Colleen Mullally, DVM Emergency/Critical Care
Jake is a 6 year old neutered male Jack Russell Terrier who came to us after being hit by a car. Jake was initially found by an Animal Control officer who transferred him to a local practice for treatment. Luckily Jake had ID tags on and his owners could be found. After being assessed and treated for shock and pain at the local practice Jake was transferred to RVRC for radiographs and further care.
On examination, Jake was unable to walk on his rear limbs. A fracture could be felt in his right femur, and he had pain over his left femur and hip. He did not have anal tone or tail tone. There was a large laceration over the left side of his chest, and he had severe swelling and bruising of his skin and muscles from in front of his hips to the tip of his tail. Radiographs were taken which showed multiple fractures of his pelvis, a right femoral neck fracture, and a left sacroiliac luxation.
Jakes bladder could not be seen radiographically or with ultrasound, so there was concern he may have ruptured his bladder as well. The severity of Jake’s condition was discussed with his owner. The specific concerns about his urinary bladder and his absence of neurologic function to his rectum and tail suggesting that he may not know he is defecating and may have fecal incontinence in the future were addressed. Jake’s owners opted to go forward with diagnostics to ascertain if his bladder had ruptured in addition to his other injuries. A urinary catheter was placed into his bladder, and dye was injected through the catheter to determine if there was a possibility that Jake’s bladder had ruptured in the accident.
Luckily Jake’s bladder had not ruptured, and despite the concern that he would be fecally incontinent in the future, his owners elected to go forward with surgery to repair his fractures. Jake was stabilized overnight on fluids and pain medications with a plan for surgery to repair his femoral fracture and sacroiliac luxation the next day.
Jake’s red blood cell count decreased overnight, so he was given a blood transfusion prior to going to surgery. The surgery was successful, and his femoral fracture and sacroiliac luxation were repaired. The remaining pelvic fractures were not weight bearing bones and therefore were left to heal on their own. A large drain was placed over each fracture site as the skin and muscle had been so damaged that there was significant bleeding into the tissues. The laceration over his chest was also cleaned and sutured.
Jake was doing well enough to go home. His owners were advised that he would need strict confinement and cage rest to allow the swelling associated with his injuries to subside and for his fractures to heal.
Jake was brought in for a recheck examination because he had chewed his drain out the day before. The skin and tissue around the drain were becoming more swollen, and fluid was leaking from the area. On examination there was a large area of tissue that appeared necrotic. There was a soft fluctuant swelling over one of the incisions from his surgery. Jake was anesthetized and sutures were placed to tack down the skin and close the space where the fluid was present and a drain was replaced.
Day 17 and 18:
Jake presented for a recheck examination. The previously placed drain had again been pulled out at home by Jake. The area of necrotic skin over his dorsum was beginning to peal away along the edges. Jake was evaluated by the surgical service. The necrotic skin was removed and a tie down bandage was placed to protect the area and allow it to heal on its own.
Day 29 -48
Jake presented 1-2 times per week to have bandage changes and his wound re-evaluated. The wound began closing well on its own. By day 49 Jake had a scab extending across his back but the majority of the wound had healed.
Jake’s wound has completely healed. He continues to do well at home. This case is an example of the severity of wounds that can occur when our patients are hit by a car. It is also an example of how closely the critical care and surgery services work together to take care of our critical patients. Jake is a lucky dog to have survived being hit but even luckier for having owners who had the patience and understanding that it would take a long time for him to recover from his injuries.