Page 779 - Clinical Small Animal Internal Medicine

69 Central Nervous System Trauma 747

splint movement that occurs in the first 24 hours. Splints
VetBooks.ir should be checked daily by the owner for development of
decubital ulcers and should be checked and potentially
changed by the veterinarian after the first 3–5 days and
then on a weekly basis for six weeks. Splints do not pro-
tect from compressive loading of the spine, and offer
poor protection against rotatory forces. In addition, it is
not possible to stabilize the lumbosacral spine with an
external splint. Splints are inappropriate if there are open
wounds affecting areas that would be incorporated into
the bandage.

Bladder Management
Figure 69.7 Multiple internal fixation materials and methods exist Urinary tract infections (UTI) in dogs being treated for
to stabilize vertebral fractures and luxations. This lateral SCI should be considered. Female dogs, dogs that cannot
radiograph demonstrates the use of screws and
polymethylmethacrylate to stabilize a lumbosacral vertebral ambulate or voluntarily void urine, dogs which are not
fracture luxation. given antimicrobials during surgery, and dogs whose
body temperature falls below 35 °C during surgical
ongoing damage to the sacral nerve roots that could decompression of the spinal cord all have an increased
result from inadvertent movement of the tail. likelihood of developing a UTI. The frequency of UTIs in
Surgical complications from any spinal stabilization dogs with an indwelling urinary catheter may approach
procedure can be serious and include iatrogenic injury to 50%. Indiscriminate antimicrobial use for animals with
the spinal cord, damage to the vasculature immediately an indwelling catheter should be avoided, though intra-
ventral to the vertebral column, failure of the fixation operative antimicrobials should be administered at the
(Figure 69.8), and infection. time of surgical decompression of the spinal cord.
Placement of the splint is achieved by wrapping the If the patient is unable to urinate, the owner must be
appropriate part of the body in cast padding and then able to express or catheterize their pet three times a day.
forming the splint from a material such as Vetcast® (3M) Addition of phenoxybenzamine (0.25–0.5 mg/kg orally
to cover the dorsal aspect of the thoracolumbar spine or q8–12h) or prazosin (dog: 1 mg if less than 15 kg body
the ventral aspect of the neck (from below the chin to the weight or 2 mg if over 15 kg PO q8–12h; cat: 0.25–0.5 mg
sternum). Following padding of the splint to ensure that PO q12–24h) and diazepam (0.5 mg/kg orally 20 min
there are no sharp edges, it is incorporated into the prior to expression) may help to reduce urethral
bandage with a cover of bandaging material such as sphincter tone and facilitate expression. Since marked
Vetwrap®. Pressure points, particularly between thoracic hypotension can result from prazosin, patients should
and pelvic limbs, should be checked and padded care- be monitored for lethargy, collapse, pallor, syncope or
fully. The patient should always be hospitalized over- seizures. Skin should be kept clean and dry and checked
night after the first placement of a splint to ensure that regularly for development of decubital ulcers over pres-
the splint is tolerated, and to allow adjustment for any sure points, or urine scald.

Figure 69.8 Fixation failure can be due to
breakage or migration of the implants as
can be seen to have occurred with these
transarticular pins which needed to be
removed.