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Osteotomy refers to the surgical cutting of a bone. A release osteotomy is most commonly used to relieve the 'bow-string' tension on a long bone, when its rate of growth is slower than its partnering long bone. This tension causes the limb to deviate as it grows. This can be the result in puppyhood of damage to the growth plate of that long bone or as a result of genetic factors coding for distorted legs, such as the dachshund or Basset hound.
Release osteotomy is usually performed by a specialist veterinary orthopedic surgeon. This is because of the intricacies involved with judging where to make the cut, how much bone to remove, and ensuring the smooth function of associated joints.
In severe cases of limb deformity, surgical realignment, of which release osteotomy is an integral part, is the patient's best option.
A series of radiographs are taken of both the normal and affected limb. Several views are taken so that a 3D image of the ALD is built up. The surgeon then carefully plans where to make the incision in the bone, how much to remove, and any supporting orthopedic implants (such as a plate or external fixator) needed to stabilize the bones.
The dog is given a general anesthetic and the limb clipped up for surgery. Under strict aseptic conditions the surgeon makes a long incision over the forearm to expose the ulna. Using an orthopedic saw, a cut is made through the ulna - this is the release osteotomy. When the degree of twisting of the limb is extreme, a second cut parallel to the first is made and the section of bone inbetween removed. This allows for the bone end to migrate apart without a bony callus prematurely bridging the gap.
The elbow alignment is checked, and appropriate orthopedic implants, typically plates and screws, are used to maintain the bone in the new position.
Successful release osteotomy can be life-transforming for the patient. The dog may go from a state of semi-disability to having a fully functional limb, with all that this implies for improved quality of life.
The alternatives to surgery include restricting the dog's physical activity and the regular use of pain relieving medications. However, this is largely managing the symptoms in order to reduce discomfort, rather than correcting the underlying issues.
The success or otherwise of a release osteotomy depends to a large extent on adequate pre-op planning and the skill of the surgeon.
Orthopedic surgery is painful and the dog will require pain relief for days to weeks post-surgery. The skin sutures are removed around 10 to14 days after the operation. The dog must be strictly rested until healing is complete some three to six months later. It should be remembered that until the bone has healed, the strength of the limb relies on metal implants. Overexertion can cause the implants to bend and fail, necessitating repeat surgery.
This is expensive surgery. A consultation with an orthopedic surgeon to discuss the surgery is likely to be $220 upwards. The actual procedure includes taking multiple radiographs or a CT scan ($1,000 to $1,500) and then the operation (anywhere from $4,000 to $8,000 depending on the complexity of the angular deviation).
Whilst there is everything to gain by proceeding with surgery, it is not without risk. There is a chance that the leg will continue to grow in a bowed manner and that surgery is only partially successful. In addition, there are complications from the surgery which range from death under anesthesia, to infection of the surgical site, or bending of the metal implant.
Problems can arise as a result of poor bone healing, which effectively leaves the dog with a permanently fractured leg. In addition, removing a slice of bone can cause the leg to be physically shorter than the other limb, leading to a mechanical lameness.
Mechanical trauma to growth plates in puppies should be avoided at all costs. This involves avoiding jumping from heights or landing heavily on the limbs. Typically, dogs should not start agility until they are skeletally mature and finished growing, which for a regular sized dog is around 12 to 18 months of age.
In addition, some dogs, such as dachshunds, are bred with deformed limbs that are accepted as part of the breed standard. The ethics of breeding for physical deformity should be questioned, and when a dog needs corrective surgery, that dog should not be used for breeding and it would be wise to retire the parents from breeding also.
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