Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
Canine Forelimb Splint Placement: Don't Disregard the Digits!
Discover how exposed digits increase weight bearing and alter sub-bandage pressures in dogs with forelimb splints with Sarah Stark, a fourth-year veterinary student from the University of Minnesota. Guided by her mentor, Dr. Wanda Gordon-Evans, Sarah shares her groundbreaking research on forelimb splints and their influence on weight bearing and pressure distribution in dogs. Her study unveils how the design of splints, particularly whether the digits are exposed or enclosed, can significantly impact fracture healing. These revelations not only provide vital insights for veterinary professionals but also open doors for veterinary students to gain recognition through journal awards.
But the journey doesn't stop there. We also spotlight the indispensable role pet owners play in their animal's recovery process. From understanding the intricacies of splint placement to the critical task of monitoring exposed digits, owners are key players in ensuring proper post-injury care. Be sure to check out Sarah's article in JAVMA and join us in appreciating her significant contributions to veterinary medicine.
JAVMA open access article: https://doi.org/10.2460/javma.24.10.0684
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You're listening to Veterinary Vertex, a podcast of the AVMA Journals. In this episode we chat about how exposed digits increase weight bearing and alter subbandage pressures in dogs with forelimb splints, with our guest Sarah Stark.
Lisa Fortier:Welcome to Veterinary Vertex. I'm Editor-in-Chief, Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today we have Sarah Stark joining us. Sarah, thank you so much for being here with us today and sharing some evidence on some rehab and other things that I'm keenly interested in.
Sarah Stark:Yeah, thanks so much for having me. I'm excited to talk with you guys.
Sarah Wright:All right, let's dive right in. So, Sarah. Your JAVMA article discusses how exposed digits increase weight bearing and alter sub bandage pressures in dogs with forelimb splints. Please share with our listeners the background on this article.
Sarah Stark:Yeah, so I'm actually a fourth year veterinary student at the University of Minnesota and this study was conceptualized and designed by my mentor, Dr Wanda Gordon-Evans, who's one of the surgery faculty here, and the idea came from just kind of clinical experience and seeing how there seem to be two groups of people when it comes to putting splints on and the distal extent of the splint. Some people choose to end the splint just proximally to the end of the. Some people choose to end the splint just proximally to the end of the, really to the ends of digits three and four, and that's to allow for monitoring of the digits for swelling. Obviously we don't want that. And then there's a different group of people that extend the splint a little farther and fully encompass the digits with the splint. So it's the distal extent of the splint is past the distal end of the digits and that's to encourage the animal to weight bear on the splint itself. You can still monitor the digits for swelling when it's like that. You can kind of observe the toenails for lateral spread to see that's indicative of swelling of the toes or palpate them or kind of look into the end of the bandage. So it's like a little less obvious but it's still totally possible to monitor them.
Sarah Stark:Well. And then, you know, she just kind of wanted to know is there a difference in these splint types for the patient? And so what we did was take 10 university employee-owned dogs and apply each of these splint types to the same forelimb, and we used sub-bandage pressure sensors and a force platform to record how much weight they're bearing on the limb itself, as well as to see if there's any differences in subbandage pressure distribution between the two splint types. And you know, similarly, actually in the literature there's kind of a group of people that say leave the toes past the end of the splint, and some people say leave the toes inside the splint and some people don't say at all. So it's really, you know, kind of an interesting thing to look at, because it doesn't seem like people have really investigated that before if there's an impact to splint length.
Sarah Stark:And so what we found was that in the toes out bandage so where the toes are slightly past the end of the splint there was an increase, a significant increase in pressure along those exposed digits versus with the toes-in bandage. There was kind of a more even spread and even pressure distribution. There was kind of a more even spread and even pressure distribution. And also we found with the toes out bandage that the dogs actually bear significantly more weight on the splinted limb overall than they do with a toes in splint. So definitely there's some, you know, interesting clinical relevance there. If you're considering fracture healing and Wolf's Law, you know we don't want too much force going through a fractured limb that can delay healing, and so you know it's just kind of something to be considering in practice. That I think that we kind of haven't really talked about before is we should be thinking about that when we're applying bandages.
