Amputation As Treatment For Osteomyelitis In A Dog

A veterinarian never knows what he’s going to see from day to day.

osteomyelitis
Poor puppy with a broken leg for several weeks and infection to boot. This is a “front to back” view.

I sure got fooled by this one. At least at first I was surprised.

A cute little puppy came in for her first examination after being adopted from the Humane Society of South Mississippi. She was reportedly limping on the left front leg and had a good appetite, but the leg hurt so bad the new owners had to take the food bowl to her to keep her nourished.

The rest of the examination was fairly unremarkable. She had some discharge in both ears, with a bad odor and some sensitivity when we touched the ears, so we performed a cytology to determine the cause.

I saved the “bad” leg for last so as to avoid concentrating on the obvious problem, possibly causing me to miss other physical abnormalities.

When I got to the left humerus (upper arm bone between the shoulder and elbow), I was immediately struck by the amount of heat produced locally. That told me there was something major going on.

My brain began to work its way back to third-year pathology class, reciting to myself the list of juvenile bone diseases that could affect the distal part of the humerus.

Of course, it was necessary to include the obvious: infection. Infection in bone is called osteomyelitis. The word comes from a combination of Greek parts: osteo from osteon, meaning “bone,” myel, from myelos, referring to the bone marrow, and itis, a suffix meaning inflammation. Osteomyelitis is almost always caused by bacteria, although there are sterile forms of inflammation and fungal forms of infection of the bone.

What I saw when I processed the radiograph (X-ray) was not what I suspected. The humerus was broken and the two fragments were overriding. The leg muscles had contracted for so long that the two parts of the bone overlapped over an inch. They even appeared to be trying to heal to each other. Nearby, there was a large area of mineralization, probably also packed with infection. The ends of the bones have become rounded, a result of the body trying to clean up the bone and infection over a period of weeks.

osteomyelitis_
Side view of the same leg, with clear evidence of mineralization and, probably, infection.

Saving the leg is mostly out of the question. One could easily spend $10,000.00 on surgery and antibiotics and still lose the limb.

Amputation, which will quickly resolve the problem by removing it, is the best course of therapy in this situation. We humans think of amputation as being life-changing. Pets, on the other hand, hardly seem to miss the leg. You can read about some amputation success stories by clicking here.

The new owners asked a valid question: “You have amputation success stories. What about amputation failure stories?”

“I don’t have a single one, actually. I’ve never seen a single pet who didn’t adapt quickly to loss of a limb.”

Having owned the puppy for less than a week, they are already thoroughly attached to her. Still, they needed some time to talk about options and make a final decision. The “E” word, euthanasia, came up, but I told them that was not an option. She should have a long, full life with a single surgery for amputation.

So, we say a prayer for her and hope the owners make the right choices.

We just never know what any given day will hold.

20 Comments

  1. Hi I know that this thread is from so long ago but reading some of these comments has been really helpful. My seven year old pitbull mix tore both of her CCL‘s this past year and had double TPLO surgery. One healed beautifully. Unfortunately she ended up with an infection in one of her legs causing her fibula to break. Our vet has treated it with multiple antibiotics, and she has been on strict kennel rest for 6+ months. Her leg is still not healing and they suspect osteomyelitis. She is currently on another antibiotic as a last ditch effort before we consider amputation. I am so concerned that with her age and the fact that her immune system is obviously not the best that she would develop an infection from the amputation, or whatever infection she already has already spread to other parts of her body and we would be putting her down not long after that. Is it possible to do a biopsy to see the exact kind of bacteria we are dealing with, or if it’s bone cancer? I know that you’re not able to really tell someone what to do in this situation, but any information you can offer is helpful. Thank you.

    • First, you’ve been dealing with this for nearly a year; it’s not osteosarcoma (bone cancer) or it would have gotten a LOT worse by now (for completeness’ sake, I’ll say 99% it’s not osteosarcoma). Second, I assume your veterinarian has cultured, not biopsied the site to determine the correct antibiotic. A biopsy WOULD tell you whether osteosarcoma were there and MIGHT identify bacteria, but, identifying bacteria isn’t going to help with treatment. Culture and sensitivity would, if that hasn’t been done. Regarding infection of the amputation site from the osteomyelitis site is highly unlikely. Bone infections are problematic for a variety of reasons, but, sterile amputation surgery should not result in infection of the site. It is a common practice to send the affected part of the leg to a pathologist for histopathology after amputation, and I recommend that. READ ALL OF THE ARTICLES FOR WHICH I’VE PROVIDED LINKS; doing so will help you better understand your dog’s condition. Please write back so that we and our readers can know the outcome of your baby’s condition. Meanwhile, we’re sending up a prayer for an excellent result. Thanks for reading, Dr. Randolph.

