Altynay and her 11 year old daughter Nicole, bring in their four and a half month old Staffordshire Bull Terrier puppy Rex with a badly deformed elbow from birth. Noel carries out a complicated procedure to realign the bones in his elbow to get him out of pain and improve his ability to walk. However, it’s a complex task and the road to recovery is long. Altynay and Nicole are faced with being parted from their new family member for longer than they had hoped…


 

Staffie Puppy Rex is Altynay and her daughter Nicole’s first dog. Nicole is an only child and calls Rex her naughty little brother – he causes mischief and trouble and keeps things as far from boring as possible!

At just four months old however, the family noticed that Rex had problems with his right elbow and was having difficulties walking normally. The family vet sent Rex and his scans to Fitzpatrick Referrals and Professor Noel Fitzpatrick to see what options were available to the little dog with so much life still ahead of him.

Before Noel had even met Rex he could see from the imaging that it was a complex growth deformity, known as an antibrachial growth deformity.  When Noel met the family and examined Rex it was even more obvious, Rex was noticeably lame, and most unfortunately this meant he was undoubtedly in pain. Noel explained to Altynay and Nicole that the humerus in his upper forelimb was fine, the ulna in his lower forelimb was ok – but the radius was completely out of the elbow joint and had probably never been in correctly. This was a condition that Rex was born with, and it would inevitably get worse as he grew.

Radiography and CT scan were ordered to get a full understanding of the challenge ahead. Noel discussed in detail the implications if surgery were to be attempted, and the likelihood of further procedures needing to be performed over time depending on the nature of the deformity, the limb length and other potentially progressive issues.  Altynay wanted the team to try and do their best for Rex, even if it meant they would have to be parted from their little puppy for many weeks.

The journey begun – and Noel took Rex to the operating theatre. Noel first exposed the head of the radius and inserted special wires with stoppers on the end into the bone; this required pin-point accuracy as the wires would be used to slowly guide the radius back into place millimetre by millimetre.  Next, Noel cut the radius on a steep slope to allow it to move with the wires back into position. Finally, Noel applied a customised external skeletal fixator which attached to the two wires going into Rex’s radius so that the team could control the movement of the bone by turning a small cube attached to the frame at specified intervals throughout the day and night. After two hours, the complex surgery was complete. Rex’s continued healing would depend on biology being kind and the ligaments stretching enough to allow his radius to move back into place.

Two weeks into his journey, Rex was taken back to x-ray to check that the radius was moving into its correct orientation and, fortunately, the gradual tightening of the frame had done its job and good progress was being made. However, Noel spotted a new problem; moving Rex’s radius into the correct position had caused his carpus (wrist) to turn outwards and further surgery would be required to correct it. Without surgery, the wrist would have continued to deform and cause Rex further pain and difficulty. This had no option but to take Rex back into the operating theatre and Altynay and Nicole would have to go even longer without Rex at home.

Noel took Rex to surgery once more and cut the radius lower down in order to straighten the wrist. Additional framework was added to allow Noel to rotate Rex’s carpus and paw in line with the elbow joint and hold it in position whilst the bones healed. Rex’s leg was now a bionic vision and Noel struggled to see the bones beyond all the metalwork on the x-ray! Noel was optimistic that the little dog would continue to heal and that their hard work and commitment would all be worthwhile.

Three weeks on and Noel was happy with Rex’s bone healing and so his frame could be reduced. Rex was a very boisterous puppy and was starting to use his leg very well, but it was vital to bring out his energy in a productive way. Daily physiotherapy and hydrotherapy began and played a significant role in the success of Rex’s treatment. Rehabilitation would strengthen the ligaments in Rex’s leg and aid mobility as the bone healed and his daily swims were beneficial for getting his endless puppy energy out in a controlled and constructive environment!

Finally, the day came when Noel said Altynay and Nicole could take Rex home to continue his recovery. With strict instructions that exercise had to be carefully managed, the family were finally reunited!

Two months on and the long journey that had spanned over several months resulted in a transformed Rex. He was no longer struggling to walk and it was clear to everyone that the young dog was now fully recovered. No longer in pain, Nicole has her forever companion in Rex and no longer has to worry about his future. We are delighted to have been able to serve this wonderful family!

 

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