Charlie, the Staffordshire terrier pup, came in to see me one wet and wild Monday night with a very sore leg. At 18 weeks of age, he was (I should say, is) full of energy and very bouncy, and not immune to accidents so it seems! He had already had some dental problems from chewing on rocks, but this night he had been a little too excited to see his owner’s when they came home. Jumping several feet into the air he had landed awkwardly on his right hind leg, tripping over a bar stool, and was suddenly very sore and lame.
My suspicion on examining Charlie was that he had injured his tibial crest. The tibia is the main long bone in the leg below the knee. The tibial crest is the top and front part of the bone. In young animals, it is not well adhered to the bone as it is part of the growing apparatus. Young bones have “growth plates” where new cells are constantly forming to help baby bones grow. These areas are soft and prone to injury. Damage to the growth plates can interfere with normal growth of the limb and potentially lead to deformities if not repaired in a timely manner.
Charlie was sedated and x-rays were taken of both his back legs to compare the knee joints. The changes were subtle but there were some slight changes that suggested he may have a tibial crest avulsion. When traumatised, the ligament of the patella (the knee cap), which is attached to the tibial crest, can pull on the soft tissue attachments and separate if off the tibia where it normally sits. Many puppies who suffer this injury can have significantly displaced tibial crests, Charlie was fortunate that his was only marginally injured.
When an avulsion occurs, the joint is very painful and may become quite swollen. Charlie was holding the limb up to take weight off of it and relieve the discomfort. He was very bright and happy otherwise. He was given some pain relief for overnight and was scheduled to see a specialist the following morning.
The recommended treatment for a tibial crest avulsion, and other growth plate injuries, is generally surgery. Surgery will often be performed in these cases to fix the crest back onto the tibia and help to stabilise the joint in growing dogs, so as to reduce the incidence of long term problems with the limb. In very mild cases, rest and anti-inflammatories may be all that is required and each case needs to be judged on an individual basis.
Charlie saw the surgeon the following morning. He was becoming more comfortable on the limb and the surgeon assessed his injury as being mild with a stable and comfortable tibial crest and knee joint. Conservative treatment (rest and pain killers) was elected to see how he progressed over the first few days, so a plan for a re-examination was made and Charlie was sent home. Interestingly, though this injury can occur in any breed, I tend to see it mostly in Staffy pups – running into retaining walls, jumping off beds, you name it! Charlie was a great little puppy to have in hospital and hopefully his streak of bad luck has ended…if he can control the mischief!