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.

10 comments

  1. Kristin Hall says:

    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.

  2. Goody says:

    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.

  3. RumpyDog! says:

    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!

  4. Amy says:

    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.

  5. Pug Daddy says:

    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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