Twist of Fate
by Dr Susan Orosz

Susan E. Orosz, Ph.D., D.V.M., Diplomate ABVP, Avian Practice, Diplomate, European College of Avian Medicine and Surgery, Professor. Dr. Orosz is a Professor at the University of Tennessee, Knoxville, specializing in Avian Medicine

Tim came with a brooder tucked under his arm containing his first blue and gold macaw chick. While he had been helped by an experienced hand-feeder, something had gone wrong. The chick's left leg had started to twist, so that it was now turned almost backwards. Tim had come with hope and a prayer that we could, somehow, make this poor chick "right" again.

The prognosis was poor and the cost of trying was considerable. But in this case, all of us wanted to try. Our technician, Julia, was willing to take care of the macaw chick. So the plan that emerged was that Tim would donate the chick to the hospital and then we would try to repair the twisted leg. "We" would come to involve a substantial team.

Although splay leg has been reported, the cause and the cure for this problem in young growing chicks is poorly understood. We thought that this would be an important opportunity to learn and possibly understand this condition. One of our small animal veterinary surgeons was willing to help out as well as other colleagues with their respective expertise. Dr. Blake, the surgeon, wanted detailed radiographs of both legs. As someone who was mechanically oriented, Dr. Blake asked numerous detailed questions after the radiographs were developed. But, oh no, that was not enough! He also requested that the veterinary radiologist ultrasound the legs as well. Their excitement mounted as they tried to unravel where "exactly" the twist had occurred. Was it "focal" or in one spot or did one entire bone twist? Or was it that both the femur and the tibia had twisted?

We spent at least an hour poring over the radiographs, ultrasound images, normal x-rays of macaw legs, and bone preparations of legs from birds. After much discussion, we decided that the "twist" had occurred right at the stifle or knee. The surgical approach would be difficult. I used drawings from my anatomic text, as well as several anatomic specimens, to show Dr. Blake the topography of the area. But he wanted more--more information and more answers to ever-more detailed questions. Finally, I reached a point where I could not answer his questions to the level he wanted. While this was frustrating, I was also encouraged--I could tell that he was developing a plan.

The next day, discussions began again with the radiologist, the surgeon, and me. This time, we included concerns about the length of the surgical time required, as well as a plan for anesthesia. Birds, especially chicks, lose their temperature more quickly than mammals and this can cause problems during anesthesia. Whatever surgery we did would have to be done quickly! Our total anesthesia time would need to be less than 2 hours. With our plans complete, we were ready to give it our best shot the next morning.

Morning dawned with us scurrying about to get everything ready in the prep area and the surgical suite. The radiographs, ultrasound images, and sterilized bird bones were brought to the surgical suite and set up for use if needed. Dr. Blake was on his way to the surgical scrub room as we entered the anesthesia prep area. It didn't take us long to get the chick anesthetized and place the monitors on his little body. By the time we were finished getting his leg scrubbed surgically, Dr. Blake had all of his surgical instruments laid out on the table, ready to go.

With quickness born of experience, he opened the skin around the left knee, exposing the parts that he was going to work on. As he felt the various bumps and depressions, the detailed questions started again. I showed him what I knew with the skeleton and the leg preps. Then, in what seemed just a few moments, he made 3 small cuts in the connective tissue of the knee…and the lower leg swung back to its normal position! He placed several sutures in the side of the leg at the knee and then sutured the skin. He was done.

I stood there wondering, "Is that it?" It seemed so easy, yet we had spent countless hours preparing. We placed a small bandage on the leg to protect it and then woke the chick up. As Dr. Blake exited to his next case, he said, "Let's see what happens!"

We brought the chick back to its ICU cage for warmth and oxygen where it recovered uneventfully. Now it was Julia's turn to lovingly care for the chick. She was his hand-feeder and physical therapy nurse rolled into one. Within a couple of weeks, the chick was perching and it became difficult to tell which was the bad leg. Within several months, no one could tell which leg had been twisted. When the bird was about to be weaned, we finally knew he was going to make it! Julia carefully selected a veterinary student to become the bird's owner. The student gave the bird his name, and once the creature was completely weaned, took him home with her.

I will never forget how such a difficult case was transformed by Dr. Blake's surgical expertise. A little knowledge, lots of planning, and deft surgery had allowed us to treat the chick without the customary pins and wires. I was left with my jaw open, and the bird was made whole.

Copyright 2000 Susan Orosz