Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.
Issue link: http://todaysveterinarypractice.epubxp.com/i/619503
Today's VeTerinary PracTice | January/February 2016 | tvpjournal.com PracTice To PracTice Peer reviewed 118 recommending against surgery. For example, an overweight 13-year-old Labrador retriever, with an acute ccL rupture, that spends most of the day recumbent and only goes outside to eliminate may be a better candidate for a stife brace than a 13-year-old Labrador retriever in good body condition that goes on daily runs and hikes. The more active dog is better served by surgical treatment. Types although numerous stife braces are available for veterinary use, in our experience custom-made, hinged braces are the most effective. Proper construction is imperative to create a comfortable and functional brace (see Constructing a Custom Canine Stife Brace). While braces that are not custom-made are more affordable and easily acquired, they do not support the stife or eliminate instability. Furthermore, if the brace is not designed to ft a specifc patient, rubbing of the skin against the brace can lead to skin wounds (see Fitting & Using Custom Stife Braces). Mechanics in theory, custom-made, functional hinged stife braces remove the strain on the ccL, allowing the stife joint to function normally and the patient to perform normal activities of daily living, which should reduce muscle atrophy. The brace provides a set path of motion for the tibia under the femur by locking onto the long bones of the leg and preventing excessive cranial–caudal movements. 3 Unfortunately, data proving this in veterinary medicine are lacking; furthermore, the theory of why functional hinged stife braces work can only be applied to custom- made braces. FIGURE 3. A functional, hinged stife brace on a patient with a cranial cruciate ligament rupture. Photo courtesy Jeff Collins FIGURE 2. The stife casting is poured with plaster of Paris ( A ) to create a positive model of the affected limb (B). Photo courtesy Jeff Collins Constructing a Custom Canine Stife Brace The most important step when constructing a custom stife brace is taking a proper cast mold of the affected limb. • Using soft fiberglass casting, cast the limb from mid thigh to just proximal to the paw (Figure 1, page 117). • A normal, standing angle at the stifle (approximately 130°) must be reflected in the cast as accurately as possible. • The standing angle is most easily accomplished by either applying the cast: » While the patient is standing » With patient in lateral recumbency and the limb in a neutral position. Once the cast is made, send it to an orthotist, who will: 1. Pour the cast with plaster of Paris to create a positive model of the affected limb (Figure 2). 2. Modify the mold to accommodate for bony prominences and sensitive areas as well as sculpt it to ft the affected limb. 3. Heat and vacuum-form foam and high-temperature thermoplastic around the mold in varying layers/designs to create the most functional custom product (Figure 3). A B