Overview of Canine Fracture Repair
A fracture is any break in bone or cartilage, whether it is complete or incomplete which is a common problem in dogs. With any fracture there is also damage to the surrounding soft tissues.
The majority of fractures are caused by trauma sustained by motor vehicle accidents. Occasionally they will occur because of an underlying bone disease such as a bone tumor or from repetitive stress applied to a certain bone, as in a fatigue fracture in a racing greyhound.
Because trauma is the most common reason for fractures, young, male non-neutered dogs, may be at a higher risk as they are more prone to wander and to get into trouble.
What to Watch For
Symptoms of fractures in dogs may include:
A fracture may be an incidental finding among other more serious and life threatening injuries following trauma.
Diagnosis of Fractures
In many cases, a history of trauma will be obvious, but your veterinarian will carefully question you about the events leading up to the fracture. For example, a fracture in an older dog, secondary to minimal trauma, say slipping on a floor, may suggest underlying weakness in the bone, perhaps a fracture secondary to a bone tumor.
There may be swelling and pain associated with a fracture, together with instability and crunchiness on palpation. A leg may be completely non-weight bearing, or in the case of certain pelvic fractures, a dog may use the leg as if nothing has happened. In addition to a physical examination, other tests may include:
Treatment of Fracture Repairs
To repair a fracture, the ends of the bone must be opposed and the continuity of the bone restored as close to normal as possible. This can be done closed, that is without exposing the bones, using traction and manipulation, trying not to disturb the natural healing processes already underway. Or, it can be done open, surgically exposing the bones by separating and, if necessary, cutting through muscle to visualize the fracture and to put it back together. Both techniques require general anesthesia.
The fracture must be immobilized to allow it to heal and this can be done in several ways.
In the case of a cast or splint, the toes or the top of the bandage will need to be checked daily for swelling, rubbing or chaffing. The cast or splint will need to stay clean and dry. It may need to be checked and changed frequently to avoid or address pressure sores, particularly the top of the elbow and the knee.
External fixators must have the skin-pin interface cleaned daily or twice daily, where the pins pass through the skin toward the bone. Crusting and discharge is common at this location, but excessive swelling or discharge should be brought to your veterinarian's attention.
In cases of open fracture repair there will be an incision that needs to be monitored for swelling, redness, or discharge. Stitches or staples will need to be removed in 10 to 14 days.
Your pet will need to rest to allow the fracture to heal. This time frame will be less for younger animals (2 to 4 weeks), and longer for older animals (6 to 12 weeks, or even more, dependent on the nature of the fracture).
Follow up x-rays will be taken with your veterinarian to ensure the fracture is healing and that there are no problems with the implants.
Since most fractures occur secondary to being hit by a car, all dogs should be kept on a leash and adequate fencing provided in a yard.
In-depth Information on Fracture Repair in Dogs
In-depth Information on Diagnosis of Fractures
Following a traumatic injury, fractures will be low down on the list of priorities for your dog in comparison to bleeding problems and breathing disorders. Life threatening problems will be evaluated and treated initially.
For this reason, all fractures of the extremities will be noted on a thorough examination but will be addressed once other systems are stable. Fractures associated with the skull and the spine may necessitate careful handling of your pet and modifications of early treatment protocols to offset spinal cord or brain swelling. Once stabilized, tests and treatment may include:
Treatment Options for Fracture Repair in Dogs
The type of fracture, its location, the age of the animal, the presence of other injuries/fractures and the financial means of the owner are all major considerations in the choice of fracture repair undertaken. For any given fracture there are often many different treatment options.
Some types of repair may require special equipment and experience and your veterinarian may recommend referral to a board certified surgeon.
Because there are many ways to fix the same fracture. Each option will be discussed and considered for its advantages and disadvantages in the context of your dog and his or her particular injury/injuries.
Follow-up and Home Care for Dogs after Fracture Repair
The cast or splint needs to be kept clean and dry. The top of the cast may have a tendency to rub or chaff the skin. The toes at the bottom will need to be assessed for swelling, sweating or pain. Sore areas will necessitate that the cast is changed. The cast may have fitted snugly at the time of initial placement but because the swelling at the fracture site resolves, the cast may become loose.
Casts and splints may seem like the least expensive option but cast complications that necessitate numerous changes can add up, particularly if sedation or anesthesia is required to change a cast. In many cases, other forms of fixation may not actually cost that much more.
The skin-pin interface of an external fixator will need attention to keep the area clean and dry as discharge and crusting commonly occur at these sites. Sometimes pus will be noticed at this interface and is not uncommon. You should consult with your veterinarian to ensure that the discharge is reasonable and to be expected.
External fixators may not be appropriate for some pet owners who find the devices distasteful to look at and manage.
Cats must be restricted and confined when wearing an external fixator as it is possible to snag the device on furniture or other household items if the pets are given too much freedom.
When internal fixation has been performed, there will be a surgical incision which will have to be checked daily for swelling, redness and discharge. Stitches or staples will need to be removed in 10 to 14 days following surgery.
All animals that are recovering from fracture repair surgery or are in a cast or splint will need restrained activity: they should be confined to a small area; going up or down stairs (unless unavoidable) should not be allowed; they should not be allowed to jump on and off furniture; and they must be kept indoors.
The fracture will be re-evaluated and x-rayed again by your veterinarian from 4 to 8 weeks after the surgery or cast placement, depending on the nature of the fracture and the age of your pet. Young kittens heal quickly and may have cast removal after only a few weeks, whereas older debilitated animals may not heal properly for months.
The external fixator may be removed in stages in order to increase the work of the healing bone that has been stabilized. This can involve removal of a couple of pins at a time over a number of weeks until the device is fully removed. The holes where the pin was removed should be kept clean until they dry up and scab over. Infection tracking along a pin and into the underlying bone is extremely unusual.
Most plates, screws, pins and wires can remain in place if they are not causing a problem. If they are backing out or migrating from the bone they will usually cause swellings, pain or lameness and should be removed. This may require sedation or a general anesthesia.