OrthoPets Blog

October 2017 OrthoPets Case Study for the Canine Rehabilitation Institute: Duke

Duke is a 12-year-old mixed breed who presented to his primary veterinarian for right hind limb lameness in March of 2016. There, he was diagnosed with a right cranial cruciate ligament tear and chronic joint effusion, which is a common injury in dogs. An ACL, also known as a CCL or CrCL tear, is the same injury as seen in humans. When surgery isn’t an option due to age, health, financial reasons, or any other reason, OrthoPets can offer an alternative solution via a custom made orthosis. In Duke’s case, his owner chose an orthotic solution due to his age and opted to not put him under anesthesia for the corrective surgery most commonly known as TPLO (tibial plateau leveling osteotomy) or TTA (tibial tuberosity advancement). After we reviewed his case, it was decided that a standard stifle orthosis would be the best option for him at this time. Due to his age and therapeutic goals, a lower durometer (more flexible) hinge was installed on the lateral side along with a standard resistance hinge on the medial side to still provide stability and control but allow an easier range of motion. OrthoPets utilizes a number of different types of hinges and chooses the appropriate one for each patient based on a number of factors.

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Left: Duke’s fiberglass impression. Right: Duke’s stifle orthosis.

Once the device was fabricated, it was shipped to the clinic where the referring veterinarian was able to fit it properly and discuss with Duke’s owners the recommended break-in schedule. Duke had been wearing the device for a few weeks and had been going on longer walks and even playing catch with a Frisbee, but unfortunately he reinjured his right stifle likely due to high levels of activity. Our stifle orthosis when properly donned will control tibial thrust, but patient activity in and out of the device as well as environmental factors may play a role in progressive tears. For partial tears, an orthosis is just a portion of the patient’s overall treatment plan for achieving a “curative outcome.” Most partial CCL tear patients are receiving accompanying therapies in addition to the use of an orthosis, including laser therapy, PRP injections, shock wave, and a few others. The patient’s body requirements for healing are not changed with application of an orthosis.

After reviewing additional media and discussing an adjustment plan with the owner, we decided it would be beneficial to Duke for us to switch out his lower resistance hinge on the lateral side for a standard resistance hinge. The owners were weary of Duke being without his device, so they decided to order a “back-up” device for him. Sometime after completing the adjustments for the original device and sending out the back-up device, we followed up with the owner and received a reply email with an amazing update as stated below:

“Thank you so much for checking in! Duke is doing great – he loves the brace and it enables him to do all the things he loves to do! Hiking, Frisbee, ball, and just enjoying life. I am so grateful for your company creating such a wonderful alternative for dogs so they don’t have to go through surgery.”

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Duke, post-orthosis.

A year had passed after Duke had been using his device, and his mom reached out to us for a complete refurbishment of his devices, which is recommended every 1-2 years depending on environment and activity level in the device. We stripped the device down to the shell and added new foam, straps, and hardware to his device. After shipping them back out, his mom sent us another great email giving us kudos and letting us know how big of a difference we had made in Duke’s life. Her response was as follows:

“We just received Duke’s adjusted brace (actually yesterday) and it looks great!! Really wonderful – thanks so much!! I will be in the office on Tuesday and will send the other brace to you overnight (you will have it on Wed) for the refurb! Can’t wait – it’s really worn looking so it will be great to have it look nice again! We are so reliant on the brace for Duke – it’s really made it so he can do all the things he loves! 🙂 Thanks again!”

We here at OrthoPets are so happy to be able to offer an alternative solution to help so many people and their pets. We wish you all the best and enjoy hearing of the success your pet has with their devices!

Tiger the CCF Cheetah Scat Dog

Our Partner Vet, Dr. Ilana Strubel (who runs our OrthoPets Partner Clinic in San Francisco, A Well Adjusted Pet) recently took a safari trip in Africa. While she was in Namibia, she helped fit an OrthoPets elbow orthotic for Tiger, a Cheetah Scat detection dog for the Cheetah Conservation Fund. Dr. Strubel writes:

One of the most exciting parts of the visit to CCF for me personally was bringing a custom-made Elbow Orthotic (Brace) donated by my custom orthotics partner Ortho Pets in Colorado! I had pre-ordered the device for “Tiger” who is a Cheetah Scat Detection dog who had been injured and unable to perform his important work.

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Dr. Strubel places Tiger’s orthotic.

I first learned about “Tiger” (the best ‘Cheetah Scat Detection Dog’ in all of Namibia) at a lecture given by CCF Director, Dr. Laurie Marker at the Wildlife Conservation Network Expo last April. She mentioned that “Tiger” had broken his left front leg and that despite the best veterinary care available in Namibia, he was still too painful on the leg and he was no longer able to do his important work of detecting “black gold” = Cheetah Scat (fecal matter)!

