Page 9 - Clinical Connections - Autumn 2023

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Page 9 - Clinical Connections - Autumn 2023
P. 9

Unusual goat case
        KID GETS NEW LEASE OF LIFE WITH
        PROSTHESIS


        Melanie Perrier, Senior Lecturer in Equine Soft Tissue Surgery


             histle,  a  five-week-old  kid  (Nubian   Amputation and prosthesis   Since Thistle had been walking on three
             goat)  was  first  referred  to  the   The owner elected to proceed with   legs since birth she presented with severe
        T ºÚÁÏÉç’s Equine Referral Hospital for   amputation at the level of the distal   muscle atrophy over her right forelimb, and
        evaluation of a suspected open fracture   metacarpi, which was performed under   this needed to be built up progressively. She
        of her right front digits. She was born with   general anaesthesia. A postoperative   wore her prosthetic for a little longer each
        what was initially believed to be an angular/  CT was performed to obtain exact   day and underwent regular  physiotherapy
        flexural  deformity  and  was  treated  with   measurements of the size and shape of the   exercises once back home. Initially she wore
        splints for a few weeks.            stump in order to help design and fabricate   the prosthesis for a few hours daily to get
          However, her condition did not improve   a 3D printed prosthetic foot. Professor   accustomed to it gently; this was increased
        therefore radiographs were taken, and an   Richard Bomphrey, of the Structure and   progressively over the following weeks.
        open fracture of the digits was diagnosed   Motion Lab, was consulted during the
        by the referring veterinarian.  Thistle was   whole process and manufactured the
        subsequently referred to the ºÚÁÏÉç for further   prosthesis for Thistle.
        evaluation and treatment.             Thistle recovered well from general
          On presentation to the Equine Referral   anaesthesia. The surgical site appeared dry
        Hospital, Thistle was bright and alert, with   following  surgery,  there  was  no  discharge
        all  vital  parameters  within  normal  limits.   and only minimal swelling. She was
        She  was  non  weight-bearing  lame  on  her   discharged home six days later under the
        right forelimb. She presented with a 4cm   recommendations of keeping her in a small
        transverse wound proximal to the coronary   pen or paddock until suture removal after
        band.  The  wound  was  full  thickness   a fortnight. During that time, the bandage
        and associated with moderate to severe   on her right forelimb was changed every   Thistle on her prosthesis
        instability at the digits level.    few days, or whenever it became loose or
                                            soiled, until she came back to the Equine   At present she wears the prosthesis
        Diagnosis                           Referral Hospital for suture removal three   three to four hours twice daily. While she
        A  Computed  Tomography  (CT)  scan  was   weeks later.                 is apparently very attached to her new foot
        taken  to  further  evaluate  the  fracture  and   When  Thistle returned to the ºÚÁÏÉç, her   and is very reluctant to have it removed,
        determine possible treatment options and   skin sutures were removed, and the new   she gets a bit tender if the prosthesis is left
        prognosis.  This  identified  chronic,  open,   prosthetic  limb  fitted  under  light  sedation.   for longer period of time.  The owner will
        comminuted,  displaced,  non-articular,  The prosthesis resembles a ski boot with   therefore continue to increase the amount
        diaphyseal fractures of the phalanges. There   Velcro  straps.  It  was  3D  printed  with  PLA   of time she wears the prosthesis slowly with
        was also complete loss of preservation   filament and a threaded bolt was inserted   the ultimate goal to keep it during the day
        and joint congruency of the distal   at the bottom to allow for adjustments in   and have it removed at night.
        interphalangeal joint, with intra-articular gas   height as she grows. Several modifications   Our  small  animal  physiotherapy
        suggestive of septic arthritis and luxation.   were made to the design of the prosthesis   nurses (Emily Cowderoy and Holly
          Given  the  CT  findings,  repair  of  the   over the course of her stay to make it more   Smith) designed regular physiotherapy
        fracture  with  internal  or  external  fixation   comfortable and, in particular, easier for her   exercises  to  encourage Thistle  to  use  the
        was not deemed possible as there was not   to lay down.                 limb and develop her proprioception and
        enough bone left at the distal phalanges   Thistle's progress postoperatively and her   musculature. She has been having careful
        level. Other options were discussed with the   initial response to the prosthesis have been   daily  monitoring  of  the  amputated  limb  to
        owner, including euthanasia, amputation at   very  encouraging.  While  she  initially  only   check for the formation of any pressure
        the level of the radius and amputation at the   used the prosthesis for a few steps, after a   sores  relating  to  the  prosthesis  as  she
        level of the distal metacarpi, with the hope to   few days she was mostly weight-bearing on   grows.
        fit a prosthesis on the distal limb.  it and showing a more natural gait.   We look forward to seeing Thistle again
                                                                                in the future as adjustments become
                                                                                necessary.  Like  human  kids,  she  might
                                                                                need new shoes quite regularly!






                                                                                       For equine referrals, please call: 01707
                                                                                     666297
                                                                                       Email:
                                                                                     equinehospital@rvc.ac.uk
         Thistle’s stump three weeks following amputation (left) and her fitted prosthesis (above)t
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