  2. Hi Doc,
    I’ve got a Great Dane mix, he is somewhere around 7 (we guess since he was a rescue). After having him a short while, we discovered he had a significant amount of hardware in his right front leg which basically ran the entire length of his humerus (A plate, a rod, about 10 screws and a lot of wire). Fast forward a couple of surgeries and heartworm treatment we had a surgery to remove the hardware because he began to have a recurring abscess that is now just a drainage tract that is always open. The surgeon was not able to get all of the wire out of his leg and told me he would have broken his leg on the table if he had kept removing bone that had grown over the wire. A biopsy was done and was consistent with osteosarcoma. We opted for palliative care, its been almost three years since he was diagnosed. We are beginning to have more problems with his leg now, his leg is at least twice this size of the other and is extremely red and inflamed. Our current vet thinks the remaining wire most likely caused osteomyelitis and is pushing for amputation. He figures it couldn’t be osteosarcoma since he has made it so long. I feel like it is a gamble for amputation since he is older for a large breed and most of his weight is in his front side, not to mention the heartworm history. He has had such a hard life, I just want to do the best thing for him but I honestly don’t know what that is. Any advice is very much appreciated.

    • If I were smart, I’d probably bow out of this question altogether, but, I’m going to make some observations without making a suggestion. One, as a large-breed dog, he’s already old. Two, large-breed dogs carry 60% of their weight on their front legs. You’d be asking a lot of the remaining front leg. Third, check the regional lymph nodes and obtain a chest radiograph. IF he has metastasis, amputation is a bad choice. BUT! HIS doctor seems to think he’s up to it, and that carries a LOT of weight. Write back and let us know what you decide. Then, after surgery and recovery, update us again, please. Thank you, Dr. Randolph.

      • I just wanted to let you know that I very much appreciated your response. I wish I could give a better update but sadly we had to have Jax euthanized. Shortly after my original comment he became lame on one of his back legs for about a week. We had it X-rayed and they saw some inflammation and couldn’t rule out lymph node involvement but the lameness resolved after a couple days and he went on about with his happy playful self. Yesterday, however, after coming in from outside, I stepped out to let our other dog inside and when I came back he had lost function of both of his back legs. He was in a lot of pain and we took him in shortly after that. He beat all the odds and made it to his 3 year anniversary of his osteosarcoma diagnosis. I wish it was a better update but he is no longer in pain. Again I thank you so much for your response.

        • I know your heart is broken, yet, I also know you are comforted by the huge gift you had of three years after an osteosarcoma diagnosis. I once had a patient live five years after histopathologic osteosarcoma diagnosis, amputation and aggressive chemotherapy, then, she died of something else. There are few cases of “cure” with osteosarcoma, but, I believe she was one. May the Lord comfort you as you grieve and seek to heal. Thank you so much for the update, Dr. Randolph.

  3. Hi, my Rottweiler (male, 8 years old) had a surgery on his left forelimb when he was young. over the past 2 months we has been diagnosed with osteomyelitis and they started IV fluids and antibiotics for 5-6 weeks. His WBC counts still kept getting higher and there is pus accumulating in his stifle and hock joint. The vet is saying he has septicaemia, he has lost so much body weight. My parents have decided to not amputate his leg since he is weak and it is risky, they are just keeping him comfortable at home and waiting for him to die. The vet said he could perform an amputation and a blood transfusion to help with the septicaemia and blood loss during surgery. What do you think should be done? Is it too late to consider amputation now? is he too sick to survive an amputation surgery and recover post op, or will the septicaemia get worse even after amputation?

    • How heartbreaking! At age 8, with a history of damage to a different leg, I can’t imagine that amputation of a rear leg and inability to 100% use the other three legs would result in a good outcome, EVEN IF we didn’t have the complicating factor of septicemia. HOWEVER, I haven’t examined this baby and I would put my trust in the doctor who’s caring for him. Thanks for reading, Dr. Randolph.

