George and Susan travel to Fitzpatrick Referrals all the way from Scotland with their lovable and adored ten-year-old Labradoodle, Fletcher. Previous surgery to fix a bad ankle fracture, sustained in an accident, has failed. Amputation isn’t a good option for Fletcher and the family have already considered euthanasia before making the trip to Surrey. Professor Noel Fitzpatrick discusses the options for revision surgery for the chronically injured ankle, and the family choose a custom-made plate for complete fusion. Sadly, Fletcher is overweight and has a pre-existing heart condition, so intervention carries added risk, but his family want to give him the best chance for a pain-free life.

Their Story

Fletcher lives with George and Susan in Scotland. The couple have fostered a number of children over the years and Fletcher’s friendly and loveable nature has been an important part of their lives.

The Problem

A year prior to his visit to Fitzpatrick Referrals, Fletcher had a serious accident whilst playing in a river – fracturing his right hind ankle. He had emergency surgery to repair the ankle in Scotland but it was unsuccessful. Fletcher was also overweight and suffered from a heart condition – severely limiting his quality of life. As a last hope, George and Susan turned to Professor Noel Fitzpatrick and they travelled all the way from Scotland to seek his advice.

After examining Fletcher, Noel determined that during previous surgery, the calcaneus bone had attempted to be fixed but the fracture had not healed properly. The standard metal plate that was inserted to stabilise the fracture had become loose – stretching the tendons in his ankle and causing his toes to contract when the ankle collapses. A CT scan showed that all of the screws positioning the plate had broken and the fracture had pulled apart.


Noel suggested a full ankle fusion with a custom-made plate – to ensure same incident wouldn’t repeat itself. He advised Susan and George that the couple would need to make an ethical decision. As Fletcher was over 10 years old and already suffered from health problems, they would need to decide if the surgery was a fair option for him. They simply wished for Fletcher to live the fullest life that he could and decided to go ahead with the surgery. They returned to Scotland whilst the custom-made plate was designed and produced – returning to Fitzpatrick Referrals for Fletcher’s surgery day.
With the plate ready, the couple returned to Surrey for Fletcher’s operation. Noel suggested that if he placed a keel on the plate, it would make the positioning significantly stronger. By digging a notch into the bone recess and placing the keel into it, it would form a robust structure. He also planned to coat the plate in hydroxyapatite – a bone-on-growth mineral that would allow new bone to grow around the implant.

Noel began the operation by cutting into Fletcher’s ankle bone. He used a template to guide the plate in and cut a slot into it to place the keel in with additional screws to make it extra-strong. As it would require making another incision, Noel decided to leave the old plate in Fletcher’s ankle – much like a lodged bullet. This would prove very safe and meant that he could avoid making any further incisions into his ankle.

The operation was a success and Fletcher was sent straight for scans to ensure that the plate was in place and his heart was fine under the anaesthetic. Noel kept a watchful eye on him over the next few days – he made a promising recovery. Four days later, George and Susan returned to take Fletcher home to Scotland. They were relieved that he came through the anaesthetic with his heart condition and couldn’t wait to get him back home and on the road to recovery.

12 weeks after the operation, the couple returned to Surrey for a final checkup with Noel. He conducted an x-ray to ensure the plate was doing its job and the bone was healing properly. The news was positive – both the ankle had healed and new bone was growing around it. Due to the custom-made plate being so robust, there was a slim chance of the bone ever breaking again.

He’s the baby I didn’t have. I had fertility treatment, couldn’t have children and just shortly afterwards that’s when we got Fletcher. So for me, he is the baby.


Back in Scotland, Fletcher’s fused ankle had fully healed. George and Susan were over-the-moon to see him walking properly again. He was free to live his golden years pain-free.

Sadly, a year after his operation, Fletcher passed away in the arms of his loving parents. Noel and the team at Fitzpatrick Referrals were deeply saddened to hear the news of his passing. George and Susan were brave to share their journey and their efforts to provide the best quality of life for a cherished member of their family. Fletcher not only provided unconditional love to George and Susan but to the extended family, they welcomed into their home over the years.