 

 

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Handsome Tiger models his orthotic.

The Cheetah Conservation Fund (CCF) runs the scat sampling project through its Applied Biosystems Conservation Genetics Laboratory, with the aim to provide a non-invasive method of collecting DNA from animals. The genetics lab collects scat samples to help obtain genetic ID of individual cheetahs around CCF and it also helps determine the number of different cheetah represented in the samples. The samples are mostly collected with the aid of the scat-detecting dogs!

 

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Tiger with his caregivers and Dr. Strubel.

So far “Tiger” is acclimating well to his new elbow orthotic (Brace). The most recent progress report from his caregivers, William and Stephanie, is that he is adjusting to using the orthotic well, putting more weight on that leg again, and having less pain and lameness after he’s been in his brace. Our goal is to hopefully get him back out in the field doing what he loves most- sniffing for and finding wild Cheetah scat, and just being a sweet and goofy dog (playing fetch with his favorite object, lemons) without pain!!

 

To read more about why dogs are trained to find wild Cheetah Scat (fecal matter) click here: https://cheetah.org/blog/news-scat-dog-program/

 

You can get involved and help support the work of CCF here:
https://cheetah.org/you-can-help/

 

Overall, visiting southern Africa was simply AMAZING and helping Cheetah conservation in action by sharing my rehab skills in helping “Tiger” with his custom orthotic was equally exciting.

Thanks for the update, Dr. Strubel!

 

September 2017 OrthoPets Case Study for the Canine Rehabilitation Institute: Pirate

unnamed.jpgPirate, a Landrace cross pig, was rescued by a sanctuary in Canada. He had suffered either an unknown trauma or birth defect resulting in his tarsus being fused in a flexed position. Landrace pigs can grow to an estimated weight of 450-600 pounds for sows and 500-700 pounds for males. Pirate began his journey with us when he was 4 months old and still had a considerable amount of growing to do.

There are considerations in pursuing V-OP (veterinary orthotic and prosthetic devices) for patients who are not yet fully grown. Typically, the younger the patient, the smoother the transition to a device will be. This is due to less compensatory time. Many times, a supportive device can help reduce or prevent compensatory changes prior to them developing. However, the younger you begin a patient, the more likely it is for a patient to outgrow their device increasing the likelihood of multiple devices.

Pirate’s device required special consideration due to his size, age and the environment that he lives in. As he’s grown, his tarsus has also become more flexed. He received an accommodative tarsal orthosis that was designed to cradle his tarsus, metatarsals and hoof. The device utilizes a “runner” for him to easily maneuver whether on grass or while wallowing. His device was also designed to accommodate some circumferential growth and featured extra foam liners that can be removed as he grows. Pirate took to the device right away.

Now on his third device due to growth, Pirate continues to do well. The sanctuary plans to continue use of the orthosis for the rest of his life. He has regained his quality of life and is able to spend his days wallowing with the other pigs on the sanctuary.

August 2017 OrthoPets Case Study for the Canine Rehabilitation Institute

OrthoPets Case Study: Kaia 

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Fitting Kaia’s prosthetic.

Any prosthetic case can be tricky to work with. There are many factors in play that can determine the failure or success of a prosthesis. To determine some of these factors and get a more objective assessment of this novel treatment option for dogs we have been working closely with Dr. Felix Duerr from Colorado State University (CSU). CSU is conducting a prospective study evaluating prosthetic devices for dogs with lower limb pathology. More information about the study can be found here – there are still a few spots for enrollment that may benefit your patient!

Choosing to avoid a full limb amputation and pursuing a partial limb amputation requires life-long dedication from the owner and the need for a team of dedicated individuals (frequently including a surgeon, veterinarian, and rehabilitation specialist). We at OrthoPets are happy to aid with the fabrication of the device as well as supporting the animal health professionals, the pet, and the client for the life of the patient.

The main challenges we face in veterinary prosthetic patients is device suspension, device rotation and of course the possibility of pressure sores or friction. Compared to people, we cannot use suction devices/techniques to aid with the suspension in our furry patients. Therefore, we require a minimum limb length that facilitates suspension of the device and avoids rotational problem. In our experience, the required length in order for us to fabricate a functional prosthesis for a patient is approximately mid-way of the radius/tibia. This is a general guideline, however, success depends on many individual patient factors particularly the anatomy and presence of bony prominences.

