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Orthopaedics & Soft Tissue

Find out more about referrals at Lime Trees Vets

Orthopaedic and Soft Tissue Surgery referrals are seen by Horatio Marchis PGCertSAS MRCVS. Horatio is available to support you with no obligation and free advice including X-ray and laboratory results interpretation.

Hip replacements can also be performed at Lime Trees Vets in conjunction with Tom Gilding BVSc BSc CertSAS MRCVS.

We are happy to accept cases for a complete referral, or if preferred, we can work with you. We have many years experience of dealing with routine and complex surgical cases, and are able to offer excellent value for money by today’s referral standards whilst still maintaining excellent levels of care.

We endeavour to deliver an excellent certificate level referral service which is friendly, reliable, local and independent.  As many of you know ‘Vets Now’ Stoke service runs from our hospital in Meir Park.  This means all our cases receive 24 hour Veterinary Care should they require it from an experienced expert team of emergency vets lead by Rafal Boron, who recently completed his certificate in emergency and critical care training.

Examples of orthopaedic and neurological cases seen

  • Cruciate ligament rupture (by TTA, TPLO, and lateral suture techniques)
  • Patella (knee cap) luxation
  • All fracture repairs
  • Arthrodesis
  • Hip dysplasia treatment and prevention
  • Lameness investigation
  • Shoulder and elbow conditons including dysplasia, OCD, muscle, tendon and ligament disease
  • Achilles tendon injury
  • Spinal disease investigation and surgery.
  • Angular limb deformities
  • Joint luxations
  • Total Hip Replacements

Examples of soft tissue conditions treated

  • Chest surgery including pericardial strips, pyothorax management, vascular ring anomalies such as PRAA, PDA, oesophageal foreign body removal (surgical and endoscopic), diaphragmatic herniation and lung lobectomy.
  • Abdominal surgery including urinary incontinence investigation and treatment, gastric dilation and volvulus (GDV) treatment and prevention, pyloric stenosis correction, abdominal tumour treatment, kidney disease, prostate disease, gastrointestinal disease, liver disease
  • Skin and wound reconstruction for traumatic and cancer cases
  • Oral cancer removal and reconstruction
  • Perineal hernia repair
  • Laryngeal paralysis correction via tieback
  • Overlong soft palate correction.
  • Stenotic naral correction
  • Hard and soft palate reconstruction.
  • Entropion/ Ectropion (eyelid abnormality) surgery
  • Dystichiasis correction
  • Ear surgery e.g. TECA/LBO, Lateral wall resections and vertical canal ablations.
  • Screw tail correction
  • Cherry eye correction
  • Anal saculectomy
  • Rectal surgery and neoplasia treatment

Testimonial

"Nice, clean, welcoming and very reasonably priced vets. My dog Kit came here for surgery following breaking her leg in two places & also ligament damage. The people were lovely I had no worries on leaving her in their capable hands. I could call anytime of the day or night to see how she was doing. Would not hesitate to use them again. Many thanks."

Kit's Mum

Case Studies

Tibial diaphyseal fracture in a cat

J, a domestic short hair cat of 2 years of age went missing for a couple of days and came back home in a bad shape. He was referred to our surgical department for a fracture on the right hind leg. He obviously had an encounter with a car some days before.

Due to his nature and due to the trauma suffered it was impossible to examine him on presentation. Some bruising was present around his right eye. The owner told us that he is not the most friendliest of cats even when in perfect health.

He was admitted in the hospital and he was sedated and examined. We confirmed some bruising around the right eye but no fractures were identified and the eye worked fine. Also he had a fracture of the right tibia (shin bone) with a lot of bruising and swelling around.

Radiographs were taken of the chest and abdomen and also of the right tibia. A comminuted fracture was diagnosed and the treatment plan was formulated. A biological healing bridging plate was the treatment of choice due to J nature at the best of times. The other option would have been an external fixator but this although cheaper needs more hands on care and in a cat like J this was considered unwise.

Under general anaesthesia the fracture was repaired and the end result looked as good as expected. J spend another night in the hospital on pain relief and then he was discharged next day for cage rest and pain relief at home. He came back for rechecks. Despite the fracture healing progressing well he continued to be less than friendly towards the people who fixed his leg so it was necessary to sedate him again in order to remove the skin staples.

