Nick’s Ankle 

D. E. Larsen, DVM

Sandy was standing behind the counter with her hands on her hips when I returned to the clinic from a morning farm call.

“Skip is on his way here with Ted’s dog,” Sandy said. “They found him in the river, and Skip said he has a broken leg.”

I glanced over my shoulder and saw Skip pulling up to the clinic with a couple of boys in the back of his pickup.

“Looks like I need to wash up,” I said. “You guys can get them settled in an exam room, and I will be right there.”

When I returned to the exam room, Nick, Ted’s old black Lab, was on the table, soaking wet but waging his tail. The boys, both the younger sons of Skip and Ted, were also soaked. They must have been the rescuers.

“Looks like you guys have been swimming,” I said. 

“Nick was way out in the river,” Matt said. “We don’t know how he broke his leg.”

Nick’s leg was a mess. His hock joint was completely disarticulated, with all the tissue on the lateral side of the hock gone. All the lateral soft tissues were gone, including blood vessels. There was river sand in all the tissues. I even flicked a few small rocks out of the wound as I examined it.

“This is pretty bad, Skip,” I said. “Where is Ted?”

“Ted is out of town,” Skip said. “He won’t be home for several days.”

“I don’t know if this is repairable,” I said. “It would be best to have Dr. Slocum in Eugene look at it.”

“I don’t think Nick is going to Eugene for surgery,” Skip said. “What do you think you can do for him?”

“My first impression is this leg needs to come off,” I said. “I don’t know if there will be enough circulation in this foot to heal.”

“I guess you could try to fix it,” Skip said. “You could always take the leg off later. I don’t want to make a decision for Ted that is so final as an amputation if there is a possibility of fixing it.”

“Well, you’re right about the leg,” I said. “We can take it off later if things don’t work. But I want to be clear, repairing this leg is over the head of this clinic. Fusing this hock joint is the only real chance of healing this leg. That is best done with a bone plate. That kind of surgery is available in Eugene, but not here.”

“Doc, you do what you can,” Skip said. “We will give it the old college try. If it doesn’t work, we can deal with that at the time.”

With that said, Skip and his crew patted Nick on his head and left him with me.

“Where do we start with this mess?” Dixie asked.

“We start in the tub,” I said. “We have a lot of sand to wash out of this wound.”

We sedated Nick and sort of pressure-washed the exposed bone and joint. Sand seemed to be everywhere, but with several scrubs of the entire leg, we were at a point where we moved to the surgery room for the final prep.

Once the wound was scrubbed and draped, I started to put things back together. 

The first and probably most challenging task was removing the cartilage from the joint surfaces to get a boney fusion to hold the foot in place.

Once that was done, I positioned the hock in a functional position. I drove a pin from the underside of the hock through the joint and into the tibia. The stability surprised me a bit.

“This looks pretty good,” I said. “It might even work.”

“How are you going to close this wound?” Dixie asked.

“I will do what is called a pedicle skin graft,” I said. “I will take a strip of skin from the upper leg, turn it around and suture it over this wound. By leaving it attached above, hopefully, the skin will survive.”

After closing the wound, I placed the leg in a Thomas Splint.

“I usually don’t use a splint when I use internal fixation, but if Nick were to walk on this leg, he would likely break the pin,” I said. “This way, we can get some boney fusion and remove the pin before he walks on the foot.”

“Do you think it will work?” Dixie asked.

“There is not a book written that would say this will work,” I said. “It is so contaminated, the whole thing might just blow up on us. Couple that with the loss of significant blood flow to the foot, our chances of this working are slim.”

I called Skip to tell him I would keep Nick at the clinic until Ted got home. That way, we could monitor the wound healing and keep Nick on pain medication. I think Skip was relieved that he didn’t have to take care of Nick for a couple of days.

***

To everyone’s surprise, including mine, Nick went on to heal well. The joint fused nicely, and we removed the pin with a brief procedure. The skin graft survived. It added a little character with the hair growing in the wrong direction.

Nick’s leg was never normal, and it looked somewhat fragile. But it served him well for the remainder of his life.

Photo by Mali Maeder on Pexels.