Limb shortening due to osseous defects/discrepancy can be addressed with the use of a procedure called Distraction Osteogenesis. This process involves cutting of the bone and slowly separating the two bone ends allowing the gap to fill in and essentially lengthen the bone. This procedure is used in canine patients for the treatment of angular limb deformities with limb length discrepancy, however, it has not been reported in the veterinary literature to facilitate the attachment of a prosthetic device. One of our Partner Clinics, Port City Veterinary Referral, in New England, had been working with a young pit bull named Kaia that unfortunately did not meet the minimum limb length requirements for the prosthesis. Luckily, Kaia’s owner is a veterinarian and was up for any sort of challenge! He worked alongside a surgeon, our Partner Clinic and Martin here at OrthoPets. Together they developed the idea of using Distraction Osteogenesis in the hopes of lengthening her limb enough so that we would be able to suspend a prosthesis for her.

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Pre-procedure radiographs.

Kaia’s surgery was performed in September 2016, and by January 2017 she had 2.5 cm of bone growth based on radiographs. By April 2017 the external fixator was removed, and Kaia had enough limb length for the suspension of a prosthesis. Though there was a slight curvature to the limb and bone healing was not complete, Kaia’s team decided to move forward and get her into the prosthesis. Kaia did wonderfully at her first fitting and is using the limb well. Kaia continues to spend time working on her gait re-education and functional integration of the residuum into a quadruped gait.

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Post-procedure radiographs.

Kaia is a great example of how thinking outside the box by her owner as well as her veterinary and VOP team can help solve problems that seem impossible to solve!

July 2017 OrthoPets Case Study for the Canine Rehabilitation Institute

Dudley is a 2-year old, 64-pound mixed breed dog. Dudley initially presented to his veterinarian December 2016 for a Grade 2 patellar luxation secondary to patella alta on the left pelvic limb. When his patella luxated, he was in immense pain. Surgical correction was performed that same month. The trochlear groove was noted to be normal depth and a trochleoplasty was performed. Dudley did very well post-operatively and was using his limb with no apparent lameness within 3 days following surgery. In January, Dudley presented on emergency with severe pain of his left stifle. Radiographs revealed an avulsion of the left tibial tuberosity, just proximal to the previously placed pins.

Initial radiographs prior to the initial device

A second surgical repair was performed. Dudley was then placed in a lateral splint and remained hospitalized to reduce his post-operative activity. Three days later, Dudley was noted to be acutely painful on his left hind limb again. He had another surgery where it was noted that the tibial tuberosity had fractured vertically through the two previously placed pins. Another repair was performed. Unfortunately, radiographs performed 3 weeks later revealed a failure to the repair. Dudley remained in a splint at the point and his veterinary team reached out to OrthoPets for potential support via orthosis.

After reviewing the case with our surgical and sports medicine team at Colorado State University, it was determined that even though this was a complicated situation no matter what approach was taken and no guarantees could be made, this may have been the best chance to return comfort and mobility to Dudley.

Essentially, what OrthoPets was able to offer was similar to an orthotic design used to support post-operative patellar tendon avulsion cases. The stifle, tarsus and paw are incorporated in the device and “locked out” or non-articulating at first. As healing progresses, range of motion is slowly returned. These device configurations are very complex and require a lot of commitment from not only the clients, but also the veterinary team.

In February 2017, OrthoPets received Dudley’s case including fiberglass impression, measurements and radiographs. Due to Dudley’s multiple injuries and therapeutic goals, a special hinge called a “Camber Axis Hinge” was determined best for his device as they allow for variable ranges of flexion and/or extension to be given. The hinges were metal adding additional frontal and transverse control as well. Also, given that the entire device would be non-articulating at first, and the weight of all the componentry required, suspension would be a challenge so the device was fabricated with a neoprene suspension sleeve to increase purchase of the device to limb.

Initial Device

The owners and veterinary team continued to implement rehabilitation in Dudley’s treatment plan. By the end of March 2017, Dudley had full range of motion of this stifle and tarsus. By April 2017, no instabilities were present. Since Dudley had progressed so well, the additional componentry such as the special hinges, paw segment and tarsal cuff were not necessary. Dudley’s owners and veterinary team decided that it would be best to continue to provide support to his stifle and had a standard stifle orthosis fabricated to use as a “sports brace.”

 

Recheck radiograph prior to sports brace conversion.

Sterling

Sterling

When our 10 year old Siberian Husky, Sterling, started limping on her hind leg, we were devastated and saddened knowing she was in terrible pain. After spending $1,000 on veterinary bills while trying to get answers, we reached out to OrthoPets to see if they could help. Sterling was diagnosed with a CCL injury at her stifle joint.