He came again at 6 weeks and at 10 weeks post fracture repair for radiographs to confirm healing of the bone. At 10 weeks he was discharged from our care with regards to the fracture repair and we hope he will look both ways before crossing the road!

Pre-surgery

Post-surgery

10 weeks post-surgery

Radio ulna fracture in a toy dog

One evening, R, a 1 year old Chihuahua, decided to jump off the couch which proved to be less than ideal. Instantly, after a yelp, she could not put any weight on the front left leg.

The owner went to their own vets who took radiographs and decided that a referral would be the best way to go forward.

We were more than happy to accept the referral. Toy breeds require special attention when dealing with radial fractures due to the increased risk of complications, as opposed to bigger dogs.

R was admitted and under general anaesthetic, the fracture was reduced and a 2.0 T plate was used to stabilise and compress the fracture. Post operative radiographs showed a good reduction and alignment with one longish screw proximally.

R made a quick recovery and she went home the same evening.

5 weeks after surgery radiography revealed good healing and R was discharged.

Before surgery

After surgery

Short Ulna Syndrome

F, a female entire Springer Spaniel, 6-month-old, started to limp on walks on her left front leg. This improved with pain relief but she was not 100% and given the young age she was referred for examination and work up.

On clinical examination, there was lameness on the front left leg but only mild. Despite this the limb was standing at an abnormal angle with a carpal valgus. The deformity was obvious although not severe. There was pain on elbow examination.

Sedation and radiographs revealed elbow incongruence and a premature closure of the ulnar growth plate on the left side. Also, the ulna was showing sclerosis. The radius started to bow and twist.

F was diagnosed with short ulna syndrome and we decided to perform a CT on both front limbs in order to assess the degree of deformity and to decide the corrective action needed.

The CT confirmed the elbow incongruence on the left leg and also the mild angular limb deformity.

After discussion with colleagues specialised in dealing with angular limb deformities the decision was taken with the owner got perform a long oblique bi-planar ulna osteotomy for a start given the growing potential left in F’s case. The above osteotomy is considered the best option given the recent studies and replaces other techniques used in the past which carried a high rate of complication but is a bit more technically demanding although is not a challenging surgery.

Under general anaesthetic the ulna was cut according to the measurements done before with a long was blade.

Post operative radiographies showed a well placed and well-executed osteotomy and the resolution of the elbow incongruence immediately post operatively.

F was rested for 6 weeks and radiographies were taken which showed good progression of healing. At 12 weeks the progression of healing was considered sufficient and F was discharged. No lameness was noticeable at 12 weeks post operatively.

The radial deformity was considered at this point to be of no clinical significance.

Congenital Peritoneopericardial Hernia (PPDH)

PPDH is a common congenital anomaly in dogs and cats. It is an abnormal development of the transverse septum resulting in a gap in the ventral diaphragm, through which the abdominal contents can advance into the pericardial. This tends to be present at birth.

Z, a 3 year old schnauzer, was seen over the years for on and off digestive signs (vomiting, not eating). He was diagnosed in the past with a PPDH, but due to the lack of clinical signs associated with this at the time, it was considered that there is no need to intervene surgically. Lately, the digestive clinical signs were happening more often and the length of time for the dog to recover was longer. He was passed onto our medicine department and our colleagues, after multiple tests and imaging performed on Z, decided that the most likely cause for the recurrent digestive signs was the PPDH. The owner was aware that the small intestine of Z was not in the abdomen but in the pericardium, which is a sheet of tissue around the heart. This can lead to obstruction and other serious life-threatening complications in some cases.

The owner of Z became worried at the prospect of big surgery. The case was taken over by the surgical team and the procedure was explained in detail. The plan was to anaesthetise Z and enter the abdomen through the midline. Once in the abdomen the hernia would be assessed and the abdominal organs would be replaced into their proper place and the hernia would be closed. Most of these surgeries are straight forward but intra-surgical complications can occur due to adherences in between the heart and the abdominal organs, or, in-between the abdominal organs and the diaphragm. After the discussion with the surgery team, the owner of Z decided to go ahead with the surgery. 

