dystrophic mineralization issues

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Patient is a 4 year old, 68 lb. Labrador Retriever that sustained a severely comminuted open femur fracture to the right rear leg on10/29/07. The fracture was stabilized surgically and a bone graft was used in the distal aspect of the fracture. There was extensive soft tissue infection post-operatively and more than one procedure was performed, and due to bandaging and other reasons beyond our control (and to my EXTREME upsetness) we were not able to begin physical therapy until 11/27/07. The was severely restricted range of motion and thickening in the stifle joint, as well as muscle fibrosis noted diffusely in the distal aspects of the quadriceps AND hamstring muscle groups. There was hardly any range of motion in the stifle and the patient was unable to fully extend the digits of the toe on that side and was non weight bearing on the limb. Radiographs taken shortly thereafter showed extensive dystrophic mineralization of the soft tissues in the stifle area (in the same areas where the “fibrosisâ€/bony mineralizations were palpated). PT has included passive range of motion, stretching after warm packing, NEMS of the quads and hamstring mm. Groups, and therapeutic exercises. The dog has actually improved and now will bear some weight on the leg and use it when walking slowly. He still has only ~20 degrees total ROM in the stifle (which is ~10 degrees better than when we started!) Due to the mineralization of the muscles, I am not sure how much more progress can be made, I have never seen anything like this.

Here is the “problemâ€: The owner spoke with a human orthopedic surgeon about her dog and the surgeon told her that my physical therapy recommendations, especially as regards the range of motion exercises she was doing at home, were contraindicated and could make his dystrophic mineralization worse. Now, I have NO IDEA what specifically she told him about the problem and/or about any human pathology that is similar, however I can see no reason why our therapy, especially in light of the fact that the dog is IMPROVED, is contraindicated. I told her I would post to our rehab group here and make sure no one had any differing opinions. Input of ANY kind, appreciated.

Thanks!

A. , DVM, CCRT

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