About Fracture Management
Fractures can occur in any bone of an animal at any age. Though they are commonly caused by trauma, fractures can occur as a result of weakening of the bone from cancer or nutritional/metabolic derangements. The age of an animal, history of events, and the fracture’s appearance on radiographs (x-rays) will determine if a veterinarian suspects an underlying process. If your veterinarian or surgeon has any concerns, additional diagnostics may be recommended to ensure we make an accurate diagnosis and provide your pet with the best care.
When fractures occur from trauma, we can assume the trauma sustained by the animal was significant. Therefore, it is imperative that your pet receives a full examination to evaluate for concurrent problems that may be life-threatening, put your pet at a high risk for general anesthesia during fracture repair, or change your pet’s prognosis for a full recovery. This may include bloodwork, radiographs of the chest and abdomen, a full orthopedic and neurologic examination, and additional radiographs of other bones and joints. Occasionally advanced imaging, such as CT or MRI is needed for a full assessment. If these diagnostics show your pet is not stable enough to undergo fracture repair, other urgent medical care may be necessary before the fracture can be repaired.
How are fractures repaired?
The goal of fracture management is to regain function and comfort by providing the bone stability to allow it to heal in proper alignment. There are several options to achieve bone stability, including management in a splint/cast, surgical repair with implants (pins, wires, plates, screws, interlocking nails, external fixators), and, rarely, activity restriction alone. If there are concurrent neurologic deficits, significant soft tissue injury, high risk for successful repair, or financial constraints, amputation of a limb may be discussed to provide your pet comfort.
As each fracture is unique for every patient, evaluation of radiographs and an examination of your pet are needed for the surgeon to determine which management strategy is most appropriate. Factors that influence the method of repair and possible post-operative complications include which bone is involved, the presence of wounds near the fracture, the shape of the fracture, the number of bone fragments and their displacement from one another, and involvement of a joint surface or open growth plate. Often additional radiographs may be taken by the surgeon prior to surgery for the purpose of including a measuring device. This device ensures appropriately sized implants are used and are available at the time of the repair.
Can all fractures be successfully managed with a splint or cast?
No. Adequate stability of the bone cannot be achieved with a splint/cast for every bone and fracture type. For a splint/cast to be effective, immobilization of the joint above and below the fracture needs to be achieved. The geometry of the fracture line, the displacement of the bone fragments, and the location of the fracture also influence the effectiveness of a splint/cast.
What should I expect post-operatively and during the healing period?
Regardless of management strategy used, the care YOU provide to your pet is CRITICAL to the successful management of a fracture. Our surgeons will provide you with detailed instructions at the time of discharge.
All animals will require a period of activity restriction. The length of restriction will depend on the animal’s age and healing progress noted during recheck examinations. This means no running, jumping, or playing. Your pet will need to be taken outside on leash to urinate and defecate; excessive climbing up and down stairs or on and off furniture should be avoided. When not directly supervised your pet needs to be placed in a crate, small laundry room or bathroom, or a small, sectioned-off portion of the house. Too much activity can result in delayed bone healing and necessitate prolonged activity restriction or result in implant breakage that may require revision surgery.
Surgically repaired fractures will create incisions in the skin. These incisions will need to be monitored daily for evidence of infection, and an e-collar will be placed on your pet until the skin incision is healed, typically for 10-14 days, to prevent your pet from licking or chewing at it.
Some animals will be placed in a bandage after surgery or as a primary management strategy. Bandages must be monitored closely and typically require weekly changes by a veterinarian. Bandage sores and complications occur frequently, but most are minor and can be managed during bandage changes. If left untreated or go unnoticed, serious injuries can occur that require extensive medical or surgical management.
Depending on the fracture type, physical rehabilitation may be recommended during the post-operative period.
At approximately 2 weeks after surgery, the incision will be evaluated and staples/sutures will be removed if present. Radiographs will be needed at 4 or 8 weeks after surgery to evaluate healing, depending on the age of the animal. For certain high-risk fractures, fractures with delayed healing, or if at any time there is an abrupt change in comfort or limb use, additional recheck examinations may be recommended.
Most animals do not require removal of implants. However, if an infection develops, the implant is causing discomfort, or for some fractures in juvenile animals, the implant may be removed after the fracture is healed.
Are there possible complications if surgery is performed?
As with any surgery there is always the possibility of complications. Complications to consider include infection after surgery. To ensure keeping infection rates low your pet will receive antibiotics before, during, and in some cases after surgery. Additionally, an e-collar will be placed after surgery to prevent your pet from introducing bacteria into the incision site.
Second, there is a risk for the implant to fail before the bone has healed. Our surgeons diligently evaluate each fracture and make recommendations for management that increase the likelihood of success while avoiding unnecessary procedures.
Third, there is always the possibility that the bone takes longer than expected to heal or does not heal at all. If conservate management with a splint is performed or the implant bends/breaks, it is possible the bone heals in an abnormal alignment. Malalignment of bones can result in a range of clinical signs from no detectable lameness to severe limb dysfunction. For this reason, the doctor will walk you through each of your options and the associated risks so that you can make an informed decision for you and your pet.
Finally, there is risk for bleeding or damage to soft tissues, including nerves that are near the fracture site, and a risk involved in using general anesthesia. During surgery your pet will be continuously monitored by one of our trained staff members to ensure the highest level of safety.
What is the prognosis for a fracture?
With appropriate fracture management and diligent care during the healing period, most fractures have an excellent prognosis. Bone eventually regains 100% of its original strength when the fracture is completely healed. Our surgeons will inform you if your pet has a risk for developing osteoarthritis as a result of the fracture, bone growth abnormalities, or if your pet has an increased risk for infection or delayed/incomplete healing of the fracture.
Lisa Anderson, DVM
Practice Limited to Surgery
Beale's Best Contributor