C09997764 / invoice 10000

Reason: 6 weeks post-op rads and pin removalAppointment Notes: Special payment terms exist, Overdue reminders  ------- Sms reply: YHistory:6 weeks post R proximal tibial fracture repair (pin and T plate)Dog has been doing very well at home. Walking with no limping and very active. Appetite has been fluctuating, sometimes eating a lot sometimes eating less. No concerns overall. Owner noticed dog's RHL will stick out when sitting down but not painful and no problem getting up and walkingHad 3rd puppy vaccine 3 weeks ago. Still in confinement but getting harderEaten at 8am half of the mealTrazodone 25mg 1 tab 9amPhysical Exam:BAR, limited exam as dog very wriggly when handledMm pink, crt 1sHR 125, strong pulseRR pantingGait: ambulatory with no obvious limping . Wide stance (bilaterally) in teh pelvic limbs with valgus noted on standing. Procedure:Medetomidine 8mcg/kg + methadone 0.2mg/kg IM Proprfol 4mg/kg IV to effectOrthogonal views of the left and right pelvic limbs obtained. Fracture healed completely with no distrubtion of the tibial apophysis. No signs of implant loosening.When compared to th econtral lateral limb, there is proximal tibial valgus deformity.Assessment:  Previous fracture repair had healed completely and the patient can go back to normal activity over the next 2 weeks. It is suspected that there is an asymmetrical growth of the proximal tibia resulting proximal valgus of the tibia. Assessing the immediate post-op radiographs, it appears that physeal damage from the original injury is suspected to have resulted in the deformity. There does not seem to be implant compromising the physis from the immeidate post-op views. Gait exam and stance exam revealed bilateral wide stance of the pelvic limbs with valgus. It appears that the documented valgus deformity of the right tibia is not causing any obvious asymmetrical changes in the stance. Also Mochiko is not showing any obvious lameness. However, it would be important to follow up on this case as the physes close to document the joint angles and potentially discuss corrective osteotomy or other procedures that may require in the future. Client Communication: --- 06/03/2026 15:20:08 KKS:Called Mr Arifin and updated. Explained the above and the owner reported no obviosu assymetry of the stance and gait however at times noted Mochiko has his limb slightly 'angled' we disucssed the possibilty of physeal injury from the trauma that caused the fracture as there is no compromise of the physis from the implants. Relayed the information as above regarding the plan and the owner is keen to bring him back for a recheck in 12 months or sooner if concerned. We discussed signs to look out for including (but not limited to)1) increase in the angle of valgus deformity with asymmetry2) lameness 3) licking at the surgical siteAny concerns call us ASAP.Discharge this afternoon.    Vital Signs