|
"If it ain't broke don't fix it", goes the saying.
Whilst this motto may well seem self evident it can sometimes
require a more complex decision to be made. It is often
the case that I am faced with patients who have significant
orthopaedic problems. These abnormalities can usually be
readily identifiable either on clinical examination or with
radiography. Once a problem has been identified the dilemma
then becomes, "Can I improve the patient's function
rather than can I alter the abnormality?" If the answer
to that problem is no then it is best left alone.
"Lilly" was presented to me by her owners when
she was only 11 months old. They had become aware that she
held her leg out at a peculiar angle when sitting. A thorough
clinical examination and x-rays demonstrated that "Lilly's"
patella or kneecap had moved from its central location and
taken up residency on the inside of her leg! So pleased
was the kneecap with it's new "home" that it had
decided to stay there......permanently.
Whilst the kneecap was out of it's original location it
was still able to do it's job and "Lilly" was
running around just fine. The surgical dilemma then becomes
whether there is anything to be gained by repositioning
the kneecap back to it's original location.
At Fairfield, my colleagues and I are continually balancing
the value of therapy with the potential gain to the patient.
Whilst there are many instances when we might recommend
complex surgery or innovative medication, if we believe
that the treatment can offer little gain to the patient
we do not offer it. Each surgical and medical intervention
must have a realisable benefit for our patients. So for
the moment the kneecap gets to stay in it's new home!
Terry Dunne BVMS, Cert SAO, MRCVS
|
