pelvic limb amputation and outrigger wheel prosthesis in a … · 2019. 4. 10. · surgery of...

Pelvic Limb Amputation and Outrigger Wheel Prosthesis in a Sulcata Tortoise (Geochelone sulcata)

Background Case Report (Cont’d)

Michelle C. Whitehead, BSc, DVM,1 J. Jill Heatley, DVM, MS, DABVP (Avian, Reptilian & Amphibian), DACZM,1 Bill Bickley, BA, CPO, 2 Jennifer L. Perkins, LVT,1 Sharman M. Hoppes, DVM, DAVBP (Avian)1

1 Department of Veterinary Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical SciencesTexas A&M University, College Station, TX 77843; 2Pet Artificial Limbs & Supports (PALS), Houston, TX 77035

Discussion & Limitations

Aims

Literature Cited

Case Report

Creator: Bill Bickley and team at Pet Artificial Limbs & Supports (PALS)

Goals:• Protect amputated stump from abrasion/pressure sores

Design Specifications:• Prosthesis/cart – polypropylene plastic & medical grade thermofoam• Lightweight carbon strut, aluminum attachment bracket• Radio control airplane landing gear • 3 inch diameter wheel

1 Abu-Seida A, Saeid S. Cutaneous adenocarcinoma in a desert tortoise (Gopherus agassizii). Int J Vet SciMed. 2013;1:48-50.

2 Clabaugh KK, et al.. Undifferentiated sarcoma resolved by forelimb amputation and prosthesis in a radiated tortoise (Geochelone radiata). J Zoo Wildl Med. 2005;36(1):117-120.

3 Gal J, et al.. In situ complex adenocarcinoma on the femoral part of the hindlimb in an Asian leaf turtle (Cyclemys dentata). Acta Vet Hung. 2010;58(4):431-440.

4 Mader DR, Bennett RA. Surgery: Soft Tissue, Orthopedics and Fracture Repair. In: Reptile Medicine and Surgery 2nd edition. Saunders Elsevier, 2006;609-610.

5 Martin JC, Solano M, Mayer J. Successful use of physical therapy in resolving a chronic lameness in a large radiated tortoise (Geochelonia radiata). In: ARAV Proceedings. 2005;25-26.

6 McArthur S, Hernandez-Divers S. Surgery. In: McArthur S, Wilkinson R, Meyer J, editors. Medicine and Surgery of Tortoises and Turtles. Oxford: Blackwell Publishing, 2004; 403-464.

7 Ueda K, et al.. Intervention to improve the quality of life of a bottlenose dolphin that developed necrosis on the tail flukes. J Phys Ther Sci. 2013;25(9):1201-1207.

Signalment: 3-yr-old, 5 kg, female African sulcata tortoise Presenting complaint: chronic progressive osteomyelitis, left pelvic pes History:

• 1 month laceration, distal left pelvic limb• Traumatic, open etiology (long marginal scutes)• Rx: iodine baths, enrofloxacin PO, ceftazidime IM• Husbandry: indoor kiddy pool, UV and heat lamp• Diet: Mazuri tortoise pellets, lettuces, dandelion greens, raspberries

Physical examination findings:• Distal left pelvic limb – grossly deformed, malodorous, blackened, swollen

stifle, pes unresponsive to nociceptive stimuli• Carapacial pyramiding, soft plastron

Clinical pathology: active heterophilic inflammation Computed tomography:

• Left pes – severe SQ emphysema, bony lysis• Left tibia/fibula – complete minimally displaced fractures

DIAGNOSIS: Necrotic left pes with secondary tibial/fibular fractures Surgical intervention: amputation via disarticulation at L stifle, distal to femur

First reported outrigger wheel prosthesis successfully fitted for long term use in a tortoise

Design Intentions:• Single plastic base conformed to plastron to be donned/doffed, secured

with two fastening across-the-heart straps over the carapace• Cushion plastron interface, allowing form-fit and mild growth• Attaching the wheel at end of semi-flexible strut allowed the carbon to

mildly flex/deflect under tortoise's weight as a shock absorber

Limitations• Escape from device, uncommon• Surface wear/tear and other damages• Slippery surface vs. rugged terrain• Challenging – amount of strut flexion

to simulate natural locomotion• Continued growth of animal

• Continued modifications necessary

Conclusions• Novel outrigger wheel prosthesis in tortoise = SUCCESS!• Emerging adjunctive therapy in veterinary medicine 7• Requires innovation, modification, and application

1. Improve function & quality of life, post-amputation2. Novel outrigger wheel prosthetic device

Indications for tortoise limb amputation 4,6• Irreparable limb/joint damage or chronic pain

• Trauma• Necrotizing infectious/inflammatory• Congenital, developmental, nutritional• Neoplasia (undifferentiated sarcoma, squamous cell carcinoma,

cutaneous adenocarcinoma) 1-3 Tortoise prostheses

• Lego wheel, sectioned billiard ball, wooden block, coaster 4,6• Temporary wheelchair to facilitate physiotherapy 5• Polymethylmethacrylate via sectioned tennis ball mold, cortical screws 2

Media attention: Prostheses in variety of animals• Ex: Dogs/cats (limbs, carts), dolphin (tail fluke), eagle/toucan/macaw (beak)

Figure 1: African sulcata tortoise left pelvic limb upon presentation demonstrating gross deformation, black discoloration, and stifle swelling.Figure 2: Saggital CT view of left pelvic limb of African sulcata tortoise revealing SQ emphysema, pes bony lysis, diaphyseal tibia/fibular fractures. Figure 3: African sulcata tortoise post-operative left pelvic amputation at stifle with horizontal mattress everting sutures along lateral thigh.

Figure 4: Anesthetized African sulcata tortoise receiving whole body casting to create a mold of carapace and plastron for development of a customized prosthesis.

Prosthesis: Novel Outrigger Wheel Device

Histopathology: skin, soft tissue, bone - severe, chronic, diffuse inflammation; healthy margins

Bacteriology: Enterobacter spp., Enterococcus spp.,Micrococcus spp., Bacteroides thetaiotaomicron, Clostridium innocuum – Susceptibility supports:• Doxycycline 10 mg/kg PO q24h x 14d• Metronidazole 20 mg/kg PO q24h x 14d

Mycoplasma PCR: Negative Post-operative medical management:

• Meloxicam 0.2 mg/kg PO q24h x 10d• Silver Sulfadiazine cream topically q24h x 14d• Initial prosthesis fitting: 10d post-operative• Incision sutures removed 30d post-operative

PATIENT UPDATE: 10 months post-prosthesis fitting• Uses the prosthetic device daily• Indoors and outdoors• Escapes device!• No pressure sores on amputated limb• No erosions on plastron• Happy mobile tortoise

Michelle C. Whitehead, BSc, DVMTexas A&M Zoological Intern

mcw647@gmail.com

• Protect plastron from erosions• Simulate natural mobility• Donned/doffed as needed

• Indoor and outdoor capabilities• Allow for growth of tortoise• Positively impact quality of life

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