Page 9 - Clinical Connections - Autumn 2023

Unusual goat case
KID GETS NEW LEASE OF LIFE WITH
PROSTHESIS

Melanie Perrier, Senior Lecturer in Equine Soft Tissue Surgery

histle, a five-week-old kid (Nubian Amputation and prosthesis Since Thistle had been walking on three
goat) was first referred to the The owner elected to proceed with legs since birth she presented with severe
T RVC’s Equine Referral Hospital for amputation at the level of the distal muscle atrophy over her right forelimb, and
evaluation of a suspected open fracture metacarpi, which was performed under this needed to be built up progressively. She
of her right front digits. She was born with general anaesthesia. A postoperative wore her prosthetic for a little longer each
what was initially believed to be an angular/ CT was performed to obtain exact day and underwent regular physiotherapy
flexural deformity and was treated with measurements of the size and shape of the exercises once back home. Initially she wore
splints for a few weeks. stump in order to help design and fabricate the prosthesis for a few hours daily to get
However, her condition did not improve a 3D printed prosthetic foot. Professor accustomed to it gently; this was increased
therefore radiographs were taken, and an Richard Bomphrey, of the Structure and progressively over the following weeks.
open fracture of the digits was diagnosed Motion Lab, was consulted during the
by the referring veterinarian. Thistle was whole process and manufactured the
subsequently referred to the RVC for further prosthesis for Thistle.
evaluation and treatment. Thistle recovered well from general
On presentation to the Equine Referral anaesthesia. The surgical site appeared dry
Hospital, Thistle was bright and alert, with following surgery, there was no discharge
all vital parameters within normal limits. and only minimal swelling. She was
She was non weight-bearing lame on her discharged home six days later under the
right forelimb. She presented with a 4cm recommendations of keeping her in a small
transverse wound proximal to the coronary pen or paddock until suture removal after
band. The wound was full thickness a fortnight. During that time, the bandage
and associated with moderate to severe on her right forelimb was changed every Thistle on her prosthesis
instability at the digits level. few days, or whenever it became loose or
soiled, until she came back to the Equine At present she wears the prosthesis
Diagnosis Referral Hospital for suture removal three three to four hours twice daily. While she
A Computed Tomography (CT) scan was weeks later. is apparently very attached to her new foot
taken to further evaluate the fracture and When Thistle returned to the RVC, her and is very reluctant to have it removed,
determine possible treatment options and skin sutures were removed, and the new she gets a bit tender if the prosthesis is left
prognosis. This identified chronic, open, prosthetic limb fitted under light sedation. for longer period of time. The owner will
comminuted, displaced, non-articular, The prosthesis resembles a ski boot with therefore continue to increase the amount
diaphyseal fractures of the phalanges. There Velcro straps. It was 3D printed with PLA of time she wears the prosthesis slowly with
was also complete loss of preservation filament and a threaded bolt was inserted the ultimate goal to keep it during the day
and joint congruency of the distal at the bottom to allow for adjustments in and have it removed at night.
interphalangeal joint, with intra-articular gas height as she grows. Several modifications Our small animal physiotherapy
suggestive of septic arthritis and luxation. were made to the design of the prosthesis nurses (Emily Cowderoy and Holly
Given the CT findings, repair of the over the course of her stay to make it more Smith) designed regular physiotherapy
fracture with internal or external fixation comfortable and, in particular, easier for her exercises to encourage Thistle to use the
was not deemed possible as there was not to lay down. limb and develop her proprioception and
enough bone left at the distal phalanges Thistle's progress postoperatively and her musculature. She has been having careful
level. Other options were discussed with the initial response to the prosthesis have been daily monitoring of the amputated limb to
owner, including euthanasia, amputation at very encouraging. While she initially only check for the formation of any pressure
the level of the radius and amputation at the used the prosthesis for a few steps, after a sores relating to the prosthesis as she
level of the distal metacarpi, with the hope to few days she was mostly weight-bearing on grows.
fit a prosthesis on the distal limb. it and showing a more natural gait. We look forward to seeing Thistle again
in the future as adjustments become
necessary. Like human kids, she might
need new shoes quite regularly!

For equine referrals, please call: 01707
666297
Email:
equinehospital@rvc.ac.uk
Thistle’s stump three weeks following amputation (left) and her fitted prosthesis (above)t
Autumn 2023 9