Background

Otis, a 4-year-old neutered male Pitbull, was transferred from MVES to OPVES Surgery on May 13, 2024, after being hit by a car three days prior. Initial radiographs at MVES revealed a closed comminuted fracture of the right proximal femur and a left craniodorsal coxofemoral luxation. Thoracic radiographs showed no evidence of thoracic trauma.

Radiographic Findings

• A right closed comminuted fracture of the proximal femoral diaphysis with a butterfly fragment and a possible non-displaced incomplete fracture of the greater trochanter.

• Left craniodorsal coxofemoral luxation

Surgical Procedure

Dr. David Allen headed Otis’ surgery approach, collaborating with our anesthesiologist, Dr. Charlotte Marquis, and third-year surgery resident, Dr. Bo Barillo. Otis was positioned in left lateral recumbency, and the right pelvic limb was prepared for surgery. After clipping, the area was aseptically prepared and draped. An incision was made from the dorsal and cranial greater trochanter, extending distally to the lateral aspect of the proximal stifle. Subcutaneous dissection and hemostasis were achieved with electrocautery.

The superficial and deep fascia lata were incised to the incision margins, and the vastus lateralis was found traumatically avulsed from the origin of the greater trochanter. Gelpi and Weitlaner retractors provided exposure to the fracture site. Due to the inability to achieve anatomic reduction, the fracture was collapsed to facilitate reduction. A 5/32" Steinmann pin was inserted normograde into the trochanteric fossa and advanced into the distal femoral fragment, reducing the fracture fragments. A 13-hole 3.5mm LCP was contoured and applied to the lateral femur, with three locking screws and one cancellous screw proximally and seven locking screws distally.

The site was lavaged with sterile saline and suctioned, and three packets of consil bone putty were applied to the fracture margins. The butterfly fragment was placed in a large bone defect on the craniolateral aspect of the proximal fragment. The vastus lateralis was reattached to the lateral greater trochanter using 0-PDS in an interrupted cruciate pattern. The deep and superficial leaves of the fascia lata were closed with 0-PDS in simple continuous patterns, with subcutaneous and intradermal apposition using 2-0 and 3-0 monocryl, respectively. Skin glue was applied where necessary.

Post-Operative Care

Otis experienced some complications with his IV catheter, which were resolved by replacing the T port. His red blood cell count was low (20%) pre-surgery, necessitating a blood transfusion, which increased it to 25%.

Daily updates showed improvement in Otis's condition. Initially, he was edematous (abnormally swollen with fluid) and not eating well due to IV fentanyl, which was subsequently discontinued. His condition improved over the next few days, with reduced swelling and better urine output. By the morning of May 15, Otis ate well, and his edema had mildly improved. The plan was to keep him hospitalized for another day and remove his epidural catheter that afternoon.

Conclusion

Otis’s case highlights the complexity and intensity of trauma surgery. Through meticulous surgical technique and comprehensive post-operative care, Otis is on his way to recovery.