Arik - Angular Limb Deformity


  When I first saw Arik in early October 2014 at Island Animal Hospital (Merritt Island), he had suffered a premature closure of the growth plate in the distal (far) end of his left ulna (one of the two bones in the forearm).

     Because the growth plate in the other paired bone (the radius) was still open, that bone continued to grow, while the other bone mostly stayed the same length.

     This caused the growing bone to curve around the not-growing bone, resulting in an angular limb deformity that curved, twisted, and prevented length of the limb.


     In addition, the shortened bone was beginning to be pulled/dislocated from the elbow.

     Radiographs (x-rays) taken from the week before demonstrate the deformity.

     As Arik was 6 months old and his other growth plates were still growing, I performed an initial procedure to prevent the angular and rotational deformities from getting worse, as well as to reduce the elbow distraction and potentially allow regaining of a little bit of length. A pin was placed to prevent displacement of the ulna by the elbow.

     Fortunately, Arik had been adopted by a veterinary technician who could provide the best post-op care and monitoring. Alaina continued to monitor the bones via radiographs every couple weeks. 


     By December, the growth plate in the left radius had closed, and we made plans to perform the definitive correction.

     In addition to the angular and rotational deformities, the left "forearm" was approximately 43 mm (nearly two inches) shorter than the normal right side. In Arik, that deficit was close to 25% of the length of the normal limb.

     The image to the left compares the normal and abnormal limbs via radiographs.

     In addition, Arik had lost a lot of skin from from abrasion (road rash) in the initial trauma. The scar tissue was very thin and easily damaged, and had a long-dwelling full thickness ulcer (open wound).

     In January, both the radius and ulna were cut at the point of maximum deformity, the limb was straightened, and a circular external fixator was placed to maintain joint alignment. 

     The fixator had a set of linear "motors" in it, which allowed the bones to be slowly distracted.

     With appropriate timing and rate of distraction, the healing bone is stretched, but maintained in an early healing state, so that once the distraction stops, the bone swiftly and completely heals.


The image to the left shows the straightening of the bone as well as the increase in length.

Immediately above the bottom ring, you can see the hazy bone extending for a few centimeters proximally before the normal bone starts again.

The hazy bone is the healing bone in the process of being distracted.

During the same procedure, the chronically traumatized skin was removed 360 degrees around the wrist, and a skin graft was taken from Arik's chest to fill this wound.

Over the next 2 months, Alaina diligently turned each of the motors 4 times a day such that a total of 1 mm of length was gained in fractions over the course of the day; we adjusted the rate a few times to be sure we were not lengthening too quickly for the bone to keep up with healing. Alaina also did regular bandage changes and cleaning of the pin tracts. Finally, close to Arik's first birthday, we reached the limitations of the motors (gaining approximately 38 mm), so we stopped lengthening and allowed the bone to heal for the next month.

In April, 2015, we removed the fixator and switched to a splint and then a support wrap for a few weeks. At bandage changes, Alaina gave Arik sessions in the treadmill at Rockledge Animal Hospital. Since then Arik has regained use of the limb and put on a lot of muscle over time. He may not be perfect, but he is a happy, comfortable, and functional four legged dog again. 

Alaina has a Facebook page where you can follow his progress, including videos, etc. on "Saving Arik's Leg."


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