Due to Sterling’s age and the expense associated with surgery, we decided to pursue bracing to help support her leg and allow her to walk & run in comfort again. Within a week after casting Sterling’s leg for a new custom brace, it arrived with detailed installation, break-in, and maintenance instructions.

After installing her custom OrthoPets brace, we could immediately tell that Sterling’s hind leg was being supported properly. It fits her PERFECTLY and doesn’t slide out of place. Sterling is now able to walk, run, and navigate stairs like she could before her CCL injury and understands that the brace is helping her to do so.

Thank you so much for your compassion and for getting Sterling back on her feet so she can enjoy her retirement years with her family & friends!

Jason, Kelly, and Sterling
Minneapolis, MN USA

June 2017 OrthoPets Case Study for the Canine Rehabilitation Institute

Shine’s owner found him injured after being bit by a dog. This injury left him with irreversible damage from his pastern to his hoof. Colorado State University performed a rare hind limb amputation at the level of the pastern. They then placed him in a specialized cast that would allow him to bear weight, but not directly put weight on the amputation site while his prosthesis was being fabricated. OrthoPets owner/founder Martin Kaufmann was present at CSU during the amputation to create the fiberglass impression immediately post-operatively.

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Large animal prosthetic patients have special considerations due to their size. The skin can be friable when using a prosthesis due to the pressure from the weight of the patient. Large animal patients also require a 24-hour wearing schedule since they are often turned out to pasture. Due to the continuous wearing schedule and the outdoor living conditions, the prostheses utilize a removable foam liner that can be replaced as needed without returning the device to OrthoPets. The prosthesis allows the patient to return to their normal life style. At the initial fitting, Shine took to the prosthesis quickly.

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Shine has now returned to his normal lifestyle. The prosthesis has allowed Shine to keep up with his family whether out in the pasture, trotting, or even galloping. The prosthesis was fabricated with his lifestyle in mind. It has special modifications to manage the constant exposure of being outdoors. The prosthesis will last his lifetime as the removable foam liners can be replaced as needed. Shine has overcome the odds and will live out the rest of his life happy and healthy. The fun video here tells Shine’s story.

 

May 2017 OrthoPets Case Study for the Canine Rehabilitation Institute

We love when we are given a challenge to solve an unusual problem and always get excited when we are approached to work with a less common species! In this case it was a Pekin Duck named “Dutchess.” We were approached by her owner to discuss the possibility of fabricating a prosthesis for one of her limbs as she was missing her foot as well as a portion above it.

 

In June 2015, Dutchess was found at the town’s Aquatic Park with other wild ducks. A Good Samaritan brought her to the veterinary hospital that the current owner worked at after noticing she had fishing line wrapped around one of her legs. After further evaluation, it was determined the affected portion of the limb was not viable. A partial limb amputation was performed to save as much limb as possible.

 

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Left: Dutchess’s x-ray. Center: Dutchess on Day 1. Right: Dutchess’s prosthesis.

 

The next morning, they found her standing in her kennel hissing at the staff. At that point, her current owner decided that she would be able to have a better recovery at home as she had a few other ducks that could help motivate her. After several months of bandage changes and restriction, she was able to go out in the pen with the other ducks. In addition, all of the handling during the healing process helped tame her. Dutchess was doing well but her owners now noticed that she was starting to struggle with some normal activities such as grooming and getting around in the winter. Her owner sought out OrthoPets hoping to improve her mobility enough that she could spend some time in the water and have enough balance to groom properly.

When we started the process, there were a few challenges we needed to overcome. The owner had tried to make an impression of the limb, but Dutchess did not want any part in that process. Since sedation was too risky for Dutchess, we used calibrated radiographs and circumferential measurements of her limb in lieu of a fiberglass impression. Our computer modification system allowed us to create a 3D model of the shape of her residual limb. The next challenge was a device she could use in the water that replicated a flipper. When her foot moved forward we wanted little to no resistance against the water and when she pushed her foot back we wanted the device to somewhat open so that water could be scooped and she could propel forward. This concept was achieved by making what is called a “shroud” out of a flexible piece of plastic that is set up to flap open and closed along a bolt. The inside of the device is fabricated similarly to a standard prosthesis to ensure comfort when walking.

 

Dutchess and her owners were so happy to have her prosthesis and try it on for the first time. Though Dutchess is going to take some time to adjust to it, the owners are very dedicated to her rehabilitation and have been working with her at home. Dutchess has been seen shaking her feathers while in her device which lets the owners know she is happy with it and they feel with some time she will figure it out and greatly improve her mobility. You can see more of Dutchess’s progress in videos on our Vimeo video channel.