Sarah Wright:It's a really great topic, really clinically applicable, and there's actually two things that come to mind, too, when I hear you talking about this. First is, since you are a veterinary student, did you know that you're eligible for our journal awards?
Sarah Stark:No, I had no idea.
Sarah Wright:So we have journal awards for student, intern and resident authors of manuscripts submitted to JAVMA and AJVR. So I'll send you the instructions after this. But you would qualify
Sarah Stark:oh exciting.
Sarah Wright:And you can self-nominate too. It's fairly like informal process, so nothing too stressful about it, which is nice, that's cool, that sounds like fun. And secondly is I think this also would be a great topic for our technical tutorial videos.
Sarah Wright:Did you know that we also have video manuscripts?
Sarah Stark:No, I didn't know that either. Yeah, Also.
Sarah Wright:I'll definitely need it, Sarah Go, Sarah, I was like listening to you talk. I'm like these would be perfect. But if you want to submit a video showing just how to even like, do a splint on a dog and cat like, I think that would be excellent Because a lot of times in like vet school you might not have a case where you get to do that or you're just doing it on, like you know, like a dabber limb, and not going to actually do it in the live patient. So I think that'd be a really excellent teaching video and I'll send you more information on the podcast about how to submit and what we're looking for in those.
Lisa Fortier:Sure, yeah, while Sarah's plugging, the difference between our video manuscripts, as she said, and like a YouTube video is these will go through peer review and they get a DOI document identifier number. Very, I mean, they are manuscripts, so you get academic credit for them as well. Cool, I like that, really cool for just starting veterinarians veterinarians that might be taking on new responsibilities in their roles and maybe they, as Sarah said, maybe they, sarah right, maybe maybe you did the student didn't get to do that or even maybe even see it, depending on the caseload, maybe the student didn't get to do that, or even maybe even see it, depending on the caseload.
Sarah Stark:Sure, yeah, and definitely like part of our thought process when doing this paper was like this is super relevant for everybody, like we didn't want to submit it to a surgery specific journal because we're like this is, this is for everyone, like all across the board journal. Because we're like this is for everyone, like all across the board. Everybody has to put bandages and splints on and you know it's relevant for everyone, not just specialists, certainly.
Lisa Fortier:Yeah, very much so. A really elegant study too. You know I love these are my favorite types of studies and manuscripts where somebody says, huh, I wonder about that. And then I mean, it's just, it doesn't take a bunch of molecular diagnostics or any of that sort of stuff and you're making it, you move the needle. As a vet student, that's pretty cool.
Sarah Stark:Yeah, it was. I mean, she, wanda, has this like huge list of like study ideas. She's just one of those people that's always brainstorming and helping house officers do projects, and so she sat down and was scrolling through her list and I was like I like that one. That's straightforward, it's simple. I like the idea. It seems so relevant.
Lisa Fortier:So yeah, I was amazed about it. Funny, you say that I was at well, still am partly at Cornell, but for 30 some years as an equine surgeon. And the amazing study questions. And I just kept a rolling list of them. Yes, and students would say is that true? Do we know that that's true? And you're like, huh, I don't know. Yeah, Then you have to go back and dig in the literature. Has somebody done that before? Because maybe you just didn't read it. But yeah, those are the best studies before. Because maybe you just didn't read it.
Sarah Stark:But yeah, those are the best studies. Very rewarding. Yeah, definitely, it's been fun. It was a good one as a student. Now are you interested in pursuing surgery or what are your next steps? No-transcript residency Like that's the plan. So we're getting there.
Lisa Fortier:Very good. Well, veterinary technicians are obviously critical to our profession as well, so that's yeah, and it's.
Sarah Stark:I think it'll really like serve me well. It's certainly served me well in vet school itself, like having the clinical relevance and being especially having worked in a teaching setting for a long time, like I've I've just listened in on rounds for years and had the opportunity to absorb some of that information along the way. Or like in this case, with bandages how many bandage changes have I been present for? You know? Like hundreds and hundreds. So it's, it definitely has helped a lot and I think it'll help in my career as well, just having been in the shoes of support staff.