Z had an uneventful general anaesthetic and the surgery went according to plan. He had a small hernia through which intestines and the omentum advanced into the pericardium and were now next to the heart. The intestines and the fat were retrieved with minimal resistance and the herniation in the diaphragm was closed. The air was drained from the pericardium and the abdomen was closed. 

Z made a fast recovery without any complications and was discharged after a night in the hospital. 

No more gastrointestinal signs were noted after the surgery and Z is a happy dog with an even happier owner.

Blue arrows pointing at intestines in the pericardium around the heart.

Patella luxation

Patella luxation is a condition that causes the knee cap to pop out from its groove on the femur. It is a common condition and its seen more readily in small dogs where the knee cap tends to luxate medially. In large dogs the knee cap tends to luxate laterally. This condition is related to the alignment of the bones and muscles in the hind limb.

W, a Shih Tzu dog 3 years of age came for a consult at the surgical department. He never walked to well on his hind limbs and his hips were far from good but lately he started to feel very sore on his hind limbs and he was unable to do much. After a detailed orthopaedic examination we had to agree with the owner that indeed he was not too comfortable, his hips were not great and he also had a bilateral patellar problem, the only issue was that W liked to stand out of the crowd and his knee caps were luxating laterally and not medially.

We immediately decided on a plan. X-rays were taken of the hips and stifles. The hip dysplasia was confirmed and classed as moderate to severe, the stifles looked like having degenerative joint disease on top of the patella luxation. We decided to repair the patella luxations in a staged fashion and the leg causing more grief was done first. The groove on the femur was depend and the tibial crest was transposed so that the knee cap will stay in. We also tightened the joint capsule and released a bit the muscle.

After his patella lunation surgeries W still walks with an abnormal gait but he is in no discomfort. As such we decided to continue with the conservative treatment for the hips at this point.

Oesophageal Lesion (images of surgery)

***Images of Surgery***

B, a 1 year 6 month boxer decided that is a good idea to play with his friends using a bamboo stick. I presume you know where this is going.

Soon after the play B developed a cough and refused to eat. He was seen out of hours and he was diagnosed with pyrexia and lethargy to a point where he refused to walk. The test over the weekend raised questions of a foreign body in the stomach.

The dog was referred to the medicine department and an endoscopy revealed a bamboo stick about 20 cm long stuck on the dorsal side of the oesophagus. The stick was removed and a fistula was apparent from the oesophageal wall in to the ventral cervical musculature.

A gastric feeding tube was placed endoscopically at this point to assist with the feeding requirements.

The dog was passed on to the surgical department and a ventral neck approach to the oesophagus was performed. Due to the tear being dorsal in the oesophagus more direction than usual was necessary to find the tract and the lesion. Once identified the margins of the tear were  freshened and the oesophagus was closed in 2 layers. The tract was opened, and flushed and the surgical site was closed in a routine fashion.

B made a good recovery and 48 hours after the procedure he started eating with enthusiasm and return to be his old self.

Lateral Condylar Fracture in 5 Month Old Puppy

B went out for a run and decided to chase a pheasant over the field. Suddenly he yelped and came back towards the owner without being able to bear weight on his front left leg. The owner decided, rightly so, to seek veterinary advice. On presentation B was unwilling to stand and he needed intravenous pain killers and intravenous fluids to stabilise him. After he felt better we performed a sedation and we examined the leg. The elbow region on the left leg felt unstable and when flexed and extended made a crunching sound.

2 radiographs of the left elbow were taken and they revealed a lateral humeral condylar fracture. 

Since B was considered to be stable enough we decided to repair the fracture at that point. The owner was happy with the plan and we went to work. Due to B’s young age we decided to fix the fracture using an intra-condylar screw and an anti-rotational pin.

The repair was straight forward since the fracture was very recent.

B did well post surgery and had only one set back at 1 week after when he decided against our advice to chase a ball. At 4 weeks we have seen B back for a sedation and post-operative X-rays.

B was walking well on the leg.

On the radiographs healing was evident and we discharged B warning the owner that if there are any problems we might have to remove the screw and pin.

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