Bone fractures are frequently caused by vehicular accidents, firearms, fights, or falls. Fractures can involve single or multiple bones.
Characteristics of the fracture—such as simple, comminuted, oblique, transverse, or spiral—are based on disruptive trauma forces (bending, compression, tension, and rotation).
Fractures can be classified as open or closed based on whether there is an associated external wound through which the fracture communicates with outside environment. For open fractures, grading schemes such as the Gustilo-Anderson classification are used to describe the degree of soft tissue damage and mechanism of injury in order to facilitate standardization of treatment and prognosis (1).
Clinical signs invariably include lameness, pain, and swelling.
Radiography or CT is useful in delineating the fracture pattern (see femoral fracture radiograph).
Treatments are based on the type of fracture, age and health of the animal, technical expertise of the surgeon, and owner finances.
Courtesy of Dr. Ronald Green.
Treatment for young, healthy dogs with incomplete fractures can include external splints or casts. Other injuries are treated with external (fixators) or internal devices, such as bone plates, screws, orthopedic wires, interlocking nails, and pins. Frequently, cancellous bone grafts are used to augment fracture healing in ill or aged patients.
Antimicrobials are given for open fractures or prolonged repairs. Perioperative analgesics (eg, epidural or local nerve blocks, narcotic skin patches, systemic narcotics [including CRI], oral NSAIDs) are used to alleviate discomfort.
Physical therapy or rehabilitation is critical to restore limb function and overall well-being.
The prognosis for recovery is usually good, depending on the nature of the injury and success of repairs; successful wound therapy and monitoring of cardiopulmonary and urological functions are essential.
Follow-up care includes radiographic and clinical assessments of fracture healing. Internal implants may not need to be removed unless complications such as stress protection, infection, or soft tissue irritation develop.
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References
Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58(4):453-458.