Lisa Fortier:Absolutely, and knowing how you could leverage your support staff and how to appreciate them and promote them so they don't feel like technicians. Yeah, yeah, you'll be, fabulous Every time, sarah, when we do a study, and maybe the whole finding was surprising to you, but you know we find results that may be sort of predicted, but there's always something that's surprising. What surprised you from the findings of this?
Sarah Stark:article and there was actually a difference. There's a very statistically significant difference in weight bearing between the toes in splint and the toes out splint with the dogs. When we're looking at the sub bandage pressure sensor data, they're kind of walking on those exposed toes and so it kind of just reinforces that concept that they're walking on the exposed toes and they're also walking, you know, more, on that foot. They're bearing more weight on it. So yeah, that was surprising. It was interesting that we were excited when we found that.
Lisa Fortier:So that probably means that there there's a role in any given situation for either of the splint types.
Sarah Stark:Yes, yeah, that was kind of the takeaway for us, that, um, you know, maybe if you have a one-year-old Labrador, that's like totally bananas, like you're going to want for sure to have a toes in splint where their foot isn't touching the ground. We kind of hypothesize that maybe tactile input is the reason why they're more willing to bear weight if the toes are out. So if you're kind of taking that away by keeping the splint as the thing that's touching the ground and it encourages the dog to bear less weight on the leg, that's probably good in most situations for most fracture configurations. You know, slowing them down and having less force going through the limb is going to benefit fracture healing. But conversely, if you're talking about a two-kig mini poodle with an RU fracture that you're not fixing, primarily you're just going to manage with splinting, those dogs are already predisposed to a non-union.
Sarah Stark:Maybe having their toes exposed a little bit and allowing that tactile input would encourage weight bearing. So it's just, you know we can't say one way or another what's right or wrong, and I think it's very dependent on the patient and the situation and the fracture type and location and all of that. But it's just a good thing to keep in mind really when you're putting a splint on. It's just a good thing to keep in mind. Really, when you're putting a splint on, we think about how far to extend splints proximally or what materials to use or whatever else, but we should also probably think about how far it's going distally to.
Sarah Wright:So, sarah, you talked about how your mentor has that long list of research questions. What are next steps for research?
Sarah Stark:Well, man, I don't know what else is on her list, but I think in the case of this project there's a lot more to expand upon. You know, we kept it simple and just looked at forelimbs. Somebody could do the same thing in hindlimbs. Maybe there's less of a difference because they bear less weight on their hindlimbs than they do their forelimbs. You know it. Also, we had some limitations with small sample size and really short duration of wear. We just put the splints on, acclimated them for a few minutes and collected data and then put the next one on. So having splints on for a few days or a few weeks could allow the dog to acclimate and maybe that would negate the differences between the two splints if they've had them on longer. Yeah, I mean there's. I think that it would be interesting to continue looking at it. It's such a clinically relevant thing that kind of affects everyone. So I would love to see more people repeat it or do it in dogs with fractures. That could change things as well.
Sarah Wright:So Well, sounds like there's more work to be done. Well, sounds like there's more work to be done. Always, right, always.
Sarah Stark:So do you see a role for AI in this area of research? I mean, I bet somebody has done it already, but I feel like AI would have a really good place in gait analysis, like for any animal or people. It's, you know, kind of a complicated thing, and I bet that that would be really beneficial in that area.
Sarah Wright:Yeah, I can definitely see that. I remember when I was a vet student, one of the coolest resident rounds I saw was one of the residents did a gait analysis in Humboldt Penguins at a local zoological institution. Yeah, yeah, so it's the first thing that mind jumped to. So super cool species you can use it for. Yeah, and for those of you just joining us, we're discussing how exposed digits increase weight bearing and alter sub-vantage pressures in dogs with four-limb splints, with our guest Sarah.
Lisa Fortier:Sarah, you talked earlier about your career as a certified veterinary technician and now you're a final year veterinary student. How did or maybe you didn't how did any of that training help you write this article?