  4. Hi Dr. Randolph, this article is really old but I’m hoping that this gets to you. I have a 4 year old GSP that was bitten by a pit bull 12/22/17. We took her to the vet, they did X-rays and indicated that she had a hairline fracture, gave her rimadyl and sent us away. She limped for 6 weeks. I took her back to the same vet 2/20 because i noticed some swelling over the area though she seemed to be getting better. X-rays again and was astonished at the difference. They now think she has osteosarcoma, but it’s centered in the middle of her radius, right under where the bite was. It’s not tender to touch and I insisted she be put on antibiotics because i suspect an infection. They did minimal cultures which came back negative but I still believe it’s an infection. She is not limping at all anymore, I can palpate the area with no pain whatsoever, she has full appetite, energy etc. no changes in behavior whatsoever. I’m terrified to do a biopsy because i’ve Been told that if it is osteosarcoma it can make the situation worse and we may lose her sooner than expected. I’m having a hard time believing it’s osteosarcoma because of her age, the location and the fact that she’s not in ANY pain anymore. HELP? Can they do a fine needle aspiration to test for other bacteria types? We’re in the northeast, so not really fungal central and she really seems to be doing great with antibiotics. I really appreciate any insight you can give. Thanks so much.

    • You’re in a tough spot. Telling osteosarcoma from osteomyelitis by radiography can, in some cases, be tricky. Ultimately, a biopsy is the only way you’ll get a bottom line (and a bacterial culture and sensitivity can be done at the same time). Less invasive would be sending the radiographs to a board-certified radiologist for an opinion. More aggressive would be consulting with an oncologist and/or board-certified surgeon at a referral practice. Also, you can use the search window on our site, typing in OSTEOSARCOMA to read more.I would REALLY like to know what the outcome is for your baby, so, a followup report when you know more would be greatly appreciated. Thanks for reading http://www.MyPetsDoctor.com.

      • Hi Dr. Randolph, I am so happy to report that my wonderful little girl responded overwhelmingly positive to long term antibiotics! Not osteosarcoma after all. She’s still with us and happy and healthy! We recently took her back to have another x ray done and the spot has gotten much smaller, definitely shows marked improvement. I did notice that she seems to be limping a little bit again so I asked that she be put back on antibiotics just to be sure that we’ve cleared the infection up completely. It’s been 18 months though and she is doing fantastic. Thank you so much for responding, I completely missed your reply until just now!

  5. We have a small chihuaha-terrier mix that we got at the humane society in Nogales, AZ. She came to us with mange, a bad cough, like kennel cough though it did not respond as it should have, it finally started to get better after a year on antibiotics, then the leg foot swelled badly, was hot to the touch. After 3 vets, surgery, a CT scan, they found nothing. A year later and $10,000.00 spent they are now wanting to have infectious disease doctor see her then amputate. We also found a growth on her side yesterday, they excised, no results on that yet. She is not 2 years old yet! HELP!

    • You will have to wait for the histopathology results before you can proceed. I’d like to help, but it sounds like you have the best experts on your side already. With a little luck, the infectious disease expert will find something treatable and you won’t have to amputate, but, sometimes it’s indicated for problems that can’t be controlled any other way. I would love it if you would send us an update when you find out the test results. We will say a prayer for you and your little baby, too. Best wishes, Dr. Randolph.

  6. Or the dog was homeless and the owners were never found…. or the dog broke his leg while in the shelter and no one noticed….. there are plenty of scenarios besides assuming that the previous owners were bad people.

    • Thank you for this uplifting comment, RumpyDog. I didn’t mean to focus on the negative, and maybe the story would be just as good with that paragraph left off. However, we know that she had been at the shelter only one week, and this fracture is much older than that. And, we know she wasn’t a stray, rather she was a surrender. Even if the fracture site wasn’t infected yet when they surrendered her, it was definitely broken and she would definitely have been limping then. I always enjoy hearing from you!

  7. This is my first visit to your blog. Coincidentally while at the hospital (for therapy dog interview) yesterday I met someone whose Rottweiler had a leg amputated last week. Like Pug Daddy, I’ve actually been around dogs with 3 legs and not realized it at first because they get around so well.
    Very interesting site. I teach biology and back in the dark ages I was a vet tech. I’ll be back!

    • Thanks for a great story, Amy, and thanks for visiting our blog. Some of the most caring people in the world are, or have been, veterinarian’s technicians. I can tell from your words that you still are.

  8. Nice read. I can’t tell you how often I see dogs with only three and sometimes two legs at the dog park. It is so nice seeing these guys run around and enjoy life as much as every other dog.

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