Bleeding edge medicine Part 1: Untwisting the truly twisted

Patty Khuly, DVM
November 18, 2006
Share this:

I’m working on this series as part of a concerted effort to put a positive spin on all things veterinary (the last few posts have been decidedly depressing). I hereby promise to forgo the use of the e-word (you know the one) for the next few entries. This post is a rehashing of one I submitted months ago. I hope none of you get bored if you recognize the cast of characters. Regardless, it’s a great story I never get tired of telling.

Rudy came to see me the same day his new mom adopted him from one of our areas nicer private shelters. A gorgeous, if skinny and head-shy Lab mix, Rudy looked every bit as robust as the high gloss of his black coat implied. Once in action, however, it was clear that Rudy was not quite the complete picture of health. His forelimbs splayed out when he walked; if one pointed east, the other faced way west.

While he limped a bit and his body sloped groundwards (as in a famous yoga pose), Rudy’s youth made up for the obvious genetic discrepancy — he appeared not to suffer one bit. He bounded and scrambled around like the happy dog he clearly was. And who wouldn’t be? He’d just won the lucky dog lottery and managed to get unsprung from jail in one day.

After evaluating the precise angles of Rudy’s deformity, appearing to originate just above the wrist joint (carpus), it was determined that one limb was twisted significantly more than the other. While it didn’t seem to bother this youngling now, five more years of wear and tear on these rotated wrists and Rudy would be thoroughly crippled.

Many dogs are born with angular limb deformities like Rudy’s. Indeed, most chondrodystrophic (dwarfed) breeds have twisted wrists. Think Bassets, Bulldogs, Pugs, Shih-Tzus. Unlike Rudy, however, these breeds are usually twisted symmetrically, and seldom more than by twenty degrees. Moreover, their overall shape is such that their hind legs match their forelimbs. These features, along with their typical smaller size advantage and/or reduced activity levels help these breeds battle the very human forces behind their genetic defects.

Rudy had none of these going for him. His body and his brain were all out of whack with his asymmetrically restrictive forelimbs. One limb was rotated at twenty-five degrees, the other at forty. Any deviation beyond thirty is considered potentially devastating. We had to do something.

The next step? I had recently discussed a surgical procedure with my friend the vet surgeon and I was impressed with the strangeness of the method he had used to fix twisted bones. I thought perhaps Rudy could be a candidate for this novel procedure.

Uncommon even in human medicine, this surgical fix for angular limb deformities is called the Ilisaroth method, after its pioneer, a self-trained Siberian surgeon. Developed over fifty years ago, the method required bones to grow and heal in a way no one ever though possible. Using bicycle spokes and other behind-the-iron-curtain niceties, Ilisaroth fashioned devices that would help bones heal when they were methodically pulled apart at the fracture site.

While mysterious in the fifties, this seemingly paradoxical healing method now makes some sense to us. We assume the method stimulates stem cells in the bone on either side of the fracture. Consequently, the bone grows as if trying to fuse a growth plate (those gaps in our bones we all have until we finish growing to our full height). Today, this method is used primarily to make bones longer (in dwarfed humans) and for the occasional angular limb deformity, as in Rudy`s case.

After visually inspecting the deformity, Dr. Wosar (at Miami Veterinary Specialists) deemed Rudy a very good candidate for the surgery. He was young, healthy and, above all, he had the excellent, willing temperament of a grateful rescuee. He was scheduled for surgery immediately — only on the most deviated limb. The goal was to bring it as close to normal (10 degrees) as possible.

Rudy’s surgery required cutting into the bone above the joint with a circular saw, rotating the bones to as normal a position as possible, then placing a crazy contraption around the entire limb. The device, anchored to the bones in places above and below the incision, would act in a manner akin to that of an orthodontic apparatus. Whenever Rudy’s mom faithfully turned a crank, accessible by a sort of key, the device would pull the bones apart, creating the necessary gap to allow the bone to grow slightly as it healed at the site of its incision.

When the device finally came off, two months later, the limb was obviously much straighter. Rudy’s limp was much reduced, now more of a lope than a limp. The alteration in the bone’s direction will certainly reduce not only the unnatural stress on Rudy’s wrist, but also on his elbows, shoulders and back (as they would have had to struggle to compensate for the twist). The surgery was a resounding success.

As it happens with most successes in life, I now see dogs with angular limb deformities everywhere I look. I want to help fix them all. Not everyone, however, has access to the $2500 Rudy’s family gladly paid for this surgical boon to his quality of life. As with Barbaro, it’s only the lucky animals with means that make the news. Still too few can even dream of the improvements to their health our own pets have access to. But let’s put a positive spin on it: we’re still saving the world — even if it’s just one pet at a time.