Jodie

Jodie was a 4 month-old Golden Retriever puppy when she was referred to Anderson Sturgess Veterinary Specialists. She had been hit by a car three weeks previously and sustained a comminuted (meaning there were lots of fragments present) fracture (break) of the left femur (thigh bone). She had had two attempts at surgical repair already, but there had been complications and she had very poor limb use. Most worryingly, by the time she was seen by Andy she had quadriceps contracture -the quadrcieps muscle had fibrosed/'tied-down' to the fracture callus and this resulted in her stifle (or knee) being locked in extension with virtually no ability to flex.

Jodie prior to treatment at Anderson Sturgess 

Jodie's x-rays showed that the fracture was unstable and it was not healing. The instability was the reason why Jodie could not use the leg and this had led to the quadriceps contracture. Jodie had further surgery to revise the fracture. The old fixation (a pin and wire) were removed and the fracture was stabilised with two locking SOP plates. At the same time the quadriceps muscle was released from the fracture callus. At the end of surgery Jodie's stifle could flex to 90-degrees -some way off normal still but a vast improvement.

Pre-revision (left) and post-revision x-rays

Over the next two days however, Jodie continued to have very poor limb use and she would not voluntarily flex her stifle, despite physiotherapy and strong pain relief. At a second surgery nylon loops were placed through Jodie's pelvis and through her calcaneus (one of the bones of the hock). These loops were tied together to keep Jodie's stifle flexed. By using this flexion device the quadriceps muscle could slowly stretch over time and stifle flexion could be improved.

The flexion device in place

The device only needed to be used for 3-4 days and it was very well tolerated by Jodie. After a few days Jodie would start to use the leg more normally when the leg was released. Physiotherapy including massage, range-of-motion exercises, neuromuscular electrical stimulation and hydrotherapy was employed during this time. Jodie was discharged from Anderson Sturgess Veterinary Specialists 10 days after revision surgery, at which point she was using the leg well the majority of the time.

Jodie at discharge

The physiotherapy was continued by Jodie's dedicated owners at home and Jodie continued to make excellent progress. When examined a month after the revision surgery, Jodie was using the leg fully and had normal range-of-motion in the left stifle.

Historically quadriceps contracture has had a very poor prognosis for the return of limb function, with amputation or stifle arthrodesis (fusion) usually being required. Jodie was fortunately referred at a relatively early stage (prior to irreversible muscle fibrosis). This, along with the aggressive and novel surgical strategy and intensive physiotherapy postoperatively, allowed Jodie to return to full activity. Jodie's novel & successful treatment regime has been published in the Journal of Small Animal Practice:

Moores AP & Sutton A (2009) Management of quadriceps contracture in a dog using a static flexion apparatus and physiotherapy. J Sm Anim Pract 50, 251-254