Q I have a 7-year-old border collie. She was hit by a car a few months ago and she broke her pelvis. Our veterinarian said that the pelvic fracture would require a plate repair and that we would need to see a specialist, such as you, to repair it.
He said it would probably need a plate, and he guessed at the cost. It was more than I could afford, so he recommended that he amputate the leg. She gets around well on three legs, but I wonder if this was the best decision. What are your thoughts?
A: In veterinary medicine, there is an adage that says "Dogs are born with three legs, and a spare," meaning that they do so well on three legs that the fourth limb is like a spare tire.
This is particularly true when we are talking about a hind limb, as in your case. It is also important that the other legs are in good shape and that the pets general health is good.
Dogs and cats have a tremendous ability to adapt to the loss of a limb, or limbs.
When I was a veterinary student at the University of Illinois, a dog had chased a rabbit into an electrical transformer. When the dog contacted the wires, the bolt burned his face and passed through his body, exiting through his hind legs. Both legs were so badly burned that they required amputation.
The family had some financial issues, and could not afford to treat the dog. The local news picked up the story, and the donations began to pour in.
The surgeons planned to implant prostheses, artificial limbs, once things had healed up. Thousands of dollars were donated, more than enough to cover the cost of the surgeries. The problem was that by the time he had healed enough to have the procedures, he was literally running around on the front legs. He was happy, chasing balls, wagging his tail, etc.
Now the darker side of human nature emerged. The owners looked at this dog running around contentedly in their yard and looked at this pile of money and said, "Hmmm." Greed boiled to the surface and that dog never showed up for surgery, and the money, well, it disappeared, too.
Years later, I was faced with a case of a young pitbull who had such a severe infestation of heartworms that the blood vessels to his hind legs were completely obstructed. Gangrene had set in and the only option was to amputate.
I knew from the previous case that he would do fine. I think that my staff thought I was crazy and that the dog should be euthanized. But when he walked into the clinic for suture removal, 10 days later, their minds changed completely. He never needed a cart, or prostheses.
So, I am not shy about amputation. I do, however, think that a cavalier attitude about the "spare" limb can go too far.
Recently the spare tire fell from the bottom of my truck, unbeknownst to me, as I was driving home. Obviously, the car drives fine, but all in all, I'd rather have my spare. If one more tire goes, I'm stuck.
Fortunately, I will be able to replace my spare, but once a limb is gone, it's gone, and there is no guarantee that there will never be a problem with any of the remaining legs. For this reason, I feel that amputation really should be a treatment of last resort.
When a case is referred to me, it is here as much for my opinion as for my surgical abilities. I wish more people understood this. Yes, we perform surgery and they are generally a bit more expensive than at a general practice. But, we also provide options. My residency mentor, Dr. Mark Smith, required that I describe three alternative approaches for every condition. Often, one option is to do nothing at all. Bones will often heal, even without our help, and we cannot always predict the level of function that will return.
In general, if surgery is not an option for a pelvic fracture, I will recommend allowing it to heal on its own before deciding about amputation or euthanasia.
Definitive treatments should be based upon the ultimate level of function that is regained, and it can be surprisingly good.
Recently a good Samaritan brought in a hound that was found in the Francis Marion Forest. She was emaciated and probably had been hit by a car. Her pelvis was severely fractured and the injury was estimated to be 3 weeks old. This poor, discarded and broken dog had fended for herself in the freezing cold, alone, with a smashed pelvis. The healing was so advanced that it was no longer an option to repair it. One of our technicians fostered her, named her Mary and gave her what she needed: time. I have seen the same injury completely debilitate a dog. But not all dogs are the same. Mary has regained comfort and almost all of her function.
For many fractures, surgery is by far the best means of quickly providing comfort and assuring the best functional outcome. But when surgery is not an option, natural healing may be the next best option before a decision is made to amputate a limb, or euthanize a pet.
Dr. Henri Bianucci and Dr. Perry Jameson are with Veterinary Specialty Care LLC. Send questions to firstname.lastname@example.org or veterinaryspecialtycare.com.
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