broken pelvis / complex pelvic fracture surgery
Post Surgical Care of Complex Pelvic Fracture Surgery
Home patient care after orthopedic surgery is critical to the success of the surgery. Allowing your pet too much activity may alter the anticipated outcome of the surgery. The following instructions will be your guide to home care. Your surgeon has determined that due to the extent of the injuries to your pet’s pelvis and the stability and strength of the repair procedure that your pet’s best chance for a full recovery requires absolute strict confinement for at least four weeks. People with similar injuries are often confined to a bed for many months and not allowed to move even to go to the restroom.
Please change hobbles every 3-5 days or sooner if needed. When hobbles are off, please proceed with the steps below to stimulate blood circulation and keep good range of motion with hind limbs. After completing steps below, please place a new set of hobbles on to maintain pelvic stability.
KEEP HOBBLES ON FOR 1 MONTH UNTIL RECHECK.
Ice and Heat Packs
Pelvis should be iced 2-4 times daily to reduce swelling. Once the swelling subsides, switch to heat pack. Lay your dog on his/her stomach with the incisions up. Place a lightweight towel between the limb and the ice/heat pack. Ice/heat should be applied for 15-20 minutes.
Gentle massage will increase circulation. Lay your dog comfortably on his/her side. Begin with light strokes starting at the distal end of the limb. Stroke the limb gently in an upward, circular motion. Work your way up the entire limb. Switch sides and massage the opposite limb.
Passive Range of Motion (PROM) following massage is beneficial. PROM promotes healing, helps with recovery of soft tissue mobility, neuromuscular re-education and synovial movement. Gently grasp your dog’s paw and move the hind limb in flowing, circular, forward to backward movements. Be sure to include a few stretches during the PROM exercises. Repeat for 10-15 repetitions 2-3 times daily on both hind limbs. These exercises may be done lying or standing.
Because at this time, your dog is uncoordinated, he or she could easily get hurt if allowed to roam free in the house especially around steps or stairs. We recommend you keep your dog confined or under your direct supervision. Soft, dry bedding, at least 1 inch in thickness, must be supplied to prevent pressure sores from developing.
At 1 month from surgery we would like to reevaluate and check bone healing on x-ray. Until that time no running, playing, stairs or unsupervised activity. Regardless of what your dog says!
General Exercise and Activity Restrictions:
Your dog should be confined for a minimum of 4 weeks following the surgery.
Few Activities are allowed during this time:
- The patient is to be left in a traveling kennel or exercise pen or small room/bathroom at all times when not under your direct supervision. Never put the patient in an outside run, patio or free in backyard. Failure to follow these very strict guidelines can result in premature implant failure. Humans are usually in bed for one month after these types of surgeries and then a wheelchair.
- The patient is under the direct supervision of the owner on a short, tight leash while outside for sunning or elimination’s and their weight supported with a towel or leash under belly in front of their rear legs. Carry your pet in and out of the house!
Activities That Are Not Permitted:
- No Free Activity (playing, jumping, running or long strenuous walks)
- No Stairs
- No outdoor pet runs or “Doggie Doors”
- No slippery floors (tile, linoleum or wood)
- No general confinements (garage, patio, bathroom, porch, laundry room, bedroom or kitchen) without a kennel
If you cannot control your dog or you cannot take care of your pet postoperatively it may be better to board your dog with your veterinarian for the first 3 weeks after surgery.
Other Post Operative Instructions
- Sutures or Staples are removed in ten days. Use all medications as directed.
- Licking at the incision should be discouraged because it may lead to chewing at the sutures or staples causing a wound infection. It may be necessary to bandage the leg or use an Elizabethan collar to prevent licking.
- Bandages and splints should always be kept dry and clean. Any odors and/or persistent licking are indicators that there may be a potential problem and should be checked by your veterinarian immediately. Bandages and splints should be checked weekly by your veterinarian or veterinary technician.
- Feed your dog its regular diet but reduce it by 10% to allow for reduced activity.
- Mild swelling may occur near the incision or low on limbs. Your veterinarian should check moderate or severe swelling immediately.
- Progress radiographs are usually taken between 6-7 weeks after surgery. Sometimes we recommend radiographs at 3-4 weeks after surgery to be sure the fracture is healing properly and no implants are loosening or migrating.
Resuming full activity and exercise will be determined in most cases by the radiographs taken at 4-6 weeks after the surgery. Unless instructed otherwise, follow your dog’s individual rehabilitation program. Recheck immediately if your dog suddenly starts using their legs less than before.
Orthopedic patients heal in about 2-4 months for most bone surgeries and slightly longer for soft tissue problems such as ligaments and tendons. Most patients will return to controlled activity in 2 months and full activity in 34 months. Most athletic dogs will return to full function in 6 months.
As with any surgical procedure, complications can occur. Unlike human patients who can use a sling or crutches, our patients do not know enough to stay off a healing broken bone so restricted activity is a major responsibility of you, the pet owner. Failure to follow these instructions carefully can lead to delayed healing, broken implants, loose implants, or even re-fracture of the bone which leads to costly second surgeries.
The most common complication is delayed healing, where, despite our best efforts to reduce and stabilize the fracture, individual patients respond slower than others.
In other cases, the bone may refuse to heal and require additional procedures like bone grafting. Infections are quite uncommon in veterinary orthopedic surgery, but when they do occur they can markedly affect the ability of the bone to heal. Nerve damage can occur but it is usually temporary. Sacral fractures have a higher chance for permanent damage to the tail, rectum and bladder.
The healing of a fracture is a race between the implants failing, as all metal does, and the bone healing. Thankfully, the bone healing wins this race in almost all the cases we encounter with cooperative owners. If you have any questions, please feel free to ask your veterinarian.
Follow Up Instructions:
Please monitor your pet’s ability to urinate over the next 1-2 days. Rarely, patients that had an epidural will have transient urinary retention, straining to urinate but no stream is observed. This can lead to a ruptured bladder after several days and kidney failure if you do not seek immediate treatment.
Re-check every 2 weeks after suture removal to evaluate progress
Feed your dog its regular diet but reduce it by 10% to allow for reduced activity.
Any swelling or redness near the incision should be checked immediately. Please use an Elizabethan Collar on your pet after bandage removal to prevent licking of the incision as this is the number one cause of infections in dogs.
- Tegaderm clear bandage can be left on until it falls off or at suture removal.
- Start Keflex Clindamycin Baytril Ciprofloxin tonight and give for 14 days
- Start Rimadyl Metacam Previcox pain medication tonight and give for 14 days (refill if limp worsens after running out for as long as it is helping)
- Start Tramadol pain medication tonight and give for 3-5 days (refill if limp worsens after running out for as long as it is helping)
- Start Dasuquin, Cosequin, or Glycoflex (joint supplement) ASAP and use for 3 months to minimize osteoarthritis during healing.
- Start essential fatty acid supplement, ie. Derm Caps to reduce joint inflammation ASAP for same amount of time as joint supplement
Weight loss is very important for healing as overweight dogs place extra stress on the implants. Your pet’s bone structure only allows a certain sized screw/pin to be safely placed but the extra weight can cause premature failure. Measure your dog’s food at feeding. Weigh your dog weekly (stand on scale with and without your pet and subtract to determine weight) and continue to reduce the amount you feed until your pet is losing 5-10% of their total weight every week!
Call us if:
- Your dog is not bearing weight on both legs after two weeks
- stops improving week to week
- abruptly stops walking or stops using either leg at any time