39kgs

Clinical History: Bindi Sue has had a history of grade III/V lameness of her left hind limb for

the past several months, which had been monitored by her primary care veterinarian. According

to her owners, on August 30-31, 2014 her lameness became more apparent after a trip to thebeach, where Bindi Sue was playing in the surf. Owners administered aspirin as means of pain

control. In the past week, she has received antibiotics and a steroid injection for the control of a

hot spot on her left rear limb.

Presenting Signs: Bindi Sue presented to the surgical department on September 4, 2014 with

obvious lameness in her left hind limb. Her vital signs on presentation were all within normal

limits and her mentation bright, alert, and responsive.

Physical Examination: Physical examination of the left rear limb revealed mild atrophy of the

thigh muscle and palpable medial buttress. Stifle effusion, cranial drawer instability, and a

positive cranial tibial thrust was evident. Palpation and manipulation of the right stifle revealedmild joint effusion. Manipulation of the coxofemoral joints revealed reasonable range of motion

with no signs of obvious discomfort.

Laboratory Tests: Radiographs of the left stifle demonstrate stifle effusion with cranial

displacement of the infrapatellar fat pad, degeneration changes with osteophyte formation and

minimal sclerosis, and cranial displacement of the tibial eminences relative to the femoral

condyles. A measure of the tibial plateau angle equaled 28 degrees and is suspicious of a

complete cranial cruciate ligament tear with mild secondary arthritis.

Diagnoses: Left cranial cruciate ligament rupture; moderate osteoarthritis; left medial meniscus

release

Treatment: Metoclopramide 19.5mg was administered subcutaneously at 10:57AM. An 18

gauge, 2 IV catheter was placed in the left cephalic vein to allow for the administration of pre-

operative hydromorphone 3.9mg at 11:18 AM. Intravenous Midazolam 7.8mg was administered

at 11:2AM to begin inducing anesthesia. Propofol 117mg was administered to effect at

11:43AM. The patient was intubated with a 51 French endotracheal tube and placed on

Isoflurane. An epidural at the lumbo-sacral junction was administered using Bupivicane 3.9mg

and Duramorph 3.9mg. LRS at 390mL/hr was started. A left medial parapatella arthrotomy was

performed, revealing a completely ruptured cranial cruciate ligament; the ligament fragments

were excised and the medial meniscus released after inspection. A tibial plateau leveling

osteotomy was performed to stabilize the stifle. The tibia was cut with a 27mm circular sawblade and a six hole, 3.5 TPLO plate was placed to correct 28 degrees of tibial plateau slope. All

screw holes were filled with 3.5mm screws and tightened well. Cefazolin 858mg IV was

administered intraoperatively at 12:10PM and 2:00PM and Atropine 0.7mL IV at 1:05PM as the

patient was bradycardic at 45-55 BPM from 12PM-1PM. Closure of the surgical site using 3-0

PDS was performed without incident. Post-operative radiographs were performed and

demonstrated good implant placement and tibial alignment. Recovery from anesthesia was


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uneventful. Post-operative hydromorphone 1.95mg IV was administered at 3:22PM. Post-

operative temperature was 96.3F and heat support was applied until temperature stabilized at

1:30AM. Post-operative treatments included: cold compressing of the surgical site every six

hours, cefazolin 858mg IV every eight hours, tramadol 100mg PO every six hours, and laser

therapy of the left knee every six hours. A hydromorphone 0.01mL/kg/hr at 105mL/hr was

started at 3:30PM and decreased to 50mL/hr on September 5, 2014 at 9:00AM. NSAIDs couldnot be given due to recent steroid administration.

Prognosis: Good with proper restriction of activity, weight-control management, physical

therapy, and chrondoprotective supplementation. There is likely to be some arthritic progression

in this knee over time, and Bindi Sue may become symptomatic long-term.

Outcome: Bindi Sue was discharged at on Sept. 5 at 3:00PM after 12 hours of post-operative

care.

Discharge Instructions: Confinement phase (first eight weeks following surgery): A strict

confinement regiment must be followed for the first eight weeks following surgery. Do not allow

unsupervised activity such as running, jumping, fetch, etc. Bindi Sue can be inside on carpeted

surfaces under direct supervision. Slick surfaced such as hardwood, tile, or linoleum should be

avoided if possible. When not under supervision, confinement in a kennel or crate is strongly

recommended. She can be taken outside on a short leash for bowel movements, urination, etc 3-4

times a day for 3-5 minutes. Total exercise time should be no more than 10 minutes for the first

two weeks and no more than 15 minutes from 2-8 weeks. Towel/sling walking is recommended

on slick floors, uneven ground, or stairs. There is always some risk of premature failure with

implants, especially with overactivity, so exercise restriction is important to reduce the risk of

this happening. Playing with other animals is not allowed during confinement. If there are other

pets in the household, they will need to be kept separated. Bindi Sue should start to use the leg

within the next 3-5 days; if she is not using the leg within 5 days, please contact us. Begin gentlephysical therapy exercises starting 5 days after surgery.

Physical Therapy Instructions: Bindi Sue needs to have passive range of motion performed on

the operated knee during the confinement phase, especially if she is not started to toe-touch on

the leg by 5 days post-op. Administer anti-inflammatory medication as prescribed to reduce

inflammation and discomfort and apply a warm compress to the knee for 3-5 minutes prior to

physical therapy sessions. Perform range of motion exercises three times daily as follows: slowly

flew the knee to where Bindi Sue first feels discomfort, then slowly extend the knee until Bindi

Sue shows signs of discomfort. Repeat this process 20 times at each session for the first three

weeks, then 10-15 times per session thereafter. Do not cause pain by moving the join too far;

rather, gradually build up range of motion by stretching rather than tearing scar tissue. Ice the

knee for 3-5 minutes at the end of each therapy session, if Bindi Sue will tolerate it. Range of

motion should gradually improve over time. We have a rehabilitator on staff who can work

closely with you and Bindi Sue during the post-operative period.

Bruising and swelling adjacent to the incision should subside over the next week; some of the

fluid may accumulate around the hock joint during this time, producing a soft-tissue swelling,


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but should subside. Keep the incision clean and dry and check it daily to ensure that there is no

abnormal discharge; if necessary, use an Elizabethan collar to prevent Bindi Sue from licking,

biting, irritating, or otherwise bothering the incision. Monitor attitude and appetitethese should

return to normal over the next 2-3 days. Reduction of feedings by 20-30% is advised to reduce

weight-gain during the recovery period and is important to reduce stress on the rear legs.

Medication:

1. Tramadol 50mg tablets: give one and a half tablets by mouth ever 8 to 12 hours as needed

to control signs of post-operative discomfort

2. Fish oil or Omega-3 fatty acids: give 1200mg liquid cap orally every day. Additional

supplementation with Chondroitin sulfate and glucosamine HCl supplementation can be

used.

Documents

Case Report, Bindi Sue L