Sarah Stark:Yeah, it definitely did. I think having a lot of like relevant clinical experience, just like dealing with bandages, definitely helped, and I was like I'm comfortable placing them as well and making splints, so I placed all of the splints. And then I also have had a fair amount of opportunities to get involved in research through vet school and even before, when I worked here as a tech, I would dabble in the resident projects and stuff. So all of that has kind of allowed me to get enough practice to be comfortable doing something. Obviously I had a lot of support and a lot of questions for Dr Gordon Evans but I was able to do a lot of it. You know kind of myself. And that was really fun to have the training wheels taken off a little bit and get that practice. I really enjoy doing clinical research, so it was fun.
Sarah Wright:You look forward to seeing how your career progresses.
Sarah Stark:Me too.
Sarah Wright:We'll see. So, sarah, this next part of questioning is going to be really important for our listeners. The first one is going to be from the veterinarian's perspective, so it is one piece of information the veterinarian should know about how exposed digits increase weight bearing and alters sub-bandage pressures in dogs with foil splints of what we talked about before, just that this particular topic hasn't really been explored yet.
Sarah Stark:That we know of, and we think it just should be a conscious consideration when you're placing a splint, depending on the needs of your patient you know their disposition or their fracture type and location. It should just be something that we think about, you know, when we're placing a splint, because it could have, you know, based on our results of our study it seems to have a relevant impact on how the animal walks and how much weight they're bearing. So it should just be something to think about.
Sarah Wright:And then the other side of the relationship. What's one thing that clients should know about forelimb splints?
Sarah Stark:I mean, I think that it's just important to that owners realize how much impact they have on how their pet does with fractures or wounds. Anytime there's a bandage involved, you know the owner at home is with the pet and managing them for the, you know, the vast majority of the time. And I think it's important to empower them to realize that they have a lot of impact on how their pet does. If they're being, you know, really aware of the how the animal's doing and, um, the state of the bandage, you know they can make or break the healing process and so it's important for them to realize that they have a lot of power there. Um, if they're being really, um, you know they're being careful to monitor closely, they can really help their dog do better. So and that's kind of you know the whole monitoring the digits thing that you know, just because the digits are slightly more covered by the bandage doesn't mean we can't be aware of them.
Lisa Fortier:So yeah, Same for horses, right, yeah, and you have the two, well, three different types of clients the compliant, the ones that are completely non-compliant and the ones that are over-compliant, right, and then don't let the dog jump on the couch. Oh, I felt sorry for her. No, the horse. I remember as a resident actually, I fixed an elbow fracture in a horse, sent it home and about three days later, after it went home, I got a video of the horse. She's doing great. She's turned out galloping and bucking and running around. I was like great, great, Looks good. That's the same thing as box stall rest.
Sarah Stark:Yeah, I think we've all been there. I remember one little dog. He had like a tarsal fracture or something and he came in a couple different times and we took the bandage off and like sand fell out of it and they're like, oh yeah, he runs around down by the river and it's like, ok, great, ok yeah, sounds good.
Lisa Fortier:Well, thank you, sarah. As we wind down, we like to ask a kind of a fun question and what for you? I'd like to know what is your favorite animal fact?
Sarah Stark:I think it's super cool that whales used to be land animals like and they have all these like vestigial structures that they have evidence of having walked on land before, like just thinking about that process and like how big they are and how much transformation they had to go through to do that. I just think it's super cool. I want to know what they looked like before.
Sarah Wright:You've had so many aquatic animal facts for that question. I love it. I learn something new every time. So thank you so much, Sarah. We appreciate you being here and sharing insights from your article with us today. Yeah, thank you so much, Sarah. We appreciate you being here and sharing insights from your article with us today.
Sarah Stark:Yeah, thank you so much for having me. It was really fun to talk about. I'm excited to kind of disseminate the information I think it's important for everyone. Oh, definitely.
Sarah Wright:Agreed and to our listeners. You can read Sarah's article in Jabma. I'm Sarah Wright with Lisa Fortier. Be on the lookout for next week's episode and don